Özet:

Primary hyperparathyroid (pHPT) is a common disease and curative therapy is a surgeon. Currently, pre-operative localization studies have become standard, and the first-stage imaging methods are ultrasound and/or syntigraphy. Surgery focused on the contribution of these studies to the localization of the pathological gland has become the first preferred standard treatment. In this study, we aimed at evaluating the effectiveness of ultrasound and syntigraphin in the preoperative localization of pathological glands or glands in patients who are subjected to pHPT cause and care. Requirements and Methods: In this study, the data of patients with preoperative biochemical pHPT diagnosis, with at least one of the Tc99m-MIBI syntigraphy and/or ultrasound (USG) methods, and with surgery was evaluated retrospective. In terms of localization, the USG or sintigraphic positive injury was assessed by the neck side or neck square where it was located and the results were compared with the findings of intraoperative localization. The effectiveness of both methods and combinations was assessed by localization rates, sensitivity and positive predictive values (PPD). 3 methods compared to the Youden index (J). The average age of 380 patients in the study is 54.8+12.8 years (20-83) and 308 women and 72 men. 339 patients were syntigraphed, 344 USG, and 306 USG and syntigraphed. A hundred and twenty patients (32%) received bilateral neck exploration (BBE), 260 patients (68.4%) received minimal invasive parathyroidectomy (MIP) (unilateral exploration or focused surgery). In 358 patients (94) one adenoma, in 10 (%3) double adenoma, in 12 hyperplasia (%3) was detected. According to the upper side of the USG, syntigraphy, USG and syntigraphy combinations, localization rates were 53, 74, 75%, sensitivities 56, 85, 89% and PPDs 90%, 86, 83% respectively. According to the height side, the efficacy of syntigraphin is higher than USG (J: 0,743 vs. 0,527). The contribution of the combination with USG to the effectiveness of syntigraphin was limited (J: 0.743 vs. 0.754). According to the length square, the localization rates of the USG, syntigraphy, USG and syntigraphy combinations were 46, 64, 66%; sensitivities 51, 83, 88%; PPDs 79, 74, 73%. The efficacy of syntigraphin is higher compared to USG (J: 0.64 vs. 0.427). The contribution of the combination with USG to the effectiveness of syntigraphin was limited (J: 0.64 vs. 0.66). The result: in patients with pHPT, the first stage is a more effective method for syntigraphic USG as preoperative imaging, and if there is no contraindication, it should be preferred as the first method. The combination of sintigraphin with USG can contribute to the effectiveness of sintigraphin at a minimum level. Beginning with the positive side of the first syntigraphy of surgery in patients with the two screens are incompatible and BBE is to be applied can provide an advantage in the early detection of the pathological gland. Syntigraphy and USG methods can allow successful MIP surgery to be applied in a large portion of patients with pHPT.

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