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Tc-99m MIBI Negatif Primer Hiperparatiroidizm Olgularında Parathormon Yıkamanın Tanısal Değeri

Yıl 2021, Cilt: 5 Sayı: 1, 61 - 65, 23.04.2021
https://doi.org/10.30565/medalanya.853038

Öz

Amaç: Hiperfonksiyonel paratiroid lezyonlarının preoperatif lokalizasyonunda ince iğne aspirasyonu (İİA) yıkama sıvısında parathormon (PTH) ölçümünün duyarlılık ve pozitif prediktif değer (PPD)’ini belirlemek.

Yöntem: 2016-2020 yılları arasında kliniğimizde primer hiperparatiroidi (PHPT) tanısı alan hastaların tıbbi kayıtları retrospektif olarak incelendi. Operasyon öncesi İİA-PTH yıkama prosedürü uygulanan 36 PHPT hastası çalışmaya alındı. İİA-PTH yıkama sadece teknesyum-99m metoksi-isobutil-isonitril (Tc-99m MIBI-SPECT) negatif hastalarda yapıldı. Serum PTH seviyesinden daha yüksek PTH yıkama seviyeleri, pozitif kesme değeri olarak tanımlandı. İİA-PTH yıkama prosedürünün duyarlılık, PPD, yanlış pozitif, yanlış negatif ve tanısal doğruluk değerleri sunuldu.


Bulgular: PTH yıkama 2 olguda yanlış pozitif, 1 olguda yanlış negatif ve 33 olguda gerçek pozitifti. Gerçek paratiroid lezyonlarının ayırt edilmesinde PTH yıkamanın duyarlılığı % 97.05, özgüllüğü % 100 pozitif prediktif değeri % 94.29 ve tanısal doğruluğu % 91.67 olarak hesaplandı. PTH yıkanma seviyeleri, serum PTH ve paratiroid lezyon hacmi ile pozitif koreleydi (sırasıyla, r=0.347, p=0.041 ve r=0.356, p=0.036). Tüm hastalar prosedürü iyi tolere etti ve iİA-PTH yıkandıktan sonra herhangi bir komplikasyon gelişmedi.

Sonuç: İİA-PTH yıkaması, Tc-99m MIBI/SPECT negatif PHPT hastalarında paratiroid lezyonlarını lokalize etmek için güvenli ve kullanışlı bir yöntemdir.

