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

Yıl 2021, Cilt: 5 Sayı: 1, 61 - 65, 23.04.2021

Hakan Korkmaz

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.

Anahtar Kelimeler

İnce iğne aspirasyonu, MIBI negatif, primer hiperparatiroidizm, yıkama

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

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.

Anahtar Kelimeler

Fine needle aspiration, MIBI negative,, primary hyperparathyroidism,, washout,

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.