Kurian Keerthi E, Hamdi Osama, Roecker Zoe A, Barker Simone A, Strumpf Andrew, Garneau Jonathan C, Shonka David C
California Northstate University College of Medicine, Elk Grove, California, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA.
Head Neck. 2025 Mar;47(3):839-846. doi: 10.1002/hed.27970. Epub 2024 Oct 28.
Preoperative localization of parathyroid adenomas aids surgical planning for patients with hyperparathyroidism. This study explores the diagnostic accuracy of surgeon-reviewed 4D computed tomography (4D CT) scans for localization of parathyroid adenomas.
A retrospective review of 95 patients with hyperparathyroidism who underwent parathyroidectomy at a tertiary care center was performed. The sensitivity, specificity, positive and negative predictive values, accuracy of identifying abnormal glands by surgeon, and interrater reliability between two head and neck surgeons was assessed.
The sensitivity of surgeon localization of all glands was 71% (95% CI, 63%-78%), improving to 76% when combined with radiology reads. The specificity was 98% (95% CI, 95%-99%), the positive predictive value was 95% (95% CI, 90%-99%), and the negative predictive value was 84% (95% CI, 79%-88%) for all abnormal glands. Interrater reliability between surgeons was κ = 0.771.
The diagnostic accuracy of surgeon localization of abnormal glands on the 4D CT scan was substantial. Improvement with radiology report integration highlights the benefits of multidisciplinary collaboration. Interrater reliability between two fellowship-trained surgeons was moderate. These findings support the importance of surgeons developing proficiency in reading 4D CT scans to engage in interdisciplinary communication and improve patient outcomes.
甲状旁腺腺瘤的术前定位有助于为甲状旁腺功能亢进患者制定手术计划。本研究探讨了经外科医生审阅的四维计算机断层扫描（4D CT）对甲状旁腺腺瘤定位的诊断准确性。
对在一家三级医疗中心接受甲状旁腺切除术的95例甲状旁腺功能亢进患者进行回顾性研究。评估了外科医生识别异常腺体的敏感性、特异性、阳性和阴性预测值、准确性以及两位头颈外科医生之间的评分者间可靠性。
外科医生对所有腺体定位的敏感性为71%（95%可信区间，63%-78%），与放射科阅片结果相结合时提高到76%。所有异常腺体的特异性为98%（95%可信区间，95%-99%），阳性预测值为95%（95%可信区间，90%-99%），阴性预测值为84%（95%可信区间，79%-88%）。外科医生之间的评分者间可靠性κ=0.771。
外科医生在4D CT扫描上对异常腺体定位的诊断准确性较高。结合放射学报告可提高准确性，突出了多学科协作的益处。两位接受过专科培训的外科医生之间的评分者间可靠性为中等。这些发现支持外科医生提高阅读4D CT扫描的能力以进行跨学科交流并改善患者治疗效果的重要性。
