LOKALİZASYONU BELLİ OLMAYAN PARATİROİD ADENOMLARINDA 4D-BT KULLANILARAK CERRAHİNİN KAPSAMI DARALTILABİLİR Mİ?

Öz

Amaç: Primer hiperparatiroidizmin (pHPT) cerrahi tedavisinde doğru preoperatif lokalizasyon büyük önem taşır. Ultrasonografi ve Sestamibi SPECT/BT gibi birinci basamak görüntüleme yöntemleriyle lokalizasyon sağlanamadığında, dört boyutlu bilgisayarlı tomografi (4D-BT) ek tanısal katkı sağlayabilir.

Gereç ve Yöntemler: Bu retrospektif çalışmada, 370 paratiroidektomi hastasının tıbbi kayıtları incelendi ve primer hiperparatiroidisi olan, USG ve teknesyum-99m sestamibi SPECT/CT ile paratiroid adenomu lokalize edilemediği için 4D-CT uygulanmış erişkin hastalar analiz edildi. Sekonder ve tersiyer hiperparatiroidi nedeniyle opere edilen hastalar çalışma dışı bırakıldı. Hastaların demografik özellikleri, biyokimyasal verileri, intraoperatif bulguları ve histopatolojik sonuçları değerlendirildi. Tüm hastalarda standart üç fazlı 4D-CT protokolü ve intraoperatif PTH ölçümü kullanıldı. Görüntüleme bulguları cerrahi ve patolojik sonuçlarla karşılaştırılarak 4D-CT’nin tanısal doğruluğu belirlendi.

Bulgular: 4D-BT, 22 hastanın 13’ünde (%59) paratiroid adenomunu doğru lokalize etti; duyarlılık %68,4, özgüllük %33,3, pozitif prediktif değer %86,7, negatif prediktif değer %14,3 ve genel doğruluk %63,6 olarak hesaplandı. İki hastada mediastinal ektopik adenom saptandı, yanlış pozitif oranı %13,3 idi. Hastaların %59′unda tek taraflı veya odaklanmış eksplorasyon yeterli oldu. Postoperatif major komplikasyon izlenmedi.

Sonuç: Birinci basamak görüntüleme ile lokalizasyon sağlanamayan pHPT olgularında 4D-BT, yüksek pozitif prediktif değeriyle adenomu doğru saptayarak minimal invaziv cerrahiye olanak sağlar ve cerrahi başarı ile hasta sonuçlarını iyileştirir.

Anahtar Kelimeler

• Dört Boyutlu- Bilgisayarlı Tomografi
• Paratiroidektomi
• Paratiroid adenom
• Preoperatif Lokalizasyon
• Primer Hiperparatiroidizm

CAN THE EXTENT OF SURGERY BE NARROWED BY USİNG 4D-CT IN PARATHYROID ADENOMAS WITH UNCLEAR LOCALIZATION?

Öz

Objective: Accurate preoperative localisation is crucial for the surgical management of primary hyperparathyroidism (pHPT). When first-line imaging modalities such as ultrasonography (USG) and Sestamibi SPECT/CT fail to identify the hyperfunctioning gland, four-dimensional computed tomography (4D-CT) may offer additional diagnostic benefit.

Materials and Methods: This retrospective study reviewed 370 parathyroidectomy cases and included adults with primary hyperparathyroidism who underwent 4D-CT after ultrasonography and technetium-99m sestamibi SPECT/CT failed to localise the parathyroid adenoma. Patients with secondary or tertiary hyperparathyroidism were excluded. Demographic and biochemical data, intraoperative findings, and histopathology results were analysed. A standardised three-phase 4D-CT protocol and intraoperative PTH monitoring were used, and the imaging results were correlated with surgical and pathological outcomes to determine diagnostic accuracy.

Results: 4D-CT accurately localised parathyroid adenomas in 13 of 22 patients (59%), with a sensitivity of 68.4%, specificity of 33.3%, positive predictive value of 86.7%, negative predictive value of 14.3%, and overall diagnostic accuracy of 63.6%. Two patients had mediastinal ectopic adenomas, and the false-positive rate was 13.3%. Focused or unilateral neck exploration was feasible in 59% of patients, reducing surgical invasiveness. No major postoperative complications were observed.

Conclusion: 4D-CT provides significant diagnostic and surgical value in patients with nonlocalized pHPT following inconclusive first-line imaging. Its high positive predictive value enables precise localisation and supports minimally invasive parathyroidectomy, improving operative precision and patient outcomes.

Anahtar Kelimeler

• four-dimensional computed tomography
• parathyroidectomy
• parathyroid adenoma
• preoperative localization
• primary hyperparathyroidism

Kaynakça

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