Comparative Study and False Negative Cases Analysis of Preoperative Ultrasonography， 99Tcm-Sestamibi Scinti-graphy， and CT in Primary Hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Haiying , YANG Fuquan , TIAN Zhong , ZHANG Chunju ,  LIU Jingang

Department of General Surgery， Affiliated Shengjing Hospital of China Medical University， Shenyang 110004， Liaoning Province， China;

Corresponding author：

LIU Jingang, Email: liujg@sj-hospital.org

Keywords：

Primary hyperparathyroidism; Ultrasonography; 99Tcm-sestamibi scintigraphy; CT; Parathyroid adenoma

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Objective 　To evaluate the diagnostic significance and to analyze reasons of false negative cases for
preoperative ultrasonography， 99Tcm-sestamibi scintigraphy （MIBI scintigraphy）， and CT in primary hyperparathyroidism
（PHPT）.
Methods 　Clinical data of 69 patients with PHPT， who underwent operation in Affiliated Shengjing Hospital of China Medical University between Jan. 2003 and Aug. 2012 were retrospectively analyzed.
Results 　There were 76 parathyroid lesions in 69 PHPT patients proved by operation and pathology， including 58 cases of parathyroid adenoma with 60 lesions， 7 cases of parathyroid hyperplasia with 11 lesions， and 4 cases of parathyroid carcinoma with 5 lesions. The sensitivity of ultrasonography， CT， and 99Tcm-MIBI scintigraphy were 81.94% （59/72）， 61.76% （21/34）， and 69.57% （16/23）， the accuracy of 3 kinds of tests were 78.67% （59/75）， 61.76% （21/34）， and 66.67% （16/24）， the positive predictive value were 95.16% （59/62）， 100% （21/21）， and 94.12% （16/17） respectively. There was significant differ-ence only between ultrasonography and CT in sensitivity （P=0.03）， no other significant difference was found （P＞0.05）.
Conclusions 　Ultrasonography is complementary to 99Tcm-MIBI scintigraphy， but CT has little significance in diagnosis of PHPT. Both of ultrasonography and 99Tcm-MIBI scintigraphy should be used before operation routinely to localize parathyroid lesions.

Citation： ZHAO Haiying,YANG Fuquan,TIAN Zhong,ZHANG Chunju,LIU Jingang,.. Comparative Study and False Negative Cases Analysis of Preoperative Ultrasonography， 99Tcm-Sestamibi Scinti-graphy， and CT in Primary Hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(9): 1038-1044. doi: Copy