Kaynakça

  • 1. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet. 2018;391(10116):168‐78. doi:10.1016/S0140-6736(17)31430-7.
  • 2. Laird AM, Libutti SK. Minimally Invasive Parathyroidectomy versus bilateral neck exploration for primary hyperparathyroidism. Surg Oncol Clin N Am. 2016;25(1):103‐18. doi: 10.1016/j.soc.2015.08.012
  • 3. Teksoz S, Bukey Y, Ozcan M, Arikan AE, Erbabacan SE, Ozyegin A. Minimal invasive parathyroidectomy with local anesthesia for well-localized primary hyperparathyroidism: "Cerrahpasa experience". Updates Surg. 2013;65(3):217‐23. doi: 10.1007/s13304-013-0202-7.
  • 4. Bunch PM, Kelly HR. Preoperative imaging techniques in primary hyperparathyroidism: A review. JAMA Otolaryngol Head Neck Surg. 2018;144(10):929‐37. doi: 10.1001/jamaoto.2018.1671.
  • 5. Uludağ M. Preoperative localization studies in primary hyperparathyroidism. Med Bull Sisli Etfal Hosp. 2019;53(1):7–15. doi: 10.14744/SEMB.2019.78476.
  • 6. Thomas DL, Bartel T, Menda Y, Howe J, Graham MM, Juweid ME. Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 2009;34(10):651‐5. doi: 10.1097/RLU.0b013e3181b591c9.
  • 7. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19(2):577‐83. doi: 10.1245/s10434-011-1870-5.
  • 8. Broos WAM, van der Zant FM, Knol RJJ, Wondergem M. Choline PET/CT in parathyroid imaging: a systematic review. Nucl Med Commun. 2019;40(2):96‐105. doi: 10.1097/MNM.0000000000000952.
  • 9. Trimboli P, D'Aurizio F, Tozzoli R, Giovanella L. Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids. Clin Chem Lab Med. 2017;55(7):914‐25. doi: 10.1515/cclm-2016-0543.
  • 10. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973;4(5893):643‐6. doi: 10.1136/bmj.4.5893.643.
  • 11. Yüksel S, Ferlengez A, Çıtlak G. Is focused parathyroidectomy effective in primary hyperparathyroidism? Med Bull Haseki; 2019;57(4):345-8. doi: 10.4274/haseki.4966.
  • 12. Bergenfelz AO, Jansson SK, Wallin GK, Mårtensson HG, Rasmussen L, Eriksson HL, et al. Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg. 2009;394(5):851‐60. doi: 10.1007/s00423-009-0540-6.
  • 13. Ozkaya M, Elboga U, Sahin E, Kalender E, Korkmaz H, Demir HD, et al. Evaluation of conventional imaging techniques on preoperative localization in primary hyperparathyroidism. Bosn J Basic Med Sci. 2015;15(1):61‐6. doi: 10.17305/bjbms.2015.207.
  • 14. Mihai R, Gleeson F, Buley ID, Roskell DE, Sadler GP. Negative imaging studies for primary hyperparathyroidism are unavoidable: correlation of sestamibi and high-resolution ultrasound scanning with histological analysis in 150 patients. World J Surg. 2006;30(5):697‐704. doi: 10.1007/s00268-005-0338-9.
  • 15. Turgut S, Erdoğan EB, Association of Tc99m-MIBI scintigraphy and biochemical parameters in primary hyperparathyroidism. Osmangazi J Med. 2020. doi: 10.20515 /otd.787841.
  • 16. Türkölmez Ş, Çayır D, Koca G, Demirel K, Korkmaz M. Paratiroid adenomunda Tc-99m MIBI retansiyonu ile intakt parathormon düzeyleri arasındaki ilişki. Gülhane TD. 2007;49:36-9.
  • 17. Gökçay Canpolat A, Şahin M, Ediboğlu E, Erdoğan MF, Güllü S, Demir Ö, et al. Diagnostic accuracy of parathyroid hormone levels in washout samples of suspicious parathyroid adenomas: A single-centre retrospective cohort study. Clin Endocrinol (Oxf). 2018;89(4):489‐95. doi: 10.1111/cen.13812.
  • 18. Kiblut NK, Cussac JF, Soudan B, Farrell SG, Armstrong JA, Arnalsteen L, et al. Fine needle aspiration and intraparathyroid intact parathyroid hormone measurement for reoperative parathyroid surgery. World J Surg. 2004;28(11):1143‐7. doi: 10.1007/s00268-004-7563-5.
  • 19. Barczynski M, Golkowski F, Konturek A, Buziak-Bereza M, Cichon S, Hubalewska-Dydejczyk A, et al. Technetium-99m-sestamibi subtraction scintigraphy vs. ultrasonography combined with a rapid parathyroid hormone assay in parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach. Clin Endocrinol (Oxf). 2006;65(1):106‐13. doi: 10.1111/j.1365-2265.2006.02556.x.
  • 20. Abraham D, Sharma PK, Bentz J, Gault PM, Neumayer L, McClain DA. Utility of ultrasound-guided fine-needle aspiration of parathyroid adenomas for localization before minimally invasive parathyroidectomy. Endocr Pract. 2007;13(4):333‐7. doi: 10.4158/EP.13.4.333.
  • 21. Bancos I, Grant CS, Nadeem S, Stan MN, Reading CC, Sebo TJ, et al. Risks and benefits of parathyroid fine-needle aspiration with parathyroid hormone washout. Endocr Pract. 2012;18(4):441‐9. doi: 10.4158/EP11148.OR.
  • 22. Kwak JY, Kim EK, Moon HJ, Kim MJ, Ahn SS, Son EJ, et al. Parathyroid incidentalomas detected on routine ultrasound-directed fine-needle aspiration biopsy in patients referred for thyroid nodules and the role of parathyroid hormone analysis in samples. Thyroid 2009;19(7):743‐748. doi: 10.1089/thy.2008.0263.
  • 23. Kuzu F, Arpaci D, Cakmak GK, Emre AU, Elri T, Ilikhan SU, et al. Focused parathyroidectomy without intra-operative parathormone monitoring: The value of PTH assay in preoperative ultrasound guided fine needle aspiration washout. Ann Med Surg (Lond). 2016;6:64‐7. doi: 10.1016/j.amsu.2015.12.065.
  • 24. Xue J, Liu Y, Ji T, Zhao A, Liang Y, Deng H, et al. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun. 2018;39(12):1129‐37. doi: 10.1097/MNM.0000000000000921.
  • 25. Maser C, Donovan P, Santos F, Donabedian R, Rinder C, Scoutt L, et al. Sonographically guided fine needle aspiration with rapid parathyroid hormone assay. Ann Surg Oncol. 2006;13(12):1690‐5. doi: 10.1245/s10434-006-9180-z.

