Department of Internal Medicine I, University Hospital Schleswig-Holstein Campus Lübeck and Institute for Endocrinology and Diabetes - Molecular Endocrinology, Center of Brain Behavior and Metabolism CBBM, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
Department of Endocrine Surgery, Schön Klinik Hamburg-Eilbek, Dehnhaide 120, 22081, Hamburg, Germany.
World J Surg. 2022 Sep;46(9):2197-2205. doi: 10.1007/s00268-022-06593-y. Epub 2022 Jun 15.
Primary hyperparathyroidism (pHPT) is well treatable surgically. Sonography (US) and sestamibi scintigraphy (MIBI) are used routinely, but it is unclear how valuable they are in determining Parathyroid glands' different locations. This study aimed to evaluate the prognostic value of US and MIBI in relation to the different localization of parathyroid adenomas in one of the largest study populations analyzed to date.
1089 patients with pHPT who had treatment in one tertiary referral center between 2007 and 2016 were analyzed. Preoperative US and MIBI reports were compared with the parathyroid adenoma's intraoperative localization. All parathyroid glands were confirmed by histological diagnosis.
No gland was detectable in 22.5% and 27.7% of all patients, by US or by MIBI, respectively. In relation to the different adenoma locations, the sensitivity of US ranged from 21.3% (upper right) to 68.9% (lower left) and of MIBI ranged from 23.5% (upper right) to 72% (lower left). The specificity for US ranged from 85% (lower right) to 99.2% (upper right) and for MIBI ranged from 86.1% (lower right) to 99.1% (upper right. Positive predictive values for all gland sites were 54% and 59% for MIBI and US, respectively. The value increased for side-only prediction to 73% and 78%, respectively. Neither the parathyroid hormone level nor the calcium value level influenced the sensitivity or specificity of the two test methods.
The validity of preoperative US and MIBI depends crucially on the specific localization of adenomas. This should be considered when planning the extent of parathyroid surgery.
原发性甲状旁腺功能亢进症（pHPT）可以通过手术得到很好的治疗。超声（US）和锝 99m 甲氧基异丁基异腈扫描（MIBI）被常规使用，但目前尚不清楚它们在确定甲状旁腺腺瘤的不同位置方面有多大价值。本研究旨在评估超声和 MIBI 在与迄今为止分析的最大研究人群之一中甲状旁腺腺瘤的不同定位相关的预后价值。
分析了 2007 年至 2016 年期间在一家三级转诊中心接受治疗的 1089 例 pHPT 患者。比较了术前 US 和 MIBI 报告与甲状旁腺腺瘤的术中定位。所有的甲状旁腺均通过组织学诊断证实。
在所有患者中，有 22.5%和 27.7%的患者分别通过 US 和 MIBI 检测不到任何腺体。就不同的腺瘤位置而言，US 的灵敏度范围从 21.3%（右上）到 68.9%（左下），而 MIBI 的灵敏度范围从 23.5%（右上）到 72%（左下）。US 的特异性范围从 85%（右下）到 99.2%（右上），而 MIBI 的特异性范围从 86.1%（右下）到 99.1%（右上）。对于所有腺体部位，MIBI 和 US 的阳性预测值分别为 54%和 59%。对于单侧预测，该值分别增加到 73%和 78%。甲状旁腺激素水平和钙值水平均不影响两种检测方法的灵敏度或特异性。
术前 US 和 MIBI 的有效性在很大程度上取决于腺瘤的特定位置。在计划甲状旁腺手术范围时应考虑到这一点。