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1. Fraser WD. Hyperparathyroidism[J]. Lancet， 2009， 374(9684)：.
2. Levy JM， Kandil E， Yau LC， et al. Can ultrasound be used as the primary screening modality for the localization of parathyroiddisease prior to surgery for primary hyperparathyroidism? A review of 440 cases[J]. ORL J Otorhinolaryngol Relat Spec， 2011， 73(2)：116-120.
3. 董建宇，管珩，朱预. 甲状旁腺功能亢进症455例临床症状分析[J]. 中国医学科学院学报， 2011， 33(3)：330-333.
4. 周建平，田雨霖. 中国人原发性甲状旁腺功能亢进10年文献回顾(1995～2004年)[J]. 中国普通外科杂志， 2007， 16(1)：.
5. Udelsman R， Lin Z， Donovan P. The superiority of minimally invasive parathyroidectomy based on 1 650 consecutive patients with primary hyperparathyroidism[J]. Ann Surg， 2011， 253(3)：585-591.
6. Arciero CA， Shiue ZS， Gates JD， et al. Preoperative thyroid ultrasound is indicated in patients undergoing parathyroidectomy for primary hyperparathyroidism[J]. J Cancer， 2012， 3：1-6.
7. Wilson SD， Doffek KM， Wang TS， et al. Primary hyperparath-yroidism with a history of head and neck irradiation：the conseq-uences of associated thyroid tumors[J]. Surgery， 2011， 150(4)：.
8. Akbaba G， Berker D， Isik S， et al. A comparative study of pre-operative imaging methods in patients with primary hyperparath-yroidism：ultrasonography， 99Tcm sestamibi， single photon emission computed tomography， and magnetic resonance imaging[J]. J Endocrinol Invest， 2012， 35(4)：359-364.
9. Ruda JM， Hollenbeak CS， Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003[J]. Otolaryngol Head Neck Surg， 2005， 132(3)：359-372.
10. Untch BR， Adam MA， Scheri RP， et al. Surgeon-performedultrasound is superior to 99Tc-sestamibi scanning to localize para-thyroid adenomas in patients with primary hyperparathyroidism：results in 516 patients over 10 years[J]. J Am Coll Surg， 2011， 212(4)：522-529.
11. Chandramohan A， Sathyakumar K， Irodi A， et al. Causes of discordant or negative ultrasound of parathyroid glands in treatment naïve patients with primary hyperparathyroidism[J]. Eur J Radiol， 2012， 81(12)：3956-3964.
12. Lane MJ， Desser TS， Weigel RJ， et al. Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas[J]. AJR Am J Roentgenol， 1998， 171(3)：819-823.
13. Heller MT， Yip L， Tublin ME. Sonography of intrathyroid parathyroid adenomas：are there distinctive features that allow for preoperative identification?[J]. Eur J Radiol， 2013， 82(1)：22-27.
14. Johnson NA， Yip L， Tublin ME. Cystic parathyroid adenoma：sonographic features and correlation with 99Tcm-sestamibi SPECT findings[J]. AJR Am J Roentgenol， 2010， 195(6)：1385-1390.
15. Cating-Cabral MT， Cabungcal AC， Villafuerte CV 3rd， et al. Primary hyperparathyroidism due to an intrathyroidal parathyroid adenoma associated with chronic lymphocytic thyroiditis[J]. BMJ Case Rep， 2012， 2012.
16. Witteveen JE， Kievit J， Stokkel MP， et al. Limitations of 99Tcm-MIBI-SPECT imaging scans in persistent primary hyperparathyroidism[J]. World J Surg， 2011， 35(1)：128-139.
17. Kwon JH， Kim EK， Lee HS， et al. Neck ultrasonography as preoperative localization of primary hyperparathyroidism with an additional role of detecting thyroid malignancy[J]. Eur J Radiol， 2013， 82(1)：e17-e21.
18. Krausz Y， Shiloni E， Bocher M， et al. Diagnostic dilemmas in parathyroid scintigraphy[J]. Clin Nucl Med， 2001， 26(12)：997-1001.
19. Mihai R， Gleeson F， Buley ID， et al. Negative imaging studies for primary hyperparathyroidism are unavoidable：correlation of sestamibi and high-resolution ultrasound scanning with histologicalanalysis in 150 patients[J]. World J Surg， 2006， 30(5)：697-704.
20. Kim YI， Jung YH， Hwang KT， et al. Efficacy of 99Tcm-sestamibi SPECT/CT for minimally invasive parathyroidectomy：comparative study with 99Tcm-sestamibi scintigraphy， SPECT， US and CT[J]. Ann Nucl Med， 2012， 26(10)：804-810.
21. Shafiei B， Hoseinzadeh S， Fotouhi F， et al. Preoperative 99Tcm-sestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter：comparison of SPECT-CT， SPECT， and planar imaging[J]. Nucl Med Commun， 2012， 33(10)：1070-1076.
22. Iervolino L， Scalisse NM， Maeda SS. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?[J]. Arq Bras Endocrinol Metabol， 2012， 56(4)：265-269.
23. Adler JT， Chen H， Schaefer S， et al. Does routine use of ultras-ound result in additional thyroid procedures in patients with primaryhyperparathyroidism?[J]. J Am Coll Surg， 2010， 211(4)：536-.
24. Harris R， Ryu H， Vu T， et al. Modern approach to surgical intervention of the thyroid and parathyroid glands[J]. Semin Ultrasound CT MR， 2012， 33(2)：115-122.
25. Ogawa T， Kammori M， Tsuji E， et al. Preoperative evaluation of thyroid pathology in patients with primary hyperparathyroidism[J]. Thyroid， 2007， 17(1)：59-62.
26. -80.
27. -158.
28. .
29. -877.

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Comparative Study and False Negative Cases Analysis of Preoperative Ultrasonography， 99Tcm-Sestamibi Scinti-graphy， and CT in Primary Hyperparathyroidism

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