Kuzu Fatih, Arpaci Dilek, Cakmak Guldeniz Karadeniz, Emre Ali Ugur, Elri Tarik, Ilikhan Sevil Uygun, Bahadir Burak, Bayraktaoglu Taner
Bulent Ecevit University, Faculty of Medicine, Department of Endocrinology and Metabolism, Zonguldak, Turkey.
Bulent Ecevit University, Faculty of Medicine, Department of General Surgery, Zonguldak, Turkey.
Ann Med Surg (Lond). 2016 Feb 8;6:64-7. doi: 10.1016/j.amsu.2015.12.065. eCollection 2016 Mar.
The accurate identification of hyperfunctioning parathyroid (HP) gland is the only issue for definitive surgical treatment in primary hyperparathyroidism (pHPT). Various imaging and operative techniques have been proposed to confirm the localization of the diseased gland. Nevertheless, none of these methods proved to be the gold standard. The presented study aimed to assess the value of parathyroid hormone assay in preoperative ultrasound guided fine needle aspiration (FNA)-PTH washout fluid to verify the correct localisation for focused parathyroidectomy without intra-operative PTH monitoring.
The retrospective analysis of 57 patients with pHPT who underwent FNA-PTH was conducted from a prospective database. Biochemical assessment together with radiological (ultrasonography) and nuclear (MIBI scan) imaging was reviewed. Associations between FNA-PTH washout values and localization technics were evaluated and compared in terms of operative findings.
Focused parathyroidectomy without intraoperative PTH monitoring was performed to 45 patients with high FNA-PTH values. The median largest diameter of the target parathyroid lesion identified by ultrasonography was 13 mm (range, 6 to 36). The median serum PTH level was 190 pg/mL (range, 78 to 1709; reference range, 15 to 65) whereas the median washout PTH was 2500 pg/mL (range, 480 to 3389). According to operative findings high FNA-PTH levels correctly identified parathyroid adenoma in 40 cases (89% of sensitivity and 100% of specificity and positive predictive value) whereas MIBI scan localized the lesion in 36 of these cases (80% of sensitivity).
The higher level of PTH in preoperative ultrasound guided FNA washout is a considerable data to predict the correct localization of HP, particularly in circumstances of greater values than the serum PTH level. However, although its specificity is high, in cases of coexisting nodular thyroid disease, associated additional HP might be missed at focused parathyroidectomy without PTH monitoring, leading to recurrent disease.
准确识别功能亢进的甲状旁腺（HP）是原发性甲状旁腺功能亢进症（pHPT）确定性手术治疗的唯一关键问题。已提出多种影像学和手术技术来确定病变腺体的位置。然而，这些方法均未被证明是金标准。本研究旨在评估术前超声引导下细针穿刺抽吸（FNA）-PTH冲洗液中甲状旁腺激素检测在无需术中PTH监测的情况下对聚焦甲状旁腺切除术正确定位的价值。
对前瞻性数据库中57例行FNA-PTH的pHPT患者进行回顾性分析。回顾了生化评估以及放射学（超声）和核医学（MIBI扫描）成像。根据手术结果评估并比较FNA-PTH冲洗液值与定位技术之间的关联。
对45例FNA-PTH值高的患者进行了无需术中PTH监测的聚焦甲状旁腺切除术。超声检查确定的目标甲状旁腺病变的最大直径中位数为13mm（范围6至36）。血清PTH水平中位数为190pg/mL（范围78至1709；参考范围15至65），而冲洗液PTH中位数为2500pg/mL（范围480至3389）。根据手术结果，高FNA-PTH水平在40例中正确识别出甲状旁腺腺瘤（敏感性89%，特异性和阳性预测值均为100%），而MIBI扫描在其中36例中定位了病变（敏感性80%）。
术前超声引导下FNA冲洗液中较高水平的PTH是预测HP正确定位的重要数据，特别是在其值高于血清PTH水平的情况下。然而，尽管其特异性较高，但在合并结节性甲状腺疾病的情况下，在无PTH监测的聚焦甲状旁腺切除术中可能会遗漏相关的额外HP，导致疾病复发。
