Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York.
Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; Tufts University, School of Medicine, Boston, Massachussetts.
Endocr Pract. 2022 Jul;28(7):660-666. doi: 10.1016/j.eprac.2022.03.018. Epub 2022 Apr 1.
We studied the use of surgeon-performed office ultrasound (OU) and preincision ultrasound (PIU) in preoperatively localizing parathyroid adenomas in primary hyperparathyroidism (PHPT).
A retrospective chart review was performed for patients with PHPT who underwent parathyroidectomy between 2013 and 2015. The results of OU and PIU were recorded and compared with the final surgical pathology.
Of 348 patients with PHPT, 285 (81.9%) had single-lesion disease, 49 (14.1%) had double-lesion disease, and 14 (4.0%) had multigland disease with 3 or more lesions. For single-lesion disease, the overall sensitivity and specificity of OU to correctly lateralize the lesion were 64.2% and 91.2%, while those of PIU were 89.4% and 93.6%, respectively. The sensitivity and specificity of PIU were comparable to those of 4-dimensional computed tomography (87.1% and 90.7%, respectively) and Tc-sestamibi scintigraphy (70.4% and 95.9%, respectively). While the majority of PIU cases were preceded by other imaging studies, the accuracy in localizing lesions was not largely affected by the presence of prior computed tomography and/or Tc-sestamibi scintigraphy, as opposed to ultrasounds only. For detecting the presence of multigland disease, the sensitivity and specificity of OU were 26% and 92.2%, while those of PIU were 64.3% and 94.7%, respectively.
Surgeon-performed OU and PIU are valuable tools in preoperatively localizing the parathyroid adenoma in single-lesion disease, while their utility may be limited for double-lesion or multigland disease. PIU in particular yields high accuracy in detecting parathyroid lesions in combination with other imaging modalities.
我们研究了外科医生进行的诊室超声（OU）和术前超声（PIU）在原发性甲状旁腺功能亢进症（PHPT）中定位甲状旁腺瘤的应用。
对 2013 年至 2015 年间接受甲状旁腺切除术的 PHPT 患者进行回顾性图表审查。记录 OU 和 PIU 的结果，并与最终手术病理进行比较。
在 348 例 PHPT 患者中，285 例（81.9%）为单病灶疾病，49 例（14.1%）为双病灶疾病，14 例（4.0%）为多灶疾病，有 3 个或更多病灶。对于单病灶疾病，OU 正确定位病变的总体敏感性和特异性分别为 64.2%和 91.2%，而 PIU 分别为 89.4%和 93.6%。PIU 的敏感性和特异性与 4 维计算机断层扫描（分别为 87.1%和 90.7%）和 Tc- sestamibi 闪烁扫描（分别为 70.4%和 95.9%）相当。虽然大多数 PIU 病例之前都进行过其他影像学研究，但与仅进行超声检查相比，先前的计算机断层扫描和/或 Tc-sestamibi 闪烁扫描的存在并没有对定位病变的准确性产生很大影响。对于检测多灶疾病的存在，OU 的敏感性和特异性分别为 26%和 92.2%，而 PIU 分别为 64.3%和 94.7%。
外科医生进行的 OU 和 PIU 是术前定位单病灶甲状旁腺瘤的有价值的工具，而在双病灶或多灶疾病中其应用可能受到限制。PIU 特别与其他影像学模式相结合，在检测甲状旁腺病变方面具有很高的准确性。