The Diagnostic Value of Parathormone Washout in Tc-99m MIBI Negative Primary Hyperparathyroidism Cases

Yıl 2021, Cilt: 5 Sayı: 1, 61 - 65, 23.04.2021
https://doi.org/10.30565/medalanya.853038

Öz

Aim: To determine the sensitivity and positive predictive value (PPV) of the measurement of parathormone (PTH) in fine needle aspiration (FNA) washout fluid in the preoperative localization of hyperfunctional parathyroid lesions.

Methods: Medical records of patients diagnosed with primary hyperparathyroidism (PHPT) in our clinic between 2016-2020 washout were retrospectively evaluated. 36 patients with PHPT who underwent preoperative FNA-PTH washout procedure were included in the study. FNA-PTH washout was only performed in patients with negative technetium-99m methoxy isobutyl isonitrile /single photon emission computed tomography (Tc-99m MIBI/SPECT) imaging. It was accepted to be higher than plasma PTH level as positive cut-off value for PTH washout in determining parathyroid lesions. Sensitivity, PPV, false positive, false negative and diagnostic accuracy values of PTH washout were calculated.

Results: PTH washout was false positivity in 2 cases, false negative in 1 case and true positive in 33 cases. In the discrimination of true parathyroid lesions, the sensitivity of PTH washout was calculated as 97.05%, specificity 100%, PPV 94.29% and diagnostic accuracy 91.67%. PTH washout levels correlated positively with plasma PTH and parathyroid lesion volume.

Conclusion: The FNA-PTH washout is a safe and useful method to localise parathyroid lesions in PHPT patients with negative Tc-99m MIBI/SPECT imaging.

