Daoud Amani, Ronen Ohad
Department of Otolaryngology, Head and Neck Surgery Unit, Galilee Medical Center, Nahariya, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Department of Otolaryngology, Head and Neck Surgery Unit, Galilee Medical Center, Nahariya, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Endocr Pract. 2023 Jan;29(1):2-10. doi: 10.1016/j.eprac.2022.11.004. Epub 2022 Nov 10.
To review diagnostic imaging modalities for parathyroid cystic adenomas (PCA). Since PCAs are a rare (0.5%-1%) subclass of parathyroid adenomas, and due to their cystic component, imaging modalities known to be efficient for diagnosing solid adenomas might fail in localizing them.
We conducted a systematic review using the PubMed and Cochrane databases for English articles on PCAs published between 1995 and 2020. A meta-analysis of the retrieved data was performed.
Overall, 39 studies, reporting on a total of 160 patients, were included in the analysis. Two thirds (68%) of the patients were female, with a mean age of 53.9 years. A single cystic adenoma was detected in 98.1% of cases. The mean blood calcium corrected for albumin level was 12.6 ± 2.7 mg/dL, and the mean parathyroid hormone level was 565.5 ± 523.8 pg/mL. The mean PCA sizes as measured by ultrasound (US), computed tomography (CT), and ex vivo measurement were 4.8 ± 3.6, 5.2 ± 3.2, and 3.5 cm, respectively. The median weight was 8.1 g. PCA was detected in 86% of US examinations; 100% of US-guided fine needle aspiration, 4-dimensional computed tomography (4D-CT), or magnetic resonance imaging examinations; and 61% of 99m-technetium sestamibi scan with single-photon emission computed tomography ((99m)Tc-SPECT). (99m)Tc-SPECT showed a significantly lower diagnostic rate than US (odds ratio, 3.589), US-guided fine needle aspiration, CT combined with 4D-CT, and the combination of US, CT, 4D-CT, and magnetic resonance imaging (P < .001).
Although US and 4D-CT showed a significantly high rate in diagnosing PCA, (99m)Tc-SPECT showed a lower PCA diagnostic rate. These findings suggest that larger cystic lesions suspected as PCAs should be further evaluated using 4D-CT rather than (99m)Tc-SPECT.
回顾甲状旁腺囊性腺瘤（PCA）的诊断性影像学检查方法。由于PCA是甲状旁腺腺瘤中罕见的一个亚类（占0.5%-1%），且因其具有囊性成分，已知对实性腺瘤诊断有效的影像学检查方法可能无法对其进行定位。
我们使用PubMed和Cochrane数据库对1995年至2020年间发表的关于PCA的英文文章进行了系统综述。对检索到的数据进行了荟萃分析。
总体而言，分析纳入了39项研究，共报告了160例患者。三分之二（68%）的患者为女性，平均年龄为53.9岁。98.1%的病例检测到单个囊性腺瘤。校正白蛋白水平后的平均血钙为12.6±2.7mg/dL，平均甲状旁腺激素水平为565.5±523.8pg/mL。通过超声（US）、计算机断层扫描（CT）和体外测量测得的PCA平均大小分别为4.8±3.6、5.2±3.2和3.5cm。中位数重量为8.1g。8 US检查中86%检测到PCA；US引导下细针穿刺、四维计算机断层扫描（4D-CT）或磁共振成像检查中100%检测到PCA；99m锝甲氧基异丁基异腈单光子发射计算机断层扫描（99mTc-SPECT）检查中61%检测到PCA。99mTc-SPECT的诊断率显著低于US（优势比，3.589）、US引导下细针穿刺、CT联合4D-CT以及US、CT、4D-CT和磁共振成像的联合检查（P<.001）。
尽管US和4D-CT在诊断PCA方面显示出显著的高比率，但99mTc-SPECT显示出较低的PCA诊断率。这些发现表明，疑似PCA的较大囊性病变应使用4D-CT而非99mTc-SPECT进行进一步评估。
