Krupinova Julia A, Elfimova Alina R, Rebrova Olga Yu, Voronkova Iya A, Eremkina Anna K, Kovaleva Elena V, Maganeva Irina S, Gorbacheva Anna M, Bibik Ekaterina E, Deviatkin Andrey A, Melnichenko Galina A, Mokrysheva Natalia G
Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation.
Pirogov Russian National Research Medical University, 117997, Ostrovityanova str., 1, Moscow, Russian Federation.
J Pathol Inform. 2022 Aug 27;13:100134. doi: 10.1016/j.jpi.2022.100134. eCollection 2022.
Preoperative diagnosis of parathyroid carcinoma (PC) is critical for the determination of the scope of surgical intervention. Nowadays, specific diagnostic markers for differentiation of PC and benign tumors are unknown, and less than half of patients with PC undergo necessary surgery. The aim of this study was to develop the instrument for preoperative diagnosis of PC.
A multi-center retrospective study included 242 patients with primary hyperparathyroidism: 50 patients with PC, 30 with аtypical adenoma (AA), and 162 with adenoma of the parathyroid glands.
Patients with PC and AA had higher levels of PTH, ionized and albumin-corrected calcium, ALP, volume and the largest diameter of neoplasm, and the higher frequency of GFR decrease less than 60 ml/min/1.73 m compared to patients with adenoma. The frequency of low-energy fractures was higher in the carcinoma group versus the adenoma group (32% vs 8%). Heterogeneous structure and indefinite contour of glands detected by US were more typical for PC than for AA and adenomas. The mathematical model was developed using CatBoost gradient boosting algorithm for the noninvasive preoperative differential diagnosis of PC, AA, and adenoma.
Model can predict adenoma with PPV 100% and PC with PPV 81-92%. Using model clinicians could plan extended resection for PC and selective parathyroidectomy for adenoma. If AA is predicted, he has to make a decision on the choice of the necessary volume of PTE based on his experience, because AA are the zone of uncertainty.
甲状旁腺癌（PC）的术前诊断对于确定手术干预范围至关重要。目前，用于区分PC与良性肿瘤的特异性诊断标志物尚不明确，且不到一半的PC患者接受了必要的手术。本研究的目的是开发PC的术前诊断工具。
一项多中心回顾性研究纳入了242例原发性甲状旁腺功能亢进患者：50例PC患者、30例非典型腺瘤（AA）患者和162例甲状旁腺腺瘤患者。
与腺瘤患者相比，PC和AA患者的甲状旁腺激素（PTH）、离子钙和白蛋白校正钙、碱性磷酸酶（ALP）水平、肿瘤体积和最大直径更高，且肾小球滤过率（GFR）降低至低于60 ml/min/1.73 m²的频率更高。癌组低能量骨折的发生率高于腺瘤组（32%对8%）。超声检测到的腺体结构不均匀和轮廓不明确在PC中比在AA和腺瘤中更典型。使用CatBoost梯度提升算法开发了用于PC、AA和腺瘤的无创术前鉴别诊断的数学模型。
该模型预测腺瘤的阳性预测值（PPV）为100%，预测PC的PPV为81%-92%。使用该模型，临床医生可以为PC规划扩大切除术，为腺瘤规划选择性甲状旁腺切除术。如果预测为AA，由于AA属于不确定区域，临床医生必须根据自己的经验决定所需甲状旁腺切除术的范围。
