Application research of combined fine needle aspiration cytology smear and eluent detection of PTH in protecting parathyroid gland during radical thyroidectomy for thyroid cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Pingping ¹ ,  ZHANG Yongsheng ² , CUI Jiudong ¹ , ZHANG Wenzhen ¹ , GAO Ping ²

1. Departmet of Breast and Thyroid Surgery, Rizhao Central Hospital, Rizhao, Shandong 276800, P. R. China;
2. Department of Pathology, Rizhao Central Hospital, Rizhao, Shandong 276800, P. R. China;

Corresponding?author：

ZHANG Yongsheng, Email: 45384022@qq.com

Keywords：

thyroid cancer radical surgery; parathyroid gland; fine needle aspiration; washout fluid; parathyroid hormone

DOI：

10.7507/1007-9424.202410002

Video：

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Objective To investigate the clinical value of fine needle aspiration cytology (FNAC) combined with washout fluid detection of parathyroid hormone (PTH) in identifying parathyroid glands during thyroid cancer radical thyroidectomy. Methods A total of 108 patients who underwent thyroid cancer radical thyroidectomy in Rizhao Central Hospital from June 2020 to December 2022 were selected as the study subjects. During the surgery, highly suspected parathyroid tissues were punctured with fine needle aspiration. FNAC and washout fluid were collected for PTH detection. Using the results of postoperative histopathological examination as the gold standard, the accuracy of different methods in identifying parathyroid glands during surgery was analyzed. Results Among the 73 positive cases, the PTH level in the washout fluid was (591.20±84.30) pg/mL, while in the 35 negative cases, it was (18.69±2.53) pg/mL. The PTH level was significantly higher in the positive cases compared to the negative cases (P＜0.05). Postoperative routine histopathological examination confirmed parathyroid tissues in 91 cases, while in 17 cases, they were confirmed as adipose tissues (11 cases) or lymphoid tissues (6 cases). In the 17 cases confirmed as non-parathyroid tissues, both two methods considered them as non-parathyroid tissues. The sensitivity of puncture eluent in detecting PTH was 80.22% (73/91), that of cytological smear was 70.33% (64/91), and that of puncture eluent combined with cytological smear was 94.50% (86/91). There was no significant difference between the sensitivity of puncture cytology smear and puncture eluent in detecting PTH (P＞0.05). The sensitivity of combined detection of the two methods was higher than that of individual detection, and the difference was statistically significant (P<0.05). Conclusion The combined detection of PTH by fine needle puncture smear and eluent can improve the accuracy of identification of parathyroid gland during radical thyroidectomy, and is beneficial to the identification and protection of parathyroid gland during surgery.

Citation： WANG Pingping, ZHANG Yongsheng, CUI Jiudong, ZHANG Wenzhen, GAO Ping. Application research of combined fine needle aspiration cytology smear and eluent detection of PTH in protecting parathyroid gland during radical thyroidectomy for thyroid cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(11): 1370-1375. doi: 10.7507/1007-9424.202410002 Copy

