Khan A, Samtani S, Varma V M, Frost A, Cohen J
Division of Otolaryngology and Head and Neck Surgery, George Washington University Medical Center, Washington D.C.
Otolaryngol Head Neck Surg. 1994 Oct;111(4):467-72. doi: 10.1177/019459989411100413.
The utility of preoperative parathyroid localization remains controversial. The gold standard for identification of abnormal parathyroid glands is exploration of the neck by an experienced surgeon. However, both for the experienced and less experienced surgeon, it may be desirable to localize the abnormality before surgery. Such a study would not only direct the surgeon to the site of the lesion but also would help reduce unnecessary dissection, the number of negative explorations, and operative anesthesia time. Unfortunately, currently used noninvasive techniques including ultrasonography, thallium-technetium subtraction, computed tomography scan, and magnetic resonance imaging have had only limited success (35% to 78%) in demonstrating abnormal parathyroid glands. Thirty patients with proven hyperparathyroidism were enrolled to compare a new imaging agent, technetium 99m sestamibi, as an alternative to thallium 201 for subtraction scintigraphy with technetium 99m pertechnetate. Only 14 of 30 patients operated on at George Washington University underwent an identical surgical approach (exploration of all four glands) and had complete preoperative calcium and parathormone levels, postoperative calcium levels, and total time of surgical procedures to formulate the basis of this report. The remaining 16 had their surgeries at other institutions. A surgical approach different from that used at George Washington University and unavailability of postoperative calcium levels and times of surgical procedures from these institutions necessitated deletion of these 16 patients from this report. Technetium 99m sestamibi-technetium 99m subtraction scans accurately localized the abnormal parathyroid gland in 13 of 14 patients, as compared with only 9 of 14 thallium 201-technetium 99m pertechnetate subtraction scans. These results support technetium 99m sestamibi scanning as the superior modality for preoperative parathyroid localization.
术前甲状旁腺定位的实用性仍存在争议。识别异常甲状旁腺的金标准是由经验丰富的外科医生对颈部进行探查。然而，对于经验丰富和经验不足的外科医生来说，在手术前定位异常情况可能都是可取的。这样的研究不仅能引导外科医生找到病变部位，还有助于减少不必要的解剖、阴性探查的次数以及手术麻醉时间。不幸的是，目前使用的非侵入性技术，包括超声检查、铊 - 锝减影、计算机断层扫描和磁共振成像，在显示异常甲状旁腺方面仅取得了有限的成功（35%至78%）。30例经证实患有甲状旁腺功能亢进的患者被纳入研究，以比较一种新的显像剂——锝99m甲氧基异丁基异腈，作为铊201用于锝99m高锝酸盐减影闪烁显像的替代物。在乔治华盛顿大学接受手术的30例患者中，只有14例采用了相同的手术方式（探查所有四个腺体），并且有完整的术前血钙和甲状旁腺激素水平、术后血钙水平以及手术总时长，以此作为本报告的依据。其余16例患者在其他机构接受手术。由于手术方式与乔治华盛顿大学不同，且这些机构无法提供术后血钙水平和手术时长，因此本报告不得不剔除这16例患者。与14例铊201 - 锝99m高锝酸盐减影扫描中只有9例能准确定位异常甲状旁腺相比，14例锝99m甲氧基异丁基异腈 - 锝99m减影扫描中有13例能准确定位异常甲状旁腺。这些结果支持将锝99m甲氧基异丁基异腈扫描作为术前甲状旁腺定位的更优方法。
