Department of Otolaryngology-Head & Neck Surgery, Medical College of Georgia, Augusta, USA.
Am J Otolaryngol. 2011 Nov-Dec;32(6):574-7. doi: 10.1016/j.amjoto.2010.11.013. Epub 2011 Feb 11.
The intraoperative parathyroid hormone (IOPTH) assay is an important tool that facilitates targeted parathyroidectomy and may increase surgical cure rates. We sought to evaluate the utility of a point-of-care assay to distinguish parathyroid adenomas from nonparathyroid tissues, which can sometimes pose a challenge during parathyroidectomy and is commonly achieved with the use of frozen sections. We hypothesized that point-of-care rapid IOPTH assays of needle aspirates from suspected adenomas would be faster and equal in accuracy to frozen sections.
Parathyroid and nonparathyroid lesions were excised, and the tissues were needle aspirated, diluted in saline, and submitted to a rapid IOPTH assay located in the operating room. Frozen sections were simultaneously sent for analysis. The time intervals to result availability were tracked and compared using a paired t test.
Point-of-care IOPTH assays of needle aspirates were available in a mean (±SD) of 11.6 ± 1.5 minutes compared to 18.7 ± 4.0 minutes for frozen sections (P = .005). The findings were concordant 100% of the time for both parathyroid (mean parathyroid hormone [PTH] > 3338.9 pg/mL) and parathyroid tissues (mean PTH = 8.7 pg/mL).
Point-of-care IOPTH assay of needle aspirates is an accurate method of distinguishing parathyroid from nonparathyroid tissues. It is suggested that this would be particularly useful in instances where use of IOPTH is planned for assessment of a drop in serum PTH.
术中甲状旁腺激素（IOPTH）检测是一种重要的工具，可以辅助甲状旁腺切除术，并可能提高手术治愈率。我们旨在评估即时检测在区分甲状旁腺腺瘤与非甲状旁腺组织方面的效用，因为在甲状旁腺切除术期间，有时可能会遇到这种组织难以区分的挑战，而这通常需要使用冰冻切片来实现。我们假设，对疑似腺瘤的针吸物进行即时检测，其速度比冰冻切片更快，准确性相当。
切除甲状旁腺和非甲状旁腺病变，对组织进行针吸，在盐水中稀释，然后提交至手术室中的即时 IOPTH 检测。同时将冰冻切片送检进行分析。通过配对 t 检验，追踪并比较获得结果的时间间隔。
即时检测针吸物的 IOPTH 检测在 11.6 ± 1.5 分钟时即可获得结果，而冰冻切片的结果则需要 18.7 ± 4.0 分钟（P =.005）。即时检测和冰冻切片对所有甲状旁腺（平均甲状旁腺激素[PTH]＞3338.9 pg/mL）和非甲状旁腺组织（平均 PTH = 8.7 pg/mL）的检测结果均完全一致。
即时检测针吸物的 IOPTH 检测是区分甲状旁腺与非甲状旁腺组织的一种准确方法。建议在计划使用 IOPTH 来评估血清 PTH 下降的情况下，使用这种方法。
