Application of preoperative stereotactic localization in the operation of secondary hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Sheng ¹ , LIU Xiaofang ¹ , XIE Feilai ² , WANG Lu ³ , ZHANG Zaizhong ¹ , WANG Juan ¹ ,  DENG Lin ¹

1. Department of General Surgery, 900th Hospital of the Joint Logistics Team/Clinical Institute of Fuzhou General Hospital, Fujian Medical University/Dongfang Hospital Affiliated of Xiamen University, Fuzhou 350001, P. R. China;
2. Department of Pathology, 900th Hospital of the Joint Logistics Team/Clinical Institute of Fuzhou General Hospital, Fujian Medical University/Dongfang Hospital Affiliated of Xiamen University, Fuzhou 350001, P. R. China;
3. Ultrasonography Department, 900th Hospital of the Joint Logistics Team/Clinical Institute of Fuzhou General Hospital, Fujian Medical University/Dongfang Hospital Affiliated of Xiamen University, Fuzhou 350001, P. R. China;

Corresponding author：

DENG Lin, Email: 350236378@qq.com

Keywords：

secondary hyperparathyroidism; CT; ultrasound; methoxyisobutylisonitrile scan; parathyroid localization

DOI：

10.7507/1007-9424.202005070

Video：

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Objective To explore the selection and application value of preoperative stereotactic localization in the surgical treatment of secondary hyperparathyroidism.Methods The preoperative ultrasound, CT, and methoxyisobutylisonitrile (MIBI) scan data of 54 patients with secondary hyperparathyroidism confirmed by pathological examination in the Department of General Surgery of the 900th Hospital of the Joint Logistics Team from September 2016 to January 2020 were retrospectively analyzed, to explore the localization accuracy of the three methods alone or in combination.Results In this study, a total of 207 parathyroids were detected, 1 was misdiagnosed (ectopic thymus),9 were missed, and 216 parathyroids were removed. The preoperative localization accuracy of CT, ultrasound, and MIBI was the highest (95.39%, 207/217), followed by ultrasound and MIBI (93.55%, 203/217) and CT+MIBI (89.40%, 194/217), compared with other single or two methods, the differences were statistically significant (P<0.05). The accuracy of CT combined with ultrasound localization (82.49%, 179/217) was slightly higher than that of MIBI scan alone (78.80%, 171/217), but the difference was not statistically significant (P=0.060). Although the location accuracy of MIBI scan was slightly higher than that of ultrasound localization (77.88%, 169/217), the difference was not statistically significant (P=0.084).Conclusion In order to maximize the accuracy of preoperative stereotactic localization of secondary hyperparathyroidism, ultrasound, CT, and MIBI should be combined.

Citation： HUANG Sheng, LIU Xiaofang, XIE Feilai, WANG Lu, ZHANG Zaizhong, WANG Juan, DENG Lin. Application of preoperative stereotactic localization in the operation of secondary hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 219-223. doi: 10.7507/1007-9424.202005070 Copy