Kaynakça

  • 1. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet. 2018;391(10116):168‐78. doi:10.1016/S0140-6736(17)31430-7.
  • 2. Laird AM, Libutti SK. Minimally Invasive Parathyroidectomy versus bilateral neck exploration for primary hyperparathyroidism. Surg Oncol Clin N Am. 2016;25(1):103‐18. doi: 10.1016/j.soc.2015.08.012
  • 3. Teksoz S, Bukey Y, Ozcan M, Arikan AE, Erbabacan SE, Ozyegin A. Minimal invasive parathyroidectomy with local anesthesia for well-localized primary hyperparathyroidism: "Cerrahpasa experience". Updates Surg. 2013;65(3):217‐23. doi: 10.1007/s13304-013-0202-7.
  • 4. Bunch PM, Kelly HR. Preoperative imaging techniques in primary hyperparathyroidism: A review. JAMA Otolaryngol Head Neck Surg. 2018;144(10):929‐37. doi: 10.1001/jamaoto.2018.1671.
  • 5. Uludağ M. Preoperative localization studies in primary hyperparathyroidism. Med Bull Sisli Etfal Hosp. 2019;53(1):7–15. doi: 10.14744/SEMB.2019.78476.
  • 6. Thomas DL, Bartel T, Menda Y, Howe J, Graham MM, Juweid ME. Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 2009;34(10):651‐5. doi: 10.1097/RLU.0b013e3181b591c9.
  • 7. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19(2):577‐83. doi: 10.1245/s10434-011-1870-5.
  • 8. Broos WAM, van der Zant FM, Knol RJJ, Wondergem M. Choline PET/CT in parathyroid imaging: a systematic review. Nucl Med Commun. 2019;40(2):96‐105. doi: 10.1097/MNM.0000000000000952.
  • 9. Trimboli P, D'Aurizio F, Tozzoli R, Giovanella L. Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids. Clin Chem Lab Med. 2017;55(7):914‐25. doi: 10.1515/cclm-2016-0543.
  • 10. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973;4(5893):643‐6. doi: 10.1136/bmj.4.5893.643.
  • 11. Yüksel S, Ferlengez A, Çıtlak G. Is focused parathyroidectomy effective in primary hyperparathyroidism? Med Bull Haseki; 2019;57(4):345-8. doi: 10.4274/haseki.4966.
  • 12. Bergenfelz AO, Jansson SK, Wallin GK, Mårtensson HG, Rasmussen L, Eriksson HL, et al. Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg. 2009;394(5):851‐60. doi: 10.1007/s00423-009-0540-6.
  • 13. Ozkaya M, Elboga U, Sahin E, Kalender E, Korkmaz H, Demir HD, et al. Evaluation of conventional imaging techniques on preoperative localization in primary hyperparathyroidism. Bosn J Basic Med Sci. 2015;15(1):61‐6. doi: 10.17305/bjbms.2015.207.
  • 14. Mihai R, Gleeson F, Buley ID, Roskell DE, Sadler GP. Negative imaging studies for primary hyperparathyroidism are unavoidable: correlation of sestamibi and high-resolution ultrasound scanning with histological analysis in 150 patients. World J Surg. 2006;30(5):697‐704. doi: 10.1007/s00268-005-0338-9.
  • 15. Turgut S, Erdoğan EB, Association of Tc99m-MIBI scintigraphy and biochemical parameters in primary hyperparathyroidism. Osmangazi J Med. 2020. doi: 10.20515 /otd.787841.
  • 16. Türkölmez Ş, Çayır D, Koca G, Demirel K, Korkmaz M. Paratiroid adenomunda Tc-99m MIBI retansiyonu ile intakt parathormon düzeyleri arasındaki ilişki. Gülhane TD. 2007;49:36-9.
  • 17. Gökçay Canpolat A, Şahin M, Ediboğlu E, Erdoğan MF, Güllü S, Demir Ö, et al. Diagnostic accuracy of parathyroid hormone levels in washout samples of suspicious parathyroid adenomas: A single-centre retrospective cohort study. Clin Endocrinol (Oxf). 2018;89(4):489‐95. doi: 10.1111/cen.13812.
  • 18. Kiblut NK, Cussac JF, Soudan B, Farrell SG, Armstrong JA, Arnalsteen L, et al. Fine needle aspiration and intraparathyroid intact parathyroid hormone measurement for reoperative parathyroid surgery. World J Surg. 2004;28(11):1143‐7. doi: 10.1007/s00268-004-7563-5.
  • 19. Barczynski M, Golkowski F, Konturek A, Buziak-Bereza M, Cichon S, Hubalewska-Dydejczyk A, et al. Technetium-99m-sestamibi subtraction scintigraphy vs. ultrasonography combined with a rapid parathyroid hormone assay in parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach. Clin Endocrinol (Oxf). 2006;65(1):106‐13. doi: 10.1111/j.1365-2265.2006.02556.x.
  • 20. Abraham D, Sharma PK, Bentz J, Gault PM, Neumayer L, McClain DA. Utility of ultrasound-guided fine-needle aspiration of parathyroid adenomas for localization before minimally invasive parathyroidectomy. Endocr Pract. 2007;13(4):333‐7. doi: 10.4158/EP.13.4.333.
  • 21. Bancos I, Grant CS, Nadeem S, Stan MN, Reading CC, Sebo TJ, et al. Risks and benefits of parathyroid fine-needle aspiration with parathyroid hormone washout. Endocr Pract. 2012;18(4):441‐9. doi: 10.4158/EP11148.OR.
  • 22. Kwak JY, Kim EK, Moon HJ, Kim MJ, Ahn SS, Son EJ, et al. Parathyroid incidentalomas detected on routine ultrasound-directed fine-needle aspiration biopsy in patients referred for thyroid nodules and the role of parathyroid hormone analysis in samples. Thyroid 2009;19(7):743‐748. doi: 10.1089/thy.2008.0263.
  • 23. Kuzu F, Arpaci D, Cakmak GK, Emre AU, Elri T, Ilikhan SU, et al. Focused parathyroidectomy without intra-operative parathormone monitoring: The value of PTH assay in preoperative ultrasound guided fine needle aspiration washout. Ann Med Surg (Lond). 2016;6:64‐7. doi: 10.1016/j.amsu.2015.12.065.
  • 24. Xue J, Liu Y, Ji T, Zhao A, Liang Y, Deng H, et al. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun. 2018;39(12):1129‐37. doi: 10.1097/MNM.0000000000000921.
  • 25. Maser C, Donovan P, Santos F, Donabedian R, Rinder C, Scoutt L, et al. Sonographically guided fine needle aspiration with rapid parathyroid hormone assay. Ann Surg Oncol. 2006;13(12):1690‐5. doi: 10.1245/s10434-006-9180-z.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Hakan Korkmaz 0000-0001-5066-6335

Yayımlanma Tarihi 23 Nisan 2021
Gönderilme Tarihi 4 Ocak 2021
Kabul Tarihi 22 Ocak 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 5 Sayı: 1

Kaynak Göster

Vancouver Korkmaz H. The Diagnostic Value of Parathormone Washout in Tc-99m MIBI Negative Primary Hyperparathyroidism Cases. Acta Med. Alanya. 2021;5(1):61-5.

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