Guo Yue-Hong, Huang Jing-Wei, Wang Ying, Lu Ruigang, Yang Min-Fu
Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University.
Department of the Pathology, Beijing Chaoyang Hospital, Capital Medical University.
Nucl Med Commun. 2023 Jan 1;44(1):18-26. doi: 10.1097/MNM.0000000000001641. Epub 2022 Nov 25.
Accurate preoperative localization of tumor-bearing lesions is crucial for the successful surgical management of suspected recurrent parathyroid carcinoma. The purpose of this study was to evaluate the diagnostic value of 99m-technetium-labeled methoxyisobutylisonitrile ( 99m Tc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) and cervical ultrasound, individually and in combination, for preoperative localization of recurrent/metastatic lesions. We also analyzed the value of 99m Tc-MIBI SPECT/CT in detecting ectopic lesions in patients with suspected recurrent parathyroid carcinoma.
Twenty-nine patients with suspected recurrent parathyroid carcinoma were included in this retrospective cohort study. Patients underwent preoperative 99m Tc-MIBI SPECT/CT and cervical ultrasound. The reference standard was postsurgical histopathology. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy of the two diagnostic modalities alone and in combination were analyzed.
Of the 29 patients, histopathological results revealed 48 metastases/recurrent lesions in 26 patients. The diagnostic value of 99m Tc-MIBI SPECT/CT, cervical ultrasound, and the two modalities in combination were compared for the 27 patients who underwent new cervical surgery. Patient-level analysis of the combined use of 99m Tc-MIBI SPECT/CT and cervical ultrasound had the highest sensitivity (100.00%) and accuracy (96.30%). At the lesion level, 99m Tc-MIBI SPECT/CT had the highest specificity and PPV, at 100.00% respectively, whereas the combined use of 99m Tc-MIBI SPECT/CT and cervical ultrasound had the highest sensitivity, at 97.62%. Moreover, 99m Tc-MIBI SPECT/CT detected six ectopic lesions, and five of them showed increased 99m Tc-MIBI uptake.
The combined use of 99m Tc-MIBI SPECT/CT and cervical ultrasound is the most efficient strategy in the diagnosis of parathyroid carcinoma relapse, whereas 99m Tc-MIBI SPECT/CT is the preferred method for localizing and analyzing cervical and extra-cervical lesions before the new surgery.
对于疑似复发性甲状旁腺癌的成功手术治疗，准确的术前肿瘤病灶定位至关重要。本研究的目的是评估99m锝标记的甲氧基异丁基异腈（99mTc-MIBI）单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）和颈部超声单独及联合应用于复发性/转移性病灶术前定位的诊断价值。我们还分析了99mTc-MIBI SPECT/CT在检测疑似复发性甲状旁腺癌患者异位病灶中的价值。
本回顾性队列研究纳入了29例疑似复发性甲状旁腺癌患者。患者术前行99mTc-MIBI SPECT/CT和颈部超声检查。参考标准为术后组织病理学检查。分析了两种诊断方法单独及联合应用时的敏感性、特异性、阳性预测值（PPV）、阴性预测值和准确性。
29例患者中，组织病理学结果显示26例患者有48处转移/复发病灶。对27例行新的颈部手术的患者比较了99mTc-MIBI SPECT/CT、颈部超声及两者联合应用的诊断价值。对99mTc-MIBI SPECT/CT和颈部超声联合应用进行患者水平分析时，敏感性最高（100.00%），准确性为（96.30%）。在病灶水平，99mTc-MIBI SPECT/CT的特异性和PPV最高，均为100.00%，而99mTc-MIBI SPECT/CT和颈部超声联合应用时敏感性最高，为97.62%。此外，99mTc-MIBI SPECT/CT检测到6处异位病灶，其中5处99mTc-MIBI摄取增加。
99mTc-MIBI SPECT/CT和颈部超声联合应用是诊断甲状旁腺癌复发最有效的策略，而99mTc-MIBI SPECT/CT是新手术前定位和分析颈部及颈部外病灶的首选方法。