1.	Rodríguez-Ortiz ME, Pendón-Ruiz de Mier MV, Rodríguez M. Parathyroidectomy in dialysis patients: indications, methods, and consequences. Semin Dial, 2019, 32(5): 444-451.
2.	卢毅, 程广明, 王理想, 等. 继发性甲状旁腺功能亢进甲状旁腺定位方法研究进展. 中国实用外科杂志, 2018, 38(3): 337-340.
3.	Erratum: Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017; 7: 1-59. Kidney Int Suppl (2011), 2017, 7(3): e1.
4.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识. 中国实用外科杂志, 2016, 36(5): 481-486.
5.	颜虹. 医学统计学. 北京: 人民卫生出版社, 2005: 214-221.
6.	Rao SD. Epidemiology of parathyroid disorders. Best Pract Res Clin Endocrinol Metab, 2018, 32(6): 773-780.
7.	崔铭, 王鸥, 廖泉. 原发性甲状旁腺功能亢进症诊断及手术治疗进展. 协和医学杂志, 2020, 11(4): 395-401.
8.	王涛, 张立洪, 邱晶晶, 等. 甲状旁腺全切除术治疗继发性甲状旁腺功能亢进 12 例分析. 中国普外基础与临床杂志, 2015, 22(12): 1513-1514.
9.	Uslu A, Okut G, Tercan IC, et al. Anatomical distribution and number of parathyroid glands, and parathyroid function, after total parathyroidectomy and bilateral cervical thymectomy. Medicine (Baltimore), 2019, 98(23): e15926.
10.	陈曦, 蔡伟耀. 甲状旁腺的解剖特点及其术中探查应注意的问题. 诊断学理论与实践, 2006, 5(6): 477-478.
11.	樊海悦, 田文青, 周波. 原发性甲状旁腺功能亢进症定位诊断. 中华骨质疏松和骨矿盐疾病杂志, 2018, 11(2): 215-219.
12.	赵婉君, 苏安平, 罗晗, 等. 意外甲状旁腺腺瘤的临床特点分析及诊疗体会. 中国普外基础与临床杂志, 2018, 25(4): 416-423.
13.	Mehta S, Dhiwakar M, Swaminathan K. Outcomes of parathyroid gland identification and autotransplantation during total thyroidectomy. Eur Arch Otorhinolaryngol, 2020, 277(8): 2319-2324.
14.	Abbaci M, De Leeuw F, Breuskin I, et al. Parathyroid gland management using optical technologies during thyroidectomy or parathyroidectomy: a systematic review. Oral Oncol, 2018, 87: 186-196.
15.	Shou JD, He SM, Jiang XF, et al. Anatomical localization of normal parathyroid glands before thyroidectomy through ultrasonography reduces postoperative hypoparathyroidism. Medicine (Baltimore), 2019, 98(24): e16020.
16.	Gallagher JW, Kelley ML, Yip L, et al. Retropharyngeal parathyroid glands: important differences. World J Surg, 2018, 42(2): 437-443.
17.	Xia C, Zhu Q, Li Z, et al. Study of the ultrasound appearance of the normal parathyroid using an intraoperative procedure. J Ultrasound Med, 2019, 38(2): 321-327.
18.	Bononi M, Viviana F, De Feo MS, et al. Gonioprobe, an innovative Gamma-probe to guide parathyroid radio-guided surgery: first clinical experiences with Navigator and Lock-on-target functions. Curr Radiopharm, 2020, [Online ahead of print].
19.	Day KM, Elsayed M, Beland MD, et al. The utility of 4-dimensional computed tomography for preoperative localization of primary hyperparathyroidism in patients not localized by sestamibi or ultrasonography. Surgery, 2015, 157(3): 534-539.
20.	Zolin SJ, Crawford K, Rudin AV, et al. Selective parathyroid venous sampling in reoperative parathyroid surgery: a key localization tool when noninvasive tests are unrevealing. Surgery, 2020, [Online ahead of print].
21.	殷亮, 刘凤新, 王顺章. 继发性甲旁亢甲状旁腺全切除术术前超声定位策略. 临床医药文献电子杂志, 2017, 4(A4): 20572-20573.
22.	张长明, 马欢, 张玉芳. ⁹⁹Tc^m-MIBI 断层及同机 CT 融合显像在继发性甲状旁腺功能亢进症术前定位诊断中的价值. 中华内分泌外科杂志, 2016, 10(1): 23-25.
23.	Jason DS, Balentine CJ. Intraoperative decision making in parathyroid surgery. Surg Clin North Am, 2019, 99(4): 681-691.
24.	Hiramitsu T, Tomosugi T, Okada M, et al. Pre-operative localisation of the parathyroid glands in secondary hyperparathyroidism: a retrospective cohort study. Sci Rep, 2019, 9(1): 14634.
25.	胡琳, 崔爱民, 柏楠, 等. 原发性甲状旁腺功能亢进症再次手术分析 (附 11 例报道). 中国普外基础与临床杂志, 2018, 25(2): 178-183.
26.	崔铭, 廖泉. 原发性甲状旁腺功能亢进症诊疗模式的转变. 中国普外基础与临床杂志, 2020, 27(10): 1189-1191.

