Wang Rongzhi, Song Zhixing, Harper Claren, Zmijewski Polina V, McLeod M Chandler, Gillis Andrea, Lindeman Brenessa, Chen Herbert, Fazendin Jessica
Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0012, United States.
Department of Surgery, University of Oklahoma, 825 NE 10th Street, Oklahoma City, OK 73104, United States.
Oncologist. 2025 May 8;30(5). doi: 10.1093/oncolo/oyaf091.
Radioguided parathyroidectomy is based on the principle that hyperfunctioning parathyroid glands have increased radiotracer uptake, which can be measured instantaneously. We sought to determine if ex vivo radioactivity measurement could be used to predict parathyroid pathology and guide surgical decision-making in a time-efficient manner. Materials and Methods: We retrospectively reviewed patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution (2000-2022). All patients received a preoperative injection of 10mCi of 99Tc. Intraoperatively, radioactivity was measured by a gamma counter within 5 seconds. The ratio of radioactive counts of resected parathyroid glands (ex vivo) to background thyroid tissue (radioactive ratio [RR]) was calculated. Patient demographics, preoperative laboratory measurements, and RRs were compared between patients with single-gland disease (SGD) versus multigland disease (MGD). The predictive threshold for SGD was subsequently validated on the following cohort of 115 patients.
Of 2368 patients included, 1585 (66.9%) patients had SGD, and 783 (33.1%) had MGD. Patients with SGD had higher median (IQR) RRs than the MGD group (0.8 [0.5-1.3] vs 0.4 [0.3-0.7], P <.001). After adjusting for age, preoperative calcium and PTH, reoperative parathyroidectomy, and gland weight, the RR was an independent predictor (OR 2.155, P <.001) of SGD. A receiver operating characteristic curve was plotted using the RR to predict the likelihood of SGD. The positive predictive value (PPV) reached a plateau at 85.3% when RR was 1.2. When the threshold of 1.2 was used in the validation cohort, the PPV was 92.3%.
Ex vivo radioactivity measurement provides an instantaneous and reliable prediction of parathyroid pathology, which could be used as an adjunct to guide surgical decision-making during parathyroidectomy.
放射性引导甲状旁腺切除术基于这样的原理，即功能亢进的甲状旁腺摄取放射性示踪剂增加，且可即时测量。我们试图确定离体放射性测量是否可用于高效预测甲状旁腺病变并指导手术决策。材料与方法：我们回顾性分析了在我院接受甲状旁腺切除术的原发性甲状旁腺功能亢进患者（2000 - 2022年）。所有患者术前均注射10mCi的99Tc。术中，用γ计数器在5秒内测量放射性。计算切除的甲状旁腺（离体）与背景甲状腺组织的放射性计数之比（放射性比值[RR]）。比较单腺疾病（SGD）患者与多腺疾病（MGD）患者的人口统计学资料、术前实验室测量值和RR。随后在接下来的115例患者队列中验证SGD的预测阈值。
纳入的2368例患者中，1585例（66.9%）为SGD，783例（33.1%）为MGD。SGD患者的RR中位数（IQR）高于MGD组（0.8[0.5 - 1.3]对0.4[0.3 - 0.7]，P <.001）。在调整年龄、术前钙和甲状旁腺激素、再次手术的甲状旁腺切除术以及腺体重量后，RR是SGD的独立预测因素（OR 2.155，P <.001）。使用RR绘制受试者工作特征曲线以预测SGD的可能性。当RR为1.2时，阳性预测值（PPV）达到平台期，为85.3%。在验证队列中使用1.2的阈值时，PPV为92.3%。
离体放射性测量可即时、可靠地预测甲状旁腺病变，可作为甲状旁腺切除术期间指导手术决策的辅助手段。
