Association Between Size of Dominant Candidate Lesion on Four-Dimensional CT and Four-Gland Hyperplasia among Patients with Primary Hyperparathyroidism.

Autor:	Broekhuis JM; From Department of Surgery, Harvard Medical School, Boston, MA (Broekhuis, Cloonan, Sacks, James).; Department of Surgery (Broekhuis, Chaves, Chen, Cloonan, James), Beth Israel Deaconess Medical Center, Boston, MA., Chaves N; Department of Surgery (Broekhuis, Chaves, Chen, Cloonan, James), Beth Israel Deaconess Medical Center, Boston, MA., Chen HW; Department of Surgery (Broekhuis, Chaves, Chen, Cloonan, James), Beth Israel Deaconess Medical Center, Boston, MA., Cloonan DJ; From Department of Surgery, Harvard Medical School, Boston, MA (Broekhuis, Cloonan, Sacks, James).; Department of Surgery (Broekhuis, Chaves, Chen, Cloonan, James), Beth Israel Deaconess Medical Center, Boston, MA., Sacks BA; From Department of Surgery, Harvard Medical School, Boston, MA (Broekhuis, Cloonan, Sacks, James).; Division of Interventional Radiology and Department of Radiology (Sacks), Beth Israel Deaconess Medical Center, Boston, MA., James BC; From Department of Surgery, Harvard Medical School, Boston, MA (Broekhuis, Cloonan, Sacks, James).; Department of Surgery (Broekhuis, Chaves, Chen, Cloonan, James), Beth Israel Deaconess Medical Center, Boston, MA.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2022 Aug 01; Vol. 235 (2), pp. 332-339. Date of Electronic Publication: 2022 Apr 20.
DOI:	10.1097/XCS.0000000000000240
Abstrakt:	Background: Four-dimensional (4D) CT localization allows minimally invasive parathyroidectomy as treatment for primary hyperparathyroidism (PHPT), but false positive localization is frequent. We sought to characterize the ability of 4D CT to predict four-gland hyperplasia (HP) based on the size of candidate lesions. Study Design: We retrospectively analyzed patients with PHPT who underwent 4D CT imaging and parathyroidectomy between 2014 and 2020 from a prospectively collected institutional database. The cohort was stratified into two groups, HP vs single adenoma (SA) and double adenoma (DA), based on operative findings and pathology. Logistic regression models assessed the association between the greatest diameter of the dominant candidate lesion on 4D CT and the outcomes of four-gland hyperplasia vs SA and DA. Results: Among a cohort of 240 patients, 41 were found to have HP, and 199 had adenomas (SA = 155, DA = 44). Patients with HP were less likely to have a preoperative calcium level greater than 1 mg/dL above the upper limit of normal compared with patients with adenomas (63% vs 81%, p = 0.02) and more likely to report symptoms (61% vs 43%, p = 0.04). After adjusting for BMI, we found an estimated 13% reduction in odds of HP for every 1-mm increase in the greatest diameter of dominant candidate lesions identified on 4D CT scan (odds ratio 0.87, 95% CI 0.78 to 0.96, p = 0.009). Conclusions: A smaller size of the dominant lesion on 4D CT scan is associated with an increased risk of HP in PHPT. Use of 4D CT imaging localization may provide evidence for differentiating HP from adenomas. (Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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