1. Rodríguez-Ortiz ME, Pendón-Ruiz de Mier MV, Rodríguez M. Parathyroidectomy in dialysis patients: indications, methods, and consequences. Semin Dial, 2019, 32(5): 444-451.
2. 卢毅, 程广明, 王理想, 等. 继发性甲状旁腺功能亢进甲状旁腺定位方法研究进展. 中国实用外科杂志, 2018, 38(3): 337-340.
3. Erratum: Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017; 7: 1-59. Kidney Int Suppl (2011), 2017, 7(3): e1.
4. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识. 中国实用外科杂志, 2016, 36(5): 481-486.
5. 颜虹. 医学统计学. 北京: 人民卫生出版社, 2005: 214-221.
6. Rao SD. Epidemiology of parathyroid disorders. Best Pract Res Clin Endocrinol Metab, 2018, 32(6): 773-780.
7. 崔铭, 王鸥, 廖泉. 原发性甲状旁腺功能亢进症诊断及手术治疗进展. 协和医学杂志, 2020, 11(4): 395-401.
8. 王涛, 张立洪, 邱晶晶, 等. 甲状旁腺全切除术治疗继发性甲状旁腺功能亢进 12 例分析. 中国普外基础与临床杂志, 2015, 22(12): 1513-1514.
9. Uslu A, Okut G, Tercan IC, et al. Anatomical distribution and number of parathyroid glands, and parathyroid function, after total parathyroidectomy and bilateral cervical thymectomy. Medicine (Baltimore), 2019, 98(23): e15926.
10. 陈曦, 蔡伟耀. 甲状旁腺的解剖特点及其术中探查应注意的问题. 诊断学理论与实践, 2006, 5(6): 477-478.
11. 樊海悦, 田文青, 周波. 原发性甲状旁腺功能亢进症定位诊断. 中华骨质疏松和骨矿盐疾病杂志, 2018, 11(2): 215-219.
12. 赵婉君, 苏安平, 罗晗, 等. 意外甲状旁腺腺瘤的临床特点分析及诊疗体会. 中国普外基础与临床杂志, 2018, 25(4): 416-423.
13. Mehta S, Dhiwakar M, Swaminathan K. Outcomes of parathyroid gland identification and autotransplantation during total thyroidectomy. Eur Arch Otorhinolaryngol, 2020, 277(8): 2319-2324.
14. Abbaci M, De Leeuw F, Breuskin I, et al. Parathyroid gland management using optical technologies during thyroidectomy or parathyroidectomy: a systematic review. Oral Oncol, 2018, 87: 186-196.
15. Shou JD, He SM, Jiang XF, et al. Anatomical localization of normal parathyroid glands before thyroidectomy through ultrasonography reduces postoperative hypoparathyroidism. Medicine (Baltimore), 2019, 98(24): e16020.
16. Gallagher JW, Kelley ML, Yip L, et al. Retropharyngeal parathyroid glands: important differences. World J Surg, 2018, 42(2): 437-443.
17. Xia C, Zhu Q, Li Z, et al. Study of the ultrasound appearance of the normal parathyroid using an intraoperative procedure. J Ultrasound Med, 2019, 38(2): 321-327.
18. Bononi M, Viviana F, De Feo MS, et al. Gonioprobe, an innovative Gamma-probe to guide parathyroid radio-guided surgery: first clinical experiences with Navigator and Lock-on-target functions. Curr Radiopharm, 2020, [Online ahead of print].
19. Day KM, Elsayed M, Beland MD, et al. The utility of 4-dimensional computed tomography for preoperative localization of primary hyperparathyroidism in patients not localized by sestamibi or ultrasonography. Surgery, 2015, 157(3): 534-539.
20. Zolin SJ, Crawford K, Rudin AV, et al. Selective parathyroid venous sampling in reoperative parathyroid surgery: a key localization tool when noninvasive tests are unrevealing. Surgery, 2020, [Online ahead of print].
21. 殷亮, 刘凤新, 王顺章. 继发性甲旁亢甲状旁腺全切除术术前超声定位策略. 临床医药文献电子杂志, 2017, 4(A4): 20572-20573.
22. 张长明, 马欢, 张玉芳. ⁹⁹Tc^m-MIBI 断层及同机 CT 融合显像在继发性甲状旁腺功能亢进症术前定位诊断中的价值. 中华内分泌外科杂志, 2016, 10(1): 23-25.
23. Jason DS, Balentine CJ. Intraoperative decision making in parathyroid surgery. Surg Clin North Am, 2019, 99(4): 681-691.
24. Hiramitsu T, Tomosugi T, Okada M, et al. Pre-operative localisation of the parathyroid glands in secondary hyperparathyroidism: a retrospective cohort study. Sci Rep, 2019, 9(1): 14634.
25. 胡琳, 崔爱民, 柏楠, 等. 原发性甲状旁腺功能亢进症再次手术分析 (附 11 例报道). 中国普外基础与临床杂志, 2018, 25(2): 178-183.
26. 崔铭, 廖泉. 原发性甲状旁腺功能亢进症诊疗模式的转变. 中国普外基础与临床杂志, 2020, 27(10): 1189-1191.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of preoperative stereotactic localization in the operation of secondary hyperparathyroidism

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