The aim of this study was to evaluate sensitivity and positive predictive value (PPV) of high-resolution neck ultrasonography (US) and 99mTc-sestamibi/99mTc-pertechnetate subtraction scintigraphy (SS) in patients with primary hyperparathyroidism (HPT) and nontoxic thyroid nodules. One-hundred and twelve patients (median age 58 years, range 18-78 years) with proved primary HPT underwent both US and SS prior to successful parathyroidectomy (PTx). There were 29 (25.9%) men and 83 (74.1%) women, with no differences (p=NS, Student’s t-test) in age and in main preoperative biochemical parameters. The results of localization procedures were compared with operative and histological findings. When multiglandular disease was found, both US and SS were considered as true positive only when at least two enlarged parathyroid (PT) glands had been localized. Patients were divided into two groups: Group A (87 patients, 77.7%) with no thyroid nodules, and Group B (25 patients, 22.3%) with nontoxic thyroid nodules showed preoperatively by US and/or SS, and confirmed at neck exploration. There were 20 (80.0%) hyperplastic nodules, three (12.0%) follicular adenomas, and two (8.9%) papillary carcinomas. No differences (p=NS, Student’s t-test) were found between the two Groups (A vs B) in age (55.414.7 vs 58.710.9 years), male to female ratio (1:2.7 vs 1:3.1), preoperative serum calcium (2.860.34 vs 2.930.32 mmol/L) and PTH levels (169.5131.7 vs 248.1217.1 ng/L), and in the maximum diameter of the removed parathyroid (PT) glands measured by the pathologist (17.97.4 vs 21.28.9 mm). The excised PT glands were in an ectopic site in 17 of 87 (19.5%) and 6 of 25 (24.0%) patients (p=NS, chi-squared test), respectively. Histological findings showed 99 (88.4%) solitary PT adenomas (Group A=82, Group B=17), and three (2.7%) PT carcinomas (Group A=1, Group B=2). Moreover, three (2.7%) patients had a double PT adenoma (Group A=1, Group B=2), and 7 (6.2%) patients had diffuse PT hyperplasia (Group A=3, Group B=4). Thus, the overall incidence of multiglandular disease was 8.9%, with no difference (p=NS) between the two groups. US sensitivity and PPV were 79.8% and 95.7% (Group A), and 70.8% and 95.7% (Group B), respectively (p=NS). SS sensitivity and PPV were 83.3% and 95.9% (Group A), and 82.6% and 90.9% (Group B), respectively (p=NS). The overall sensitivity of combined US + SS was 95.5% (Group A=94.3%, Group B=92.0%; p=NS). In conclusion, the presence of thyroid nodules does not reduce US and SS sensitivity in patients with primary HPT. The combination of SS and US may significantly improve sensitivity of be 92-93% sensitive

Usefulness of neck ultrasonography and sestamibi scintigraphy in patients with primary hyperparathyroidism and nontoxic thyroid nodules

LUMACHI, FRANCO;
2001

Abstract

The aim of this study was to evaluate sensitivity and positive predictive value (PPV) of high-resolution neck ultrasonography (US) and 99mTc-sestamibi/99mTc-pertechnetate subtraction scintigraphy (SS) in patients with primary hyperparathyroidism (HPT) and nontoxic thyroid nodules. One-hundred and twelve patients (median age 58 years, range 18-78 years) with proved primary HPT underwent both US and SS prior to successful parathyroidectomy (PTx). There were 29 (25.9%) men and 83 (74.1%) women, with no differences (p=NS, Student’s t-test) in age and in main preoperative biochemical parameters. The results of localization procedures were compared with operative and histological findings. When multiglandular disease was found, both US and SS were considered as true positive only when at least two enlarged parathyroid (PT) glands had been localized. Patients were divided into two groups: Group A (87 patients, 77.7%) with no thyroid nodules, and Group B (25 patients, 22.3%) with nontoxic thyroid nodules showed preoperatively by US and/or SS, and confirmed at neck exploration. There were 20 (80.0%) hyperplastic nodules, three (12.0%) follicular adenomas, and two (8.9%) papillary carcinomas. No differences (p=NS, Student’s t-test) were found between the two Groups (A vs B) in age (55.414.7 vs 58.710.9 years), male to female ratio (1:2.7 vs 1:3.1), preoperative serum calcium (2.860.34 vs 2.930.32 mmol/L) and PTH levels (169.5131.7 vs 248.1217.1 ng/L), and in the maximum diameter of the removed parathyroid (PT) glands measured by the pathologist (17.97.4 vs 21.28.9 mm). The excised PT glands were in an ectopic site in 17 of 87 (19.5%) and 6 of 25 (24.0%) patients (p=NS, chi-squared test), respectively. Histological findings showed 99 (88.4%) solitary PT adenomas (Group A=82, Group B=17), and three (2.7%) PT carcinomas (Group A=1, Group B=2). Moreover, three (2.7%) patients had a double PT adenoma (Group A=1, Group B=2), and 7 (6.2%) patients had diffuse PT hyperplasia (Group A=3, Group B=4). Thus, the overall incidence of multiglandular disease was 8.9%, with no difference (p=NS) between the two groups. US sensitivity and PPV were 79.8% and 95.7% (Group A), and 70.8% and 95.7% (Group B), respectively (p=NS). SS sensitivity and PPV were 83.3% and 95.9% (Group A), and 82.6% and 90.9% (Group B), respectively (p=NS). The overall sensitivity of combined US + SS was 95.5% (Group A=94.3%, Group B=92.0%; p=NS). In conclusion, the presence of thyroid nodules does not reduce US and SS sensitivity in patients with primary HPT. The combination of SS and US may significantly improve sensitivity of be 92-93% sensitive
2001
The Endocrine Society 83rd Annual Meeting
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/1350515
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