1st Department of Surgery, Semmelweis University, Ulloi út 78, 1082, Budapest, Hungary.
World J Surg. 2010 Mar;34(3):538-43. doi: 10.1007/s00268-009-0351-5.
Exact tissue identification during parathyroidectomy is essential to successfully cure hyperparathyroidism. PTH level determination from tissue aspirates has been advocated as a "biochemical frozen section" for parathyroid tissue identification. We investigated the sensitivity and specificity of this method in a large cohort of consecutive patients who underwent parathyroidectomy in a tertiary referral center.
PTH levels of 359 tissue aspirates were measured intraoperatively in 223 consecutive patients from March 2006 to December 2008. Suspected parathyroid and control tissues were aspirated with a standardized technique immediately after their excision. Samples were processed for quick-PTH assay with peripheral blood samples before and after excision. PTH levels from tissue aspirates were correlated with pathological diagnosis. The Mann-Whitney test was used to determine statistical significance (P < 0.05).
A total of 255 parathyroid (196 adenoma, 30 hyperplasia, 4 carcinoma, 25 normal parathyroid) and 104 nonparathyroid tissue (88 thyroid, 16 lymph node, thymus, or fat) aspirates were compared. A highly significant difference was found between PTH levels of parathyroid (8,120 +/- 2,711 pg/ml; interquartile range (IQR): 4,949-9,075) and nonparathyroid (0.8 +/- 9.29 pg/ml; IQR: 0.4-1.4) tissue aspirates (P < 0.005). This test is 100% sensitive and 100% specific to identify parathyroid tissue for values >84 pg/ml. Furthermore, PTH levels of pathological parathyroid aspirates (8,169 +/- 2,597; IQR: 5,634-9,109) were higher than that of normal parathyroid aspirates (4,130 +/- 2,952; IQR: 2,569-8,284; P = 0.0011).
PTH level determination from tissue aspirates is a highly reliable, quick, and simple method to differentiate parathyroid and nonparathyroid tissues during parathyroidectomy. This method can obviate frozen sections in patients undergoing surgery for hyperparathyroidism.
甲状旁腺切除术过程中准确的组织鉴定对于成功治愈甲状旁腺功能亢进症至关重要。甲状旁腺组织抽吸物中的 PTH 水平测定已被倡导作为甲状旁腺组织鉴定的“生化冷冻切片”。我们在一个三级转诊中心连续进行甲状旁腺切除术的大量患者中调查了这种方法的敏感性和特异性。
2006 年 3 月至 2008 年 12 月期间，对 223 例连续患者的 359 个组织抽吸物进行了术中测量。在切除后立即使用标准化技术抽吸疑似甲状旁腺和对照组织。在切除前后用外周血样本进行快速 PTH 测定。将组织抽吸物中的 PTH 水平与病理诊断相关联。使用 Mann-Whitney 检验确定统计学意义（P < 0.05）。
共比较了 255 个甲状旁腺（196 个腺瘤、30 个增生、4 个癌、25 个正常甲状旁腺）和 104 个非甲状旁腺组织（88 个甲状腺、16 个淋巴结、胸腺或脂肪）抽吸物。发现甲状旁腺（8,120 +/- 2,711 pg/ml；四分位距（IQR）：4,949-9,075）和非甲状旁腺（0.8 +/- 9.29 pg/ml；IQR：0.4-1.4）组织抽吸物之间的 PTH 水平有非常显著差异（P < 0.005）。该检测对 >84 pg/ml 的甲状旁腺组织具有 100%的敏感性和特异性。此外，病理甲状旁腺抽吸物的 PTH 水平（8,169 +/- 2,597；IQR：5,634-9,109）高于正常甲状旁腺抽吸物（4,130 +/- 2,952；IQR：2,569-8,284；P = 0.0011）。
甲状旁腺组织抽吸物中的 PTH 水平测定是一种高度可靠、快速且简单的方法，可在甲状旁腺切除术期间区分甲状旁腺和非甲状旁腺组织。该方法可避免甲状旁腺功能亢进症患者手术中的冷冻切片。