1.	姚一菲, 孫可欣, 鄭榮壽. 《2022全球癌癥統計報告》解讀: 中國與全球對比. 中國普外基礎與臨床雜志, 2024, 31(7): 769-780.
2.	Qin Y, Sun W, Wang Z, et al. A meta-analysis of risk factors for transient and permanent hypocalcemia after total thyroidectomy. Front Oncol, 2021, 10: 614089. doi: 10.3389/fonc.2020.614089.
3.	Ponce de León-Ballesteros G, Velázquez-Fernández D, Hernández-Calderón FJ, et al. Hypoparathyroidism after total thyroidectomy: importance of the intraoperative management of the parathyroid glands. World J Surg, 2019, 43(7): 1728-1735.
4.	Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg, 2014, 101(4): 307-320.
5.	傅杭州, 呂緯苓, 陳宏, 等. 優化細針穿刺細胞學技術對甲狀腺髓樣癌的診斷價值. 中國組織化學與細胞化學雜志, 2020, 29(5): 483-487.
6.	Bian XH, Li SJ, Zhou L, et al. Applicability of rapid intraoperative parathyroid hormone assay through fine needle aspiration to identify parathyroid tissue in thyroid surgery. Exp Ther Med, 2016, 12(6): 4072-4076.
7.	張磊, 董云偉, 胡神保, 等. 美國癌癥聯合委員會甲狀腺癌分期系統(第8版)修訂對甲狀腺乳頭狀癌分期的影響. 中國癌癥雜志, 2018, 28(7): 491-496.
8.	張于芝, 丁文波, 武心萍, 等. 細針穿刺洗脫液甲狀旁腺激素測定診斷原發性甲狀旁腺功能亢進病灶的臨床研究. 國際內分泌代謝雜志, 2024, 44(1): 14-18.
9.	Obo?ończyk ?, Karwacka I, Wi?niewski P, et al. The current role of parathyroid fine-needle biopsy (P-FNAB) with iPTH-washout concentration (iPTH-WC) in primary hyperparathyroidism: a single center experience and literature review. Biomedicines, 2022, 10(1): 123. doi: 10.3390/biomedicines10010123.
10.	Ketha H, Lasho MA, Algeciras-Schimnich A. Analytical and clinical validation of parathyroid hormone (PTH) measurement in fine-needle aspiration biopsy (FNAB) washings. Clin Biochem, 2016, 49(1-2): 16-21.
11.	Zou X, Shi L, Zhu G, et al. Fine-needle aspiration with rapid parathyroid hormone assay to identify parathyroid gland in thyroidectomy. Medicine (Baltimore), 2020, 99(16): e19840. doi: 10.1097/MD.0000000000019840.
12.	劉瑾, 程若川, 蘇艷軍, 等. 術中識別甲狀旁腺光學技術的研究進展. 中國普外基礎與臨床雜志, 2019, 26(4): 498-502.
13.	賀晨宇, 姜可偉. 甲狀旁腺術中識別技術及臨床應用和研究現況. 西安交通大學學報(醫學版), 2024, 45(1): 49-54.
14.	李海鳳, 紀燕英, 周璐, 等. 甲狀旁腺病變細針穿刺標本的臨床病理分析. 中山大學學報(醫學科學版), 2022, 43(6): 1035-1040.
15.	樊菁, 魏洪亮, 黃美玲, 等. 快速細胞學檢測方法術中鑒別與保護甲狀旁腺的臨床意義. 現代腫瘤醫學, 2018, 26(7): 1020-1023.
16.	Perrier ND, Ituarte P, Kikuchi S, et al. Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification. World J Surg, 2000, 24(11): 1319-1322.
17.	Xia W, Zhang J, Shen W, et al. A rapid intraoperative parathyroid hormone assay based on the immune colloidal gold technique for parathyroid identification in thyroid surgery. Front Endocrinol (Lausanne), 2021, 11: 594745. doi: 10.3389/fendo.2020.594745.
18.	黃海燕, 李浩, 林少建, 等. 甲狀腺術中應用抽吸組織測定甲狀旁腺激素的臨床意義. 中華耳鼻咽喉頭頸外科雜志, 2013, 48(11): 934-938.
19.	Lamont JP, McCarty TM, Kuhn JA. Validation study of intraoperative fine-needle aspiration of parathyroid tissue with measurement of parathyroid hormone levels using the rapid intraoperative assay. Proc (Bayl Univ Med Cent), 2005, 18(3): 214-216.
20.	徐元兵, 潘代, 牛文強, 等. 細針穿刺洗脫液檢測甲狀旁腺激素水平在甲狀腺癌根治術中的應用研究. 中國現代醫學雜志, 2022, 32(1): 91-96.
21.	鄒賢, 朱國華, 朱利國, 等. 穿刺洗脫液的甲狀旁腺激素檢測在甲狀腺術中鑒別甲狀旁腺的應用. 中國普通外科雜志, 2018, 27(11): 1446-1451.
22.	王松, 張方潔, 代文杰, 等. 甲狀腺全切除術后甲狀旁腺激素水平變化的相關因素分析. 現代腫瘤醫學, 2022, 30(12): 2150-2156.
23.	中華醫學會內分泌學分會, 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南(第二版). 國際內分泌代謝雜志, 2023, 43(2): 149-194.
24.	向俊. 甲狀旁腺自體移植術發展歷程及展望. 中國實用外科雜志, 2018, 38(6): 687-689, 700.
25.	呂春暉, 陳海珍, 沈曉卉, 等. 甲狀腺全切除術后甲狀旁腺功能減退的相關危險因素分析. 中華普通外科雜志, 2017, 32(10): 863-867.
26.	郝軍生. 甲狀腺全切術后甲狀旁腺功能減退的恢復時間分析(附13例). 現代腫瘤醫學, 2020, 28(11): 1867-1869.

1. 姚一菲, 孫可欣, 鄭榮壽. 《2022全球癌癥統計報告》解讀: 中國與全球對比. 中國普外基礎與臨床雜志, 2024, 31(7): 769-780.
2. Qin Y, Sun W, Wang Z, et al. A meta-analysis of risk factors for transient and permanent hypocalcemia after total thyroidectomy. Front Oncol, 2021, 10: 614089. doi: 10.3389/fonc.2020.614089.
3. Ponce de León-Ballesteros G, Velázquez-Fernández D, Hernández-Calderón FJ, et al. Hypoparathyroidism after total thyroidectomy: importance of the intraoperative management of the parathyroid glands. World J Surg, 2019, 43(7): 1728-1735.
4. Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg, 2014, 101(4): 307-320.
5. 傅杭州, 呂緯苓, 陳宏, 等. 優化細針穿刺細胞學技術對甲狀腺髓樣癌的診斷價值. 中國組織化學與細胞化學雜志, 2020, 29(5): 483-487.
6. Bian XH, Li SJ, Zhou L, et al. Applicability of rapid intraoperative parathyroid hormone assay through fine needle aspiration to identify parathyroid tissue in thyroid surgery. Exp Ther Med, 2016, 12(6): 4072-4076.
7. 張磊, 董云偉, 胡神保, 等. 美國癌