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.	盧毅, 程廣明, 王理想, 等. 繼發性甲狀旁腺功能亢進甲狀旁腺定位方法研究進展. 中國實用外科雜志, 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.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 慢性腎功能衰竭繼發甲狀旁腺功能亢進外科臨床實踐專家共識. 中國實用外科雜志, 2016, 36(5): 481-486.
5.	顏虹. 醫學統計學. 北京: 人民衛生出版社, 2005: 214-221.
6.	Rao SD. Epidemiology of parathyroid disorders. Best Pract Res Clin Endocrinol Metab, 2018, 32(6): 773-780.
7.	崔銘, 王鷗, 廖泉. 原發性甲狀旁腺功能亢進癥診斷及手術治療進展. 協和醫學雜志, 2020, 11(4): 395-401.
8.	王濤, 張立洪, 邱晶晶, 等. 甲狀旁腺全切除術治療繼發性甲狀旁腺功能亢進 12 例分析. 中國普外基礎與臨床雜志, 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.	陳曦, 蔡偉耀. 甲狀旁腺的解剖特點及其術中探查應注意的問題. 診斷學理論與實踐, 2006, 5(6): 477-478.
11.	樊海悅, 田文青, 周波. 原發性甲狀旁腺功能亢進癥定位診斷. 中華骨質疏松和骨礦鹽疾病雜志, 2018, 11(2): 215-219.
12.	趙婉君, 蘇安平, 羅晗, 等. 意外甲狀旁腺腺瘤的臨床特點分析及診療體會. 中國普外基礎與臨床雜志, 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, 劉鳳新, 王順章. 繼發性甲旁亢甲狀旁腺全切除術術前超聲定位策略. 臨床醫藥文獻電子雜志, 2017, 4(A4): 20572-20573.
22.	張長明, 馬歡, 張玉芳. ⁹⁹Tc^m-MIBI 斷層及同機 CT 融合顯像在繼發性甲狀旁腺功能亢進癥術前定位診斷中的價值. 中華內分泌外科雜志, 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, 崔愛民, 柏楠, 等. 原發性甲狀旁腺功能亢進癥再次手術分析 (附 11 例報道). 中國普外基礎與臨床雜志, 2018, 25(2): 178-183.
26.	崔銘, 廖泉. 原發性甲狀旁腺功能亢進癥診療模式的轉變. 中國普外基礎與臨床雜志, 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. 盧毅, 程廣明, 王理想, 等. 繼發性甲狀旁腺功能亢進甲狀旁腺定位方法研究進展. 中國實用外科雜志, 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. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 慢性腎功能衰竭繼發甲狀旁腺功能亢進外科臨床實踐專家共識. 中國實用外科雜志, 2016, 36(5): 481-486.
5. 顏虹. 醫學統計學. 北京: 人民衛生出版社, 2005: 214-221.
6. Rao SD. Epidemiology of parathyroid disorders. Best Pract Res Clin Endocrinol Metab, 2018, 32(6): 773-780.
7. 崔銘, 王鷗, 廖泉. 原發性甲狀旁腺功能亢進癥診斷及手術治療進展. 協和醫學雜志, 2020, 11(4): 395-401.
8. 王濤, 張立洪, 邱晶晶, 等. 甲狀旁腺全切除術治療繼發性甲狀旁腺功能亢進 12 例分析. 中國普外基礎與臨床雜志, 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. 陳曦, 蔡偉耀. 甲狀旁腺的解剖特點及其術中探查應注意的問題. 診斷學理論與實踐, 2006, 5(6): 477-478.
11. 樊海悅, 田文青, 周波. 原發性甲狀旁腺功能亢進癥定位診斷. 中華骨質疏松和骨礦鹽疾病雜志, 2018, 11(2): 215-219.
12. 趙婉君, 蘇安平, 羅晗, 等. 意外甲狀旁腺腺瘤的臨床特點分析及診療體會. 中國普外基礎與臨床雜志, 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, 劉鳳新, 王順章. 繼發性甲旁亢甲狀旁腺全切除術術前超聲定位策略. 臨床醫藥文獻電子雜志, 2017, 4(A4): 20572-20573.
22. 張長明, 馬歡, 張玉芳. ⁹⁹Tc^m-MIBI 斷層及同機 CT 融合顯像在繼發性甲狀旁腺功能亢進癥術前定位診斷中的價值. 中華內分泌外科雜志, 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, 崔愛民, 柏楠, 等. 原發性甲狀旁腺功能亢進癥再次手術分析 (附 11 例報道). 中國普外基礎與臨床雜志, 2018, 25(2): 178-183.
26. 崔銘, 廖泉. 原發性甲狀旁腺功能亢進癥診療模式的轉變. 中國普外基礎與臨床雜志, 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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