Preoperative localisation of parathyroid glands in primary hyperparathyroidism.

F F Chou, P W Wang, S M Sheen-Chen
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Abstract

Objective: To assess the accuracy of preoperative localisation of abnormal parathyroid glands in patients with primary hyperparathyroidism by comparing results of echography and 201thallium and (99m)technetium subtraction scans with the operative findings.

Design: Retrospective study.

Setting: Teaching hospital, Taiwan.

Subjects: 84 Patients with primary hyperparathyroidism, 83 of whom had bilateral exploration of the neck and thymus and one mediastinotomy. Seventy-three patients (69 with adenomas and 4 with hyperplasia) had high-resolution echography and 56 (52 with adenomas and 4 with hyperplasia) had 210Tl/99mTc subtraction scans.

Main outcome measures: Results of follow-up.

Results: 78 Patients had parathyroid adenomas and 6 had hyperplasia. Parathyroid echography had a sensitivity (> or = 0.5 cm) of 55%, a specificity (< 0.5 cm) of 100%, a positive predictive value of 90%, and an accuracy of 77%. 210Tl/99mTc subtraction scanning had a sensitivity (> or = 0.5 cm) of 70%, a specificity (< 0.5 cm) of 100%, a positive predictive value of 100%, and an accuracy of 86%. The double tracer scan was slightly but not significantly more accurate than echography (p = 0.09). There were few postoperative complications except for transient hypocalcaemia, which usually lasted less than two weeks. All but one of the operations was successful. That one developed permanent hypocalcaemia, but it might have been caused by previous thyroid surgery and parathyroid injury.

Conclusion: To increase the success rate of parathyroid surgery, we recommend preoperative localisation with 210Tl/99mTc subtraction scan instead of echography, and routine bilateral exploration of the neck and thymus.

原发性甲状旁腺功能亢进症的术前定位。
目的:通过对比超声及201铊、(99m)锝减影扫描结果与手术表现,评价原发性甲状旁腺功能亢进患者术前异常甲状旁腺定位的准确性。设计:回顾性研究。单位:台湾教学医院。研究对象:84例原发性甲状旁腺功能亢进患者,其中83例行双侧颈胸腺探查及一次纵隔切开术。73例患者(69例腺瘤,4例增生)行高分辨率超声检查,56例(52例腺瘤,4例增生)行210Tl/99mTc减影扫描。主要观察指标:随访结果。结果:甲状旁腺瘤78例,增生6例。甲状旁腺超声的敏感性(>或= 0.5 cm)为55%,特异性(< 0.5 cm)为100%,阳性预测值为90%,准确率为77%。210Tl/99mTc减影扫描的灵敏度(>或= 0.5 cm)为70%,特异性(< 0.5 cm)为100%,阳性预测值为100%,准确率为86%。双示踪扫描的准确性略高于超声(p = 0.09)。除短暂性低钙血症(通常持续不到两周)外,术后并发症很少。除一次手术外,所有手术都成功了。那个人患上了永久性低钙血症,但这可能是由以前的甲状腺手术和甲状旁腺损伤引起的。结论:为了提高甲状旁腺手术的成功率,我们建议术前采用210Tl/99mTc减影扫描代替超声定位,常规双侧颈部胸腺探查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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