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

Year 2021, , 61 - 65, 23.04.2021

Hakan Korkmaz

https://doi.org/10.30565/medalanya.853038

Abstract

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.

Keywords

İnce iğne aspirasyonu, MIBI negatif, primer hiperparatiroidizm, yıkama

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

Abstract

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.

Keywords

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

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