Przydatność oznaczania stężenia PTH w popłuczynach z igły do biopsji aspiracyjnej cienkoigłowej w identyfikowaniu patologicznych przytarczyc — analiza czynników wpływających na skuteczność tej metody

Abstract

Usefulness of PTH measurements in FNAB washouts in the identification of pathological parathyroids -analysis of the factors that influence the effectiveness of this methodPrzydatność oznaczania stężenia PTH w popłuczynach z igły do biopsji aspiracyjnej cienkoigłowej w identyfikowaniu patologicznych przytarczyc -analiza czynników wpływających na skuteczność tej metody AbstractIntroduction: The aim of this investigation was to assess the usefulness of the measurement of PTH concentration in the material obtained during FNAB (PTH-FNAB) in the identification of pathological parathyroids in patients with frequently coexisting thyroid abnormalities (nodular goitre, chronic thyroiditis, previous thyroidectomy). Additionally, the influence of the size of goitre, parathyroid localisation and size on the results of PTH-FNAB measurement was examined. Material and methods: Fifty patients with primary hyperparathyroidism and sonographically detected focal lesion that was suggestive of parathyroid gland were included in this study. PTH-FNAB results were correlated with the outcome of routine cytological examination and biochemical indices of hyperparathyroidism, SPECT-CT (33 patients) and histopathological examination (20 patients). Results: Positive PTH-FNAB was observed in 80% of patients, and in more than 70% of persons with non-diagnostic smears or smears 'contaminated' with thyroid follicular cells. In the group of operated patients, sensitivity of PTH-FNAB (95.0%) was higher than SPECT-CT (64.3%, p < 0.05). Presence of nodular goitre and/or chronic thyroiditis exerts a two times stronger negative effect on percentage of negative results of SPECT-CT than of PTH-FNAB. On the other hand, lower frequency of positive PTH-FNAB but not SPECT-CT was observed when the thickness of the thyroid was ≥ 20 mm (50% v. 87.5%, p < 0.05) and when the thickness of a lesion suspected of parathyroid pathology was £ 5 mm (66.7% v. 93.3%, p < 0.05). Conclusions: In patients with thyroid abnormalities, PTH-FNAB measurements show advantages over routine biopsy and SPECT-CT in the identification of typically located pathological parathyroids. (Endokrynol Pol 2014; 65 (1): 25-32)

Parathyroid hormone in washout fluid seems to be superior to cytology for localization of the lesion in MIBI-negative patients with primary hyperparathyroidism

“…Maser et al proposed that a PTH level above the normal reference laboratory range was sufficient for diagnosis (18), while Abdelghani et al proposed that the PTH level in washout fluid should be higher than the serum level (20). When small volumes (0.5 or 1 mL) of saline usage for rinsing of the aspirates are taken into account, it can be assumed that the level would be at least 10-20 times lower than the exact value (21). However, in most of the studies PTH levels of washout were hundreds and thousands of times greater than serum PTH levels (3,19,22).…”

Parathyroid fine‐needle aspiration with parathyroid hormone washout as a preoperative localisation of parathyroid adenoma—A retrospective study

“…However, in certain circumstances, the need to further identify the culprit gland, including measurement of high PTH in a lesion suspected as a parathyroid adenoma, becomes relevant. These circumstances include discordant imaging findings, 3–5 challenging anatomy (multinodular goiter or concomitant Hashimoto's thyroiditis), 6–8 intrathyroid adenoma, 9 and a history of neck surgery 5 …”

“…These circumstances include discordant imaging findings, [3][4][5] challenging anatomy (multinodular goiter or concomitant Hashimoto's thyroiditis), [6][7][8] intrathyroid adenoma, 9 and a history of neck surgery. 5 A number of studies showed excellent sensitivity (up to 95%) and positive predictive value (PPV, up to 100%) of PTH washout [10][11][12][13][14][15] ; and provided reassurance regarding the immediate safety of the procedure.…”