Popowicz Bożena, Klencki Mariusz, Sporny Stanisław, Jankiewicz-Wika Joanna, Komorowski Jan, Pisarek Hanna, Słowińska-Klencka Dorota
Endokrynol Pol. 2014;65(1):25-32. doi: 10.5603/EP.2014.0004.
The aim of this investigation was to assess the usefulness of the measurement of PTH concentration in the material obtained during FNAB (PTH-FNAB) in the identification of pathological parathyroids in patients with frequently coexisting thyroid abnormalities (nodular goitre, chronic thyroiditis, previous thyroidectomy). Additionally, the influence of the size of goitre, parathyroid localisation and size on the results of PTH-FNAB measurement was examined.
Fifty patients with primary hyperparathyroidism and sonographically detected focal lesion that was suggestive of parathyroid gland were included in this study. PTH-FNAB results were correlated with the outcome of routine cytological examination and biochemical indices of hyperparathyroidism, SPECT-CT (33 patients) and histopathological examination (20 patients).
Positive PTH-FNAB was observed in 80% of patients, and in more than 70% of persons with non-diagnostic smears or smears 'contaminated' with thyroid follicular cells. In the group of operated patients, sensitivity of PTH-FNAB (95.0%) was higher than SPECTCT (64.3%, p < 0.05). Presence of nodular goitre and/or chronic thyroiditis exerts a two times stronger negative effect on percentage of negative results of SPECT-CT than of PTH-FNAB. On the other hand, lower frequency of positive PTH-FNAB but not SPECT-CT was observed when the thickness of the thyroid was ≥ 20 mm (50% v. 87.5%, p < 0.05) and when the thickness of a lesion suspected of parathyroid pathology was ≤ 5 mm (66.7% v. 93.3%, p < 0.05).
In patients with thyroid abnormalities, PTH-FNAB measurements show advantages over routine biopsy and SPECT-CT in the identification of typically located pathological parathyroids.
本研究的目的是评估在细针穿刺抽吸活检（FNAB）获取的材料中测量甲状旁腺激素浓度（PTH-FNAB）在鉴别经常合并甲状腺异常（结节性甲状腺肿、慢性甲状腺炎、既往甲状腺切除术）患者的病理性甲状旁腺方面的有用性。此外，还研究了甲状腺肿大小、甲状旁腺定位和大小对PTH-FNAB测量结果的影响。
本研究纳入了50例原发性甲状旁腺功能亢进且超声检测到提示甲状旁腺的局灶性病变的患者。PTH-FNAB结果与常规细胞学检查结果、甲状旁腺功能亢进的生化指标、SPECT-CT（33例患者）及组织病理学检查（20例患者）结果进行相关性分析。
80%的患者PTH-FNAB呈阳性，超过70%涂片诊断不明确或被甲状腺滤泡细胞“污染”的患者PTH-FNAB呈阳性。在接受手术的患者组中，PTH-FNAB的敏感性（95.0%）高于SPECT-CT（64.3%，p<0.05）。结节性甲状腺肿和/或慢性甲状腺炎的存在对SPECT-CT阴性结果百分比的负面影响比对PTH-FNAB的负面影响强两倍。另一方面，当甲状腺厚度≥20mm（50%对87.5%，p<0.05）以及怀疑甲状旁腺病变的病灶厚度≤5mm时（66.7%对93.3%，p<0.05），观察到PTH-FNAB阳性频率较低，但SPECT-CT并非如此。
对于合并甲状腺异常的患者，在鉴别典型定位的病理性甲状旁腺方面，PTH-FNAB测量比常规活检和SPECT-CT更具优势。
