Ozderya Aysenur, Temizkan Sule, Cetin Kenan, Ozugur Sule, Gul Aylin Ege, Aydin Kadriye
Endocr Pract. 2017 Sep;23(9):1101-1106. doi: 10.4158/EP171921.OR. Epub 2017 Jul 6.
This study aimed to evaluate the results of parathyroid hormone (PTH) assay in parathyroid aspirates to determine uniglandular disease by an endocrinologist-performed ultrasound (US) in patients with discordant or negative technetium-sestamibi scans and to evaluate whether this procedure increases the number of focused parathyroidectomies (FPs).
We analyzed the data of 65 patients who underwent an endocrinologist-performed US-guided parathyroid fine-needle aspiration (FNA) with PTH wash-out, retrospectively. The results of PTH wash-out procedure and the reports of parathyroid surgery and pathology were reviewed.
Of 65 patients, 54 had positive PTH wash-out results. The median serum PTH level of patients with positive and negative PTH wash-out results was 143 (25 and 75% interquartile range [IQR], 114 to 197) versus 154 (IQR, 115 to 255) pg/mL (P = .45), and the median PTH in FNA was 3,533 (IQR, 1,481 to 3,534) versus 6.0 (IQR, 1 to 6) pg/mL (P<.001), respectively. Forty-five patients underwent surgery. Of the operated patients, 42 had positive PTH wash-out results and had successful FP. Four patients with redo surgery had positive PTH wash-out results and were successfully re-operated with FP. Of 11 patients with negative PTH wash-out results, 3 had bilateral neck exploration (BNE) surgery and 2 patients were successfully operated, while surgery was unsuccessful in 1 patient, despite BNE.
Our study results suggest that endocrinologist-performed US and parathyroid FNA with PTH wash-out increases the number and success of FPs. In particular, patients with redo surgery may benefit from this procedure.
4D-CT = four-dimensional computed tomography BNE = bilateral neck exploration FNA = fine-needle aspiration FNAB = fine-needle aspiration biopsy FP = focused parathyroidectomy IQR = 25 and 75% inter-quartile range PHPT = primary hyperparathyroidism PPV = positive predictive value PTH = parathyroid hormone Tc = technetium US = ultrasound.
本研究旨在评估甲状旁腺细针穿刺抽吸物中甲状旁腺激素（PTH）检测结果，以确定在锝- sestamibi扫描结果不一致或为阴性的患者中，由内分泌科医生进行的超声（US）检查诊断的单腺体疾病，并评估该操作是否会增加聚焦甲状旁腺切除术（FP）的数量。
我们回顾性分析了65例接受内分泌科医生进行的US引导下甲状旁腺细针穿刺抽吸（FNA）并进行PTH洗脱的患者的数据。回顾了PTH洗脱程序的结果以及甲状旁腺手术和病理报告。
65例患者中，54例PTH洗脱结果为阳性。PTH洗脱结果阳性和阴性患者的血清PTH水平中位数分别为143（四分位间距[IQR] 25%和75%，114至197）与154（IQR，115至255）pg/mL（P = 0.45），FNA中的PTH中位数分别为3533（IQR，1481至3534）与6.0（IQR，1至6）pg/mL（P<0.001）。45例患者接受了手术。在接受手术的患者中，42例PTH洗脱结果为阳性且FP手术成功。4例再次手术的患者PTH洗脱结果为阳性，再次FP手术成功。在11例PTH洗脱结果为阴性的患者中，3例接受了双侧颈部探查（BNE）手术，2例手术成功，1例尽管进行了BNE手术但手术未成功。
我们的研究结果表明，内分泌科医生进行的US检查和带PTH洗脱的甲状旁腺FNA增加了FP的数量和成功率。特别是再次手术的患者可能从该操作中获益。
4D-CT = 四维计算机断层扫描；BNE = 双侧颈部探查；FNA = 细针穿刺抽吸；FNAB = 细针穿刺活检；FP = 聚焦甲状旁腺切除术；IQR = 四分位间距25%和75%；PHPT = 原发性甲状旁腺功能亢进症；PPV = 阳性预测值；PTH = 甲状旁腺激素；Tc = 锝；US = 超声
