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Korean J Med > Volume 89(1); 2015 > Article
내분비-대사
The Korean Journal of Medicine 2015;89(1): 48-53.
부갑상선선종의 병소 위치 결정을 위한 영상진단법의 비교
한민귀1, 윤지희1, 김수정1, 김희경1, 조진성2, 강호철1
1전남대학교 의과대학 내과학교실
2전남대학교 의과대학 외과학교실
Comparison of Ultrasonography and 99mTc-sestamibi Scan for Preoperative Localization of Parathyroid Adenoma
Min Gui Han1, Jee Hee Yoon1, Soo Jeong Kim1, Hee Kyung Kim1, Jin Seong Cho2, Ho-Cheol Kang1
1Departments of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
2Departments of Surgery, Chonnam National University Medical School, Gwangju, Korea
Corresponding Author: Ho-Cheol Kang ,Tel: +82-61-379-7620, Fax: +82-61-379-7628, Email: drkang@chonnam.ac.kr
Received: November 6, 2014;   Revised: December 29, 2014;   Accepted: March 17, 2015.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background/Aims:
Primary hyperparathyroidism can be cured by minimally invasive surgery (MIS) with optimized preoperative localization. Ultrasonography (US) and 99mTc-sestamibi (MIBI) scan are the imaging modalities most widely used for the localization of the affected glands. In this study, we defined the roles of US and MIBI scan.
Methods:
We retrospectively reviewed 40 patients who underwent parathyroidectomy for a single parathyroid adenoma between 2004 and 2013. US and scintigraphic findings were compared with operative findings.
Results:
Adenomas were accurately localized using US and MIBI scan in 38 patients (95%) and 37 patients (92.5%), respectively. Twenty-nine patients (76.3%) showed typical extrathyroidal hypoechoic nodule with central or peripheral vascularity, and, after MIS, we confirmed that they were suffering from a single parathyroid adenoma. Eight patients with atypical US findings and two patients with an undetectable lesion on US underwent MIS after localization using MIBI scan or computed tomography (CT). Only one patient showed an extrathyroidal cystic nodule evidenced by high parathyroid hormone cystic fluid on ultrasound-guided fine-needle aspiration and negative MIBI scan. All lesions not localized on US were located in the superior portion.
Conclusions:
US is a sensitive and accurate method for the preoperative localization of parathyroid adenoma, especially if the lesion has typical US features and is located inferiorly. We suggest that US be the first localization modality and that MIBI scan or CT be used in the limited number of cases with negative US findings.
Keywords: Hyperparathyroidism; Parathyroid neoplasms; Ultrasonography; Technetium Tc 99m sestamibi
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