A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US ( p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy.
Introduction: We retrospectively reviewed the data of patients with papillary thyroid cancer who were node positive and treated at our department between 1955 and 1994. Of 362 cases of papillary cancer, 134 were identified with lymph-node metastases (37%). Methods: Two types of dissection procedures were applied by a large community of surgeons. When only the cervical central lymph nodes were involved, the procedure of choice was thyroidectomy, with local lymph-node excision (LD); if the lateral nodes were also affected, modified radical neck dissection (MRND) was applied. Results: Of 88 patients considered to have minimal involvement, 70 underwent procedures of a lesser magnitude than MRND. Most of the operations were localised "picking procedures". Recurrence of the disease developed in 16 cases, twice in 8 of these. The new tumourous lymph node was found to be ipsilateral in every case and close to the place of the first operation. The rate of recurrence was 23%. In the same group, 18 MRNDs were performed, with ipsilateral lymph-node recurrence in six cases. In 41 patients undergoing surgery for extended lymph-node metastases, conservative excisions were carried out in 17 and MRND in 24 cases, including six bilateral dissections. In this group, late recurrence was 47%. Conclusion: The results of the follow-up of 30 childhood and juvenile patients with papillary thyroid carcinoma is very interesting; all of our young patients are alive.
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