[Comparison among ecography, scintigraphy and surgery in the localization of parathyroid glands in uremic patients undergoing parathyroidectomy].
BACKGROUND
Sensitivity and specificity of the most widely employed techniques of parathyroid glands localization, namely echography and scintigraphy, are mostly obtained with short-term follow-up data and do not underline the existence of a methodological problem. As a matter of fact, both methods identify only pathological glands, with no "normal" results; therefore "true negatives" cannot be obtained. Aim of our study was to compare, by means of a statistically appropriate approach, the results of echography, scintigraphy and surgery with the data obtained after a mid term follow-up period, enabling us to discover all parathyroid glands.


METHODS
Twenty six consecutive dialysis patients (14M/12F; age 50+/-12 years) underwent echography and scintigraphy immediately before a total parathyroidectomy with autotransplantation and were followed-up for 6 months to recognize all the existing glands (PTH levels and scintigraphy).


RESULTS
Total identified glands were: 73 by scintigraphy, 86 by echography, 99 by surgery and 103 by follow-up data. The concordance indexes (K0) between the number of glands effectively present in the individual patient (follow-up data) and those identified with each method were rather low with scintigraphy (0.071) and echography (0.218), and acceptable (0.578) with surgery. The number of patients correctly classified was: 9/26 (34,6%) with scintigraphy, 13/26 (50%) with echography and 22/26 (85%) with surgery. Finally, the number of wrongly identified glands (from zero to three) in each patient was similar with scintigraphy (65,4%) and echography (50%) and significantly better with surgery (15,6%; p<0.01).


CONCLUSIONS
The most reliable technique to identify parathyroid glands in uremic subjects is surgery, nonetheless a meticulous clinical follow-up is necessary to recognize all of them.
Mazzaferro
S
S
Cattedra di Nefrologia, Università di Roma La Sapienza, Roma, Italia. sandro.mazzaferro@uniroma1.it
Matera
G
G
Barresi
G
G
Mancini
E
E
Conte
C
C
Otranto
G
G
Taggi
F
F
Gallina
S
S
Gossetti
F
F
Montemurro
L
L
Proposito
D
D
Carboni
M
M
D000328:Adult; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D013670:Sodium Pertechnetate Tc 99m; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D014463:Ultrasonography; D014511:Uremia / Q000150:complications*
D017256:Technetium Tc 99m Sestamibi; D013670:Sodium Pertechnetate Tc 99m