Karstrup S
Department of Ultrasound, Herlev Hospital, Copenhagen.
Dan Med Bull. 1995 Apr;42(2):175-91.
The conventional treatment of patients with P-HPT is neck-surgery. A variety of imaging techniques has been used for localization of PT. These techniques are most conveniently divided into two categories: noninvasive imaging methods (US, CT, MR, thallium-technetium subtraction scintigraphy) and invasive localization procedures (imaging-guided biopsy/aspiration, parathyroid angiography, parathyroid venous sampling). Employing US it seems possible to localize about 2/3 of PT in patients with P-HPT before initial surgery. Most often, the PT appears as a rounded homogeneous mass with a lower echogenicity than that of the normal thyroid gland. However, the US characteristics may vary. False negative US findings are due to difficulties in detecting very small PT, and the inability to visualize PT localized in areas inaccessible to US. In patients with multinodular goitres the PT might be overlooked. False positive findings are mainly caused by misinterpretation of thyroid nodules as being enlarged parathyroid glands. In order to secure a reliable tissue diagnosis, US guided fine needle biopsies can be performed. Three different techniques were tested and found usable: aspiration biopsy either for PTH-measurement or cytological examination, and tissue biopsy for histological examination. When using aspiration biopsy for PTH-measurements, aspirates from both the suspected parathyroid tissue and from corresponding thyroid tissue are immunochemically analyzed for PTH concentration. A positive PTH-gradient-that is a higher PTH-concentration in the aspirates from the suspected PT-strongly indicates the presence of a PT. The usefulness of this technique may be hampered by accessibility and cost of the PTH-analysis. Cytological discrimination between parathyroid and thyroid cells might be difficult especially in specimens of low cellularity. Cytological examination of parathyroid cells is a method recently introduced in parallel with the possibilities of parathyroid visualization and percutaneous aspiration. Therefore, at present, reliable recognition of parathyroid cells can be expected only from cytologist with special interest and experience in parathyroid cytology. The histological appearance of parathyroid tissue is well known to most pathologists. The histological diagnosis of tissue samples obtained by US guided tissue biopsies is reliable. However, sufficient tissue for examination is obtained only in about half of the cases.(ABSTRACT TRUNCATED AT 400 WORDS)
甲状旁腺功能亢进症（P-HPT）患者的传统治疗方法是颈部手术。多种成像技术已被用于甲状旁腺（PT）的定位。这些技术最方便地分为两类：非侵入性成像方法（超声、CT、磁共振成像、铊-锝减影闪烁显像）和侵入性定位程序（成像引导活检/抽吸、甲状旁腺血管造影、甲状旁腺静脉采血）。运用超声，似乎有可能在初次手术前定位约2/3的P-HPT患者的PT。大多数情况下，PT表现为圆形均匀肿块，回声低于正常甲状腺。然而，超声特征可能会有所不同。超声检查出现假阴性结果是由于难以检测到非常小的PT，以及无法显示位于超声无法到达区域的PT。在患有多结节性甲状腺肿的患者中，PT可能会被忽略。假阳性结果主要是由于将甲状腺结节误判为增大的甲状旁腺所致。为了确保获得可靠的组织诊断，可以进行超声引导下细针活检。测试了三种不同技术并发现可用：用于甲状旁腺激素（PTH）测量或细胞学检查的抽吸活检，以及用于组织学检查的组织活检。当使用抽吸活检进行PTH测量时，对疑似甲状旁腺组织和相应甲状腺组织的抽吸物进行免疫化学分析以检测PTH浓度。阳性的PTH梯度——即疑似PT抽吸物中PTH浓度较高——强烈表明存在PT。该技术的实用性可能会受到PTH分析的可及性和成本的限制。甲状旁腺细胞和甲状腺细胞之间的细胞学鉴别可能很困难，尤其是在细胞数量少的标本中。甲状旁腺细胞的细胞学检查是一种最近随着甲状旁腺可视化和经皮抽吸的可能性而引入的方法。因此，目前，只有对甲状旁腺细胞学有特殊兴趣和经验的细胞学家才能期望可靠地识别甲状旁腺细胞。大多数病理学家都熟知甲状旁腺组织的组织学外观。通过超声引导组织活检获得的组织样本的组织学诊断是可靠的。然而，只有大约一半的病例能获得足够用于检查的组织。（摘要截取自400字）
