甲状旁腺激素在甲状旁腺功能亢进症患者中的原位测量：179 例患者的单中心经验。

Parathyroid hormone in situ measurement in patients with hyperparathyroidism: single-centre experience of 179 patients.

机构信息

Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France.

Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Le Kremlin-Bicêtre, France.

出版信息

Eur J Endocrinol. 2022 Mar 8;186(4):489-501. doi: 10.1530/EJE-21-1249.

DOI:10.1530/EJE-21-1249

PMID:35167489

Abstract

CONTEXT

The measurement of parathyroid hormone(PTH) in situ (PTHis) by fine-needle aspiration (FNA) has been proposed as a tool to preoperatively help localize parathyroid glands detected on ultrasound. However, the accuracy of PTHis is highly variable according to the few available studies.

AIM

We aimed to develop and validate the PTHis procedure and assessed the performance of PTHis in a large series of patients with hyperparathyroidism and/or undetermined cervical lesions.

PATIENTS AND METHODS

The technique set-up consisted of PTHis measurement in thyroid samples from patients with thyroid nodules and patients with high circulating PTH levels (tertiary hyperparathyroidism). Consecutive patients were recruited at one tertiary referral centre from 2017 to 2020 and submitted to ultrasound-guided FNA-PTHis determination.

RESULTS

During the method set-up, we obtained undetectable PTHis levels in all non-parathyroid tissues after sample dilutions. PTHis was higher in patients with hyperparathyroidism (n = 145; 1817 ± 3739 ng/L; range: <4.6-31 140) than in those with thyroid or undetermined cervical lesions (n= 34; <4.6 ng/mL; P < 0.0001). When evaluating PTHis performance in histologically proven samples (158 lesions from 121 patients), PTHis was detectable in 85/97 parathyroid lesions (87%; range: 22-31;140 ng/L) and undetectable in all non-parathyroid lesions (n = 61; P < 0.0001). The specificity and positive predictive value were 100%, and the sensitivity was 87.6%. False-negative lesions (n= 12) were smaller (9.4 ± 5.9 mm) and more often consisted of hyperplasias (75%) than true-positive lesions (16.1 ± 8.4 mm and 33%, P = 0.009 and P = 0.0089, respectively). The method was safe and well tolerated. Four educational cases are also provided.

CONCLUSIONS

PTHis determination is a safe and well-tolerated procedure that enhances the specificity of ultrasound-detected lesions. If accurately set-up, it confirms the parathyroid origin of uncharacterized cervical lesions.

摘要

背景

通过细针抽吸（FNA）进行甲状旁腺激素（PTH）的原位测量（PTHis）已被提议作为一种工具，用于术前帮助定位在超声上检测到的甲状旁腺。然而，根据少数可用的研究，PTHis 的准确性差异很大。

目的

我们旨在开发和验证 PTHis 程序，并在大量患有甲状旁腺功能亢进症和/或颈部不确定病变的患者中评估 PTHis 的表现。

患者和方法

该技术方案包括对甲状腺结节患者和循环中 PTH 水平升高的患者（三级甲状旁腺功能亢进症）的甲状腺样本进行 PTHis 测量。在一个三级转诊中心，连续患者于 2017 年至 2020 年被招募并接受超声引导下 FNA-PTHis 测定。

结果

在方法建立过程中，在对样本进行稀释后，我们在所有非甲状旁腺组织中均未检测到 PTHis 水平。患有甲状旁腺功能亢进症的患者（n = 145；1817 ± 3739 ng/L；范围：<4.6-31140）的 PTHis 水平高于甲状腺或颈部不确定病变的患者（n= 34；<4.6 ng/mL；P < 0.0001）。当评估在组织学上证实的样本（来自 121 名患者的 158 个病变）中的 PTHis 表现时，在 97 个甲状旁腺病变中的 85 个（87%；范围：22-31；140ng/L）中可检测到 PTHis，而在所有非甲状旁腺病变中（n = 61）均不可检测到（P < 0.0001）。特异性和阳性预测值均为 100%，敏感性为 87.6%。假阴性病变（n= 12）较小（9.4 ± 5.9 mm）且更常为增生（75%），而非真阳性病变（16.1 ± 8.4 mm 和 33%）（P = 0.009 和 P = 0.0089）。该方法安全且耐受良好。还提供了四个教育案例。