Erbil Yesim, Barbaros Umut, Salmaslioglu Artur, Tunaci Mehtap, Ozbey Nese, Bozbora Alp, Ozmarmagan Selcuk
Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, CAPA 34390 Istanbul, Turkey.
J Clin Ultrasound. 2006 Nov-Dec;34(9):425-9. doi: 10.1002/jcu.20275.
The key to successful parathyroid surgery is accurate preoperative tumor localization. This study investigates the use of ultrasound (US)-guided parathyroid fine needle aspiration (FNA) as a confirmatory diagnostic method in patients with hyperparathyroidism undergoing minimally invasive parathyroidectomy.
Patients were selected for minimally invasive parathyroidectomy based on the finding of a single parathyroid adenoma identified with US and/or sestamibi scans and confirmation of the suspected parathyroid lesion via FNA and parathyroid hormone (PTH) assay. The value of aspirate obtained from the thyroid gland intraoperatively served as the negative control.
A total of 56 tissue FNAs were performed in 27 patients. US detected masses suggestive of parathyroid lesion in all 27 patients, and 31 US-guided FNAs were performed. No complications related to the procedure were noted. Intraoperatively, FNA was performed in the thyroids of 25 patients undergoing minimally invasive parathyroidectomy. Aspirates from lesions subsequently confirmed as having developed from the parathyroid gland had a mean PTH level of 4,677 +/- 123 pg/ml (range, 3,600-5,000 pg/ml), which was significantly higher than thyroid aspirates, which yielded a mean PTH level of 48 +/- 7 pg/ml (range, 5-57 pg/ml). The sensitivity of US and sestamibi scans in the detection of abnormal parathyroid glands was 88% and 77%, respectively. The sensitivity of US-guided FNA in confirming the parathyroid origin of a lesion was 100%.
US-guided FNA for PTH assay can be performed safely for the confirmation of lesions identified with preoperative US for the selection of patients eligible for minimally invasive parathyroidectomy.
甲状旁腺手术成功的关键在于术前准确的肿瘤定位。本研究探讨超声（US）引导下甲状旁腺细针穿刺抽吸活检（FNA）作为一种确诊诊断方法在接受微创甲状旁腺切除术的甲状旁腺功能亢进患者中的应用。
根据超声和/或锝[99mTc]甲氧基异丁基异腈（sestamibi）扫描发现单个甲状旁腺腺瘤，并通过FNA和甲状旁腺激素（PTH）检测确诊疑似甲状旁腺病变，选择患者进行微创甲状旁腺切除术。术中从甲状腺获取的抽吸物用作阴性对照。
27例患者共进行了56次组织FNA。超声在所有27例患者中均检测到提示甲状旁腺病变的肿块，并进行了31次超声引导下的FNA。未观察到与该操作相关的并发症。术中，25例接受微创甲状旁腺切除术的患者在甲状腺进行了FNA。随后被确认为源于甲状旁腺的病变抽吸物的平均PTH水平为4677±123 pg/ml（范围为3600 - 5000 pg/ml），显著高于甲状腺抽吸物，后者的平均PTH水平为48±7 pg/ml（范围为5 - 57 pg/ml）。超声和sestamibi扫描检测异常甲状旁腺的敏感性分别为88%和77%。超声引导下FNA确诊病变甲状旁腺起源的敏感性为100%。
超声引导下FNA联合PTH检测可安全地用于确认术前超声发现的病变，以选择适合微创甲状旁腺切除术的患者。
