Graf Akua, Cochran Craig, Sadowski Samira, Nilubol Naris, Simonds William F, Weinstein Lee S, Chang Richard, Jha Smita
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
J Endocr Soc. 2024 Jan 2;8(1):bvad158. doi: 10.1210/jendso/bvad158. eCollection 2023 Dec 1.
The identification of parathyroid tumor(s) in patients with persistent/recurrent primary hyperparathyroidism (PHPT) is critical for a successful reoperative surgery. If noninvasive studies (ultrasound, computed tomography, magnetic resonance imaging, sestamibi) fail to conclusively localize the tumor, invasive procedures (arteriography and selective venous sampling) are performed.
To describe our experience with invasive studies for parathyroid tumor localization and provide follow-up data on selective arterial hypocalcemic stimulation with central venous sampling, a technique developed at our center.
We identified patients who underwent preoperative invasive testing for localization of parathyroid tumor from 1991 to 2020. The result of each invasive localization study [arteriogram, hypocalcemic stimulation and selective venous sampling (SVS)] was categorized as true-positive, false-positive, and false-negative based on histology and biochemical outcome.
Ninety-four patients with 96 tumor occurrences underwent invasive testing for parathyroid tumor localization. Arteriogram, hypocalcemic stimulation, and SVS accurately localized the tumor in 47 of 94 (50%), 56 of 93 (60%), and 51 of 62 (82%) tumors, respectively. Hypocalcemic stimulation was more likely to correctly localize the tumor when arteriogram showed a blush [37 of 50 (74%) vs 19 of 43 (44%), = .01]. When both arteriogram and hypocalcemic stimulation yielded concordant positive findings, SVS did not change management in the 18 cases in which all 3 were performed. Twelve patients remained with persistent PHPT; all had recurrent disease with multiple affected glands.
Hypocalcemic stimulation is a useful adjunct in patients with PHPT who require invasive localization and can obviate the need for SVS. : NCT04969926.
对于持续性/复发性原发性甲状旁腺功能亢进症（PHPT）患者，甲状旁腺肿瘤的识别对于成功进行再次手术至关重要。如果非侵入性检查（超声、计算机断层扫描、磁共振成像、锝-99m甲氧基异丁基异腈）未能明确肿瘤定位，则需进行侵入性检查（动脉造影和选择性静脉采血）。
描述我们在甲状旁腺肿瘤定位侵入性检查方面的经验，并提供关于选择性动脉低钙刺激联合中心静脉采血的随访数据，这是我们中心开发的一项技术。
我们确定了1991年至2020年期间接受术前侵入性检查以定位甲状旁腺肿瘤的患者。根据组织学和生化结果，将每项侵入性定位检查[动脉造影、低钙刺激和选择性静脉采血（SVS）]的结果分为真阳性、假阳性和假阴性。
94例患者共出现96个肿瘤，均接受了甲状旁腺肿瘤定位的侵入性检查。动脉造影、低钙刺激和SVS分别在94个肿瘤中的47个（50%）、93个肿瘤中的56个（60%）和62个肿瘤中的51个（82%）中准确地定位了肿瘤。当动脉造影显示有造影剂外溢时，低钙刺激更有可能正确定位肿瘤[50个中的37个（74%）对43个中的19个（44%），P = 0.01]。当动脉造影和低钙刺激均得出一致的阳性结果时，在同时进行了所有三项检查的18例病例中，SVS并未改变治疗方案。12例患者仍患有持续性PHPT；所有患者均为复发性疾病，多个腺体受累。
低钙刺激对于需要侵入性定位的PHPT患者是一种有用的辅助手段，并且可以避免进行SVS。试验注册号：NCT04969926。
