Department of General and Endocrine Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Endokrynol Pol. 2022;73(4):706-711. doi: 10.5603/EP.a2022.0036.
The aim of the work was to evaluate the usefulness of intraoperative determination of parathyroid hormone (PTH) concentration in the fluid of fine-needle biopsy lesions of pathologically parathyroid glands for their identification and evaluation of the effectiveness of surgical treatment of primary hyperparathyroidism (PHP).
The study group comprised 75 patients: 65 women and 10 men, aged 33-78 years (mean 57.5), operated in the years 2019-2020 due to PHP. Seventy-nine biopsies of fine-needle aspiration lesions were assessed intraoperatively as pathological parathyroid glands were collected, and the concentration of PTH was determined in their lavage fluid. The results were compared with a control group of 20 patients operated at that time for various forms of goitre, without concomitant parathyroid disease.
In 79 biopsies, the presence of the parathyroid gland was confirmed 72 times. The concentration of PTH in the biopsy fluid exceeded the value of 5000 pg/mL 70 times, 1 was 3733 pg/mL, and 1 was 1985 pg/mL. Seven times (8.9%), the biopsy was for a colloidal nodule instead of the parathyroid gland. The concentration of PTH in the fluids of these biopsies was low and ranged from 5.3 to 500 pg/mL. In the control group, the concentration of PTH in postoperative thyroid biopsies was low and did not exceed the reference value range of up to 64 pg/mL. Comparison of the results of the study group with the control group shows significantly higher PTH values in parathyroid biopsies compared to biopsies of thyroid specimens (p = 0.017), with a sensitivity of 100% and a specificity of nearly 93%.
Intraoperative determination of PTH concentration in the fluid of fine-needle biopsy lesions with diseased parathyroid glands allows for their identification and evaluation of the effectiveness of surgical treatment of PHP. Testing the concentration of PTH in the biopsy fluid of dissected parathyroid glands is characterized by high sensitivity and specificity of the method. The value of PTH concentration in fluid from parathyroid biopsies does not depend on the cause of PHP.
本研究旨在评估术中测定细针穿刺活检病变甲状旁腺组织液中甲状旁腺激素（PTH）浓度对其识别的有用性，并评价原发性甲状旁腺功能亢进症（PHP）手术治疗的效果。
本研究纳入了 75 名患者：65 名女性和 10 名男性，年龄 33-78 岁（平均 57.5 岁），因 PHP 在 2019-2020 年间接受手术治疗。术中采集了 79 例细针穿刺活检的甲状旁腺病变组织，并测定了其冲洗液中 PTH 浓度。结果与同时期接受各种形式甲状腺肿手术但无甲状旁腺疾病的 20 例患者的对照组进行比较。
在 79 例活检中，72 次证实存在甲状旁腺。70 次活检液中 PTH 浓度超过 5000pg/ml，1 次为 3733pg/ml，1 次为 1985pg/ml。7 次（8.9%）活检为胶体结节而非甲状旁腺。这些活检的 PTH 浓度较低，范围为 5.3-500pg/ml。对照组中，术后甲状腺活检的 PTH 浓度较低，不超过参考值范围，最高不超过 64pg/ml。研究组与对照组的结果比较显示，甲状旁腺活检的 PTH 值明显高于甲状腺标本活检（p=0.017），其敏感性为 100%，特异性为近 93%。
术中测定细针穿刺活检病变甲状旁腺组织液中 PTH 浓度可对其进行识别，并评价 PHP 手术治疗的效果。检测甲状旁腺组织活检液中 PTH 浓度的方法具有较高的敏感性和特异性。甲状旁腺活检液中 PTH 浓度的高低与 PHP 的病因无关。
