RESUMEN
BACKGROUND: Controversy exists regarding the superiority of single photon emission CT (SPECT)/CT over SPECT for preoperative localization of parathyroid adenomas in primary hyperparathyroidism (PHPT), as well as the cost-effectiveness. METHODS: A retrospective review was undertaken of patients undergoing surgery for PHPT from January 2009 to August 2014. Ultrasound and SPECT (ultrasound-SPECT) or SPECT/CT (ultrasound-SPECT/CT) were performed for each patient. Sensitivity and positive predictive value (PPV) of each modality were calculated. Cost-effectiveness was determined by an incremental cost-effectiveness ratio (ICER) analysis. RESULTS: Two hundred fifty-nine patients with 266 parathyroid adenomas were included in the study. Lateralization sensitivity and PPV of ultrasound-SPECT were 85.1% and 98.2%, respectively. The lateralization sensitivity and PPV of ultrasound-SPECT/CT were 86.9% and 99.4%, respectively. A cost of $2499.22 (CAD) per additional parathyroid adenoma detection by ultrasound-SPECT/CT was determined from the ICER analysis. CONCLUSION: Similar sensitivities and PPVs were observed between ultrasound-SPECT and ultrasound-SPECT/CT in preoperatively lateralizing parathyroid adenomas, with relatively equivalent cost-effectiveness. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2062-E2065, 2016.
Asunto(s)
Adenoma/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada de Emisión de Fotón Único , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiofármacos , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/economía , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único/economíaRESUMEN
BACKGROUND: Applications for sentinel node biopsy (SNB) in the head and neck are increasing with new lymphatic tracers and imaging techniques allowing previously inaccessible tumor sites to benefit from the procedure. We show that lymphatic drainage from a primary parotid malignancy can be accurately mapped using navigational surgery. METHODS: A patient with radiologically classified N0 intraparotid malignancy underwent peritumoral injection of 99mTc-nanocolloid. Planar imaging and single photon emission CT (SPECT)/CT identified the sentinel node. At surgery, real-time video combined with 3 dimensional (3D) images of intraoperative radioisotope hot spots directed the surgeon to the sentinel node. RESULTS: Lymphoscintographic images demonstrated the hot nodes, which were easily retrieved intraoperatively by 3D navigation. Three lymph nodes were removed, all were free of metastasis. CONCLUSION: The morbidity associated with total parotidectomy and elective neck dissection in low-risk malignancies may be avoided with SNB. This technique is applicable to other sites within the head and neck.
