Chou Shen-En, Yeh Cheng-Hsi, Chi Shun-Yu, Chou Fong-Fu, Wu Yi-Ju, Chang Yen-Hsiang, Chan Yi-Chia
Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Ann Surg Treat Res. 2024 Sep;107(3):136-143. doi: 10.4174/astr.2024.107.3.136. Epub 2024 Aug 26.
Preoperative localization plays an important role in secondary hyperparathyroidism (SHPT) surgery. The advantages of neck ultrasound (US) include high availability and low cost. However, the reported sensitivity of US is 54%-76%, and the reason for missed parathyroid glands (PGs) on US has been rarely addressed.
Fifty-four patients who were diagnosed with renal SHPT from September 2020 to March 2022 were included in this retrospective study. Preoperative localization included surgeon-oriented US and technetium 99m-sestamibi single-photon emission CT (SPECT)/CT.
A total of 212 PGs were pathologically confirmed, resulting in a success rate of 96.2% (52 of 54). Using echo, 193 PGs (91.0%) were accurately localized, while 19 glands (9.0%) were not identified, including those in ectopic positions (n = 12, at thymus or intrathyroid or others), of small size (<1 cm, n = 6), or overlapping with an ipsilateral PG (n = 1). US accurately detected 4 PGs in 36 (66.7%) patients, while SPECT/CT localized 4 glands in 19 patients (35.2%). Although the number of US-detectable PGs was not associated with success rate, it showed a significant negative correlation with surgical time (rs = -0.459, P = 0.002).
US detected 4 glands in 66% of SHPT patients with a sensitivity of 90% for localization. Ectopic position and small size were the most common reasons for the failure to detect PG on US. Complete preoperative echo localization might shorten operating time.
术前定位在继发性甲状旁腺功能亢进症（SHPT）手术中起着重要作用。颈部超声（US）的优点包括高可用性和低成本。然而，报道的超声敏感性为54%-76%，超声检查时甲状旁腺（PG）漏诊的原因鲜有提及。
本回顾性研究纳入了2020年9月至2022年3月期间诊断为肾性SHPT的54例患者。术前定位包括外科医生主导的超声检查和锝99m-甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）/CT。
共212个PG经病理证实，成功率为96.2%（54例中的52例）。通过超声检查，193个PG（91.0%）被准确定位，而19个腺体（9.0%）未被识别，包括异位位置的腺体（n = 12，位于胸腺、甲状腺内或其他部位）、小尺寸腺体（<1 cm，n = 6）或与同侧PG重叠的腺体（n = 1）。超声在36例（66.7%）患者中准确检测到4个PG，而SPECT/CT在19例患者中定位到4个腺体（35.2%）。虽然超声可检测到的PG数量与成功率无关，但它与手术时间呈显著负相关（rs = -0.459，P = 0.002）。
超声在66%的SHPT患者中检测到4个腺体，定位敏感性为90%。异位位置和小尺寸是超声检查未能检测到PG的最常见原因。术前完整的超声定位可能会缩短手术时间。
