Tačnost ultrasonografije u detekciji uvećanih paratireoidnih žlezda kod bolesnika sa različitim oblicima hiperparatireoidizma
Sažetak
Uvod/Cilj. Ultrasonografija je jeftina, lako dostupna i pogodna dijagnostička metoda. Ciljevi ove studije su bili: odrediti korisnost ultrasonografije kod preoperativne detekcije i lokalizacije uvećanih paratireoidnih žlezda (PTŽ) kod bolesnika sa različitim oblicima hiperparatireoidizma (HPT); odrediti učestalost detekcije uvećanih PTŽ kod bolesnika kod kojih se prethodno nije sumnjalo na ovo oboljenje, ali koji su imali simptome HPT; odrediti senzitivnost i pozitivnu prediktivnu vrednost (PPV) ultrasonografije u identifikaciji PTŽ kod HPT i uporediti ih sa rezultatima dobijenim scintigrafijom. Metode. Istraživanje je dizajnirano kao retrospektivno-prospektivna
studija. Ukupan broj bolesnika kod kojih je urađena ultrasonografija pre hirurškog zahvata je iznosio 179, a broj bolesnika kod kojih je urađena scintigrafija, pretežno 201Tl/99mTc metodom, iznosio je 112. Bolesnici (52 muškarca i 128 žena) bili su podeljeni u sledeće četiri grupe: grupa A – bolesnici sa primarnim (p)HPT (n = 78); grupa B – bolesnici sa sekundarnim (s)HPT (n = 47); grupa C – bolesnici sa tercijarnim (t)HPT (n = 13); grupa D – bolesnici sa neprepoznatim HPT, ali čija anamneza ukazuje na ovo oboljenje (n = 42). Visoko-rezoluciona ultrasonografija korišćena je za dijagnostiku od strane samo jednog iskusnog radiologa. Dijagnoza HPT postavljena je na osnovu karakterističnih kliničkih i biohemijskih parametara. Konačna potvrda bila je na hirurškom i patohistološkom nalazu. Uvećane PTŽ bile su detektovane kod 93,85% bolesnika pomoću ultrasonografije, a kod 85,89% bolesnika pomoću scintigrafije (p < 0,05). Ukupan broj pozitivnih PTŽ detektovanih ultrasonografijom iznosio je 211 u odnosu na 225 PTŽ detektovanih na osnovu hirurškog nalaza (senzitivnost – 95,9%; PPV – 99,4%). Histopatološkom analizom potvrđena je najveća zastupljenost adenoma u grupama A i D, dok je u grupi B bila dokazana hiperplazija. Grupu C je karakterisalo prisustvo adenoma u hiperplastičnim PTŽ. Prosečna veličina PTŽ izmerena ultrasonografijom je iznosila 17,59 ± 8,0 mm (n = 164), a veličina žlezda izmerenih nakon hirurškog zahvata je bila 18,36 ± 8,54 mm (n = 179). Ultrasonografija se pokazala kao tačna metoda kod svih formi HPT u pogledu senzitivnosti (93,6–100%) i PPV (95,6–100%). Nasuprot ovoj metodi, scintigrafija se pokazala manje pouzdanom i tačnom metodom kod preoperativne lokalizacije PTŽ, posebno kod sHPT (senzitivnost: 51,7%; PPV: 78,4%). Zaključak. Ultrasonografija je senzitivnija i tačnija metoda za preoperativnu detekciju PTŽ u poređenju sa 201Tl/99mTc scintigrafijom. Ova metoda se, takođe, može uspešno koristiti za detekciju uvećanih PTŽ, a time i dijagnoze HPT kod bolesnika kod kojih se na ovo oboljenje prethodno nije sumnjalo.
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