Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, M20 4GJ, Manchester, UK.
Langenbecks Arch Surg. 2023 Oct 9;408(1):389. doi: 10.1007/s00423-023-03087-w.
Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity.
We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy.
Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.
尽管在甲状旁腺肿大的生化和放射学鉴定方面取得了进展，但由于散发性多腺体甲状旁腺疾病（MGPD）引起的原发性甲状旁腺功能亢进症（PHPT）仍然是围手术期诊断难题。术前或术中未能识别 MGPD 可能会对手术治愈率产生负面影响，并导致持续的 PHPT 和患者持续发病。
我们对已发表的文献进行了全面回顾，试图确定有助于术前或术中可靠诊断散发性 MGPD 的因素。我们讨论了术前临床特征，并检查了术前和术中的生化和影像学发现，重点关注那些为外科医生和更广泛的多学科内分泌团队提供指示的领域，表明患者患有 MGDP。这可能会改变手术策略。
生化检查可以提供 PHPT 的诊断，但不能可靠地区分甲状旁腺病变。组织病理学有助于区分 MGPD 和腺瘤，但组织学表现可能会重叠。多种阴性影像学检查表明，MGPD 比单个甲状旁腺腺瘤更有可能，但诊断的金标准仍然是在 BNE 期间术中识别。MGPD 仍然是一种难以诊断和治疗的疾病。
