Michael Neuberger, Jan Axl Dropmann, Axel Kleespies, Heinrich Fuerst
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Preoperative SC could not identify an adenoma in 30 patients (34.9%), and in 12 patients (14.0%), the surgeon was subsequently unable to localize abnormal parathyroid tissue. Preoperative parathyroid hormone concentration was the only significant independent predictor of a negative SC finding (non-linear and indirect association). Independent from surgical history, an unsuccessful intraoperative focus localization was exclusively predicted by preoperative ultrasonographic (US) and SC findings (OR per diagnostic category 2.98; 95%-CI 1.03-8.58, p=0.043, and OR 2.26; 95%-CI: 1.10-4.63, p=0.027, respectively). Compared to exclusive US, however, the combination of SC and US significantly increased the sensitivity and predictive power to identify patients at a high risk for a complicated surgical procedure.</p><p><strong>Conclusion: </strong>In patients before parathyroidectomy, a low preoperative parathyroid hormone concentration is significantly associated with a high likelihood for a negative SC finding. 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引用次数: 0
摘要
目的:对于复发性原发性甲状旁腺功能亢进(pHPT)或既往甲状腺手术的患者,病理甲状旁腺的显像定位有时不成功。诊断失败的原因及其临床相关性尚不清楚。方法:对pHPT患者进行回顾性观察性研究,利用logistic回归分析评估术前显像阴性(SC)的独立预测因素及其与术中预后的相关性。结果:86例计划行甲状旁腺手术的pHPT患者中,63例(73%)既往有甲状腺或甲状旁腺手术史。30例(34.9%)患者术前SC不能识别腺瘤,12例(14.0%)患者术后无法定位异常甲状旁腺组织。术前甲状旁腺激素浓度是阴性SC发现的唯一显著独立预测因子(非线性和间接关联)。与手术史无关,术前超声检查(US)和SC检查结果完全可以预测术中病灶定位不成功(每个诊断类别的OR为2.98;95%-CI 1.03-8.58, p=0.043, OR 2.26;95% ci: 1.10-4.63, p=0.027)。然而,与单独的US相比,SC和US的结合显著提高了识别复杂外科手术高风险患者的敏感性和预测能力。结论:在甲状旁腺切除术前的患者中,术前甲状旁腺激素浓度低与SC阴性发现的高可能性显著相关。术前联合US和SC可显著增加识别术中阴性患者的机会。
Determinants and clinical significance of negative scintigraphic findings in primary hyperparathyroidism: a retrospective observational study.
Aim: In patients with recurrent primary hyperparathyroidism (pHPT) or preceding thyroid operation, scintigraphic localization of the pathological parathyroid gland is sometimes unsuccessful. Reason for diagnostic failure, and its clinical relevance is poorly understood.
Methods: This retrospective observational study in patients suffering from a pHPT evaluated independent predictors of a negative preoperative scintigraphy (SC) result, and its relevance for intraoperative outcome using logistic regression analysis.
Results: Among 86 pHPT patients scheduled for parathyroid operation, 63 (73%) had a history of a preceding thyroid or parathyroid operation. Preoperative SC could not identify an adenoma in 30 patients (34.9%), and in 12 patients (14.0%), the surgeon was subsequently unable to localize abnormal parathyroid tissue. Preoperative parathyroid hormone concentration was the only significant independent predictor of a negative SC finding (non-linear and indirect association). Independent from surgical history, an unsuccessful intraoperative focus localization was exclusively predicted by preoperative ultrasonographic (US) and SC findings (OR per diagnostic category 2.98; 95%-CI 1.03-8.58, p=0.043, and OR 2.26; 95%-CI: 1.10-4.63, p=0.027, respectively). Compared to exclusive US, however, the combination of SC and US significantly increased the sensitivity and predictive power to identify patients at a high risk for a complicated surgical procedure.
Conclusion: In patients before parathyroidectomy, a low preoperative parathyroid hormone concentration is significantly associated with a high likelihood for a negative SC finding. Combining US with SC before operation significantly increases the chance to identify patients prone to negative intraoperative findings.
期刊介绍:
Als Standes- und Fachorgan (Organ von Deutscher Gesellschaft für Nuklearmedizin (DGN), Österreichischer Gesellschaft für Nuklearmedizin und Molekulare Bildgebung (ÖGN), Schweizerischer Gesellschaft für Nuklearmedizin (SGNM, SSNM)) von hohem wissenschaftlichen Anspruch befasst sich die CME-zertifizierte Nuklearmedizin/ NuclearMedicine mit Diagnostik und Therapie in der Nuklearmedizin und dem Strahlenschutz: Originalien, Übersichtsarbeiten, Referate und Kongressberichte stellen aktuelle Themen der Diagnose und Therapie dar.
Ausführliche Berichte aus den DGN-Arbeitskreisen, Nachrichten aus Forschung und Industrie sowie Beschreibungen innovativer technischer Geräte, Einrichtungen und Systeme runden das Konzept ab.
Die Abstracts der Jahrestagungen dreier europäischer Fachgesellschaften sind Bestandteil der Kongressausgaben.
Nuklearmedizin erscheint regelmäßig mit sechs Ausgaben pro Jahr und richtet sich vor allem an Nuklearmediziner, Radiologen, Strahlentherapeuten, Medizinphysiker und Radiopharmazeuten.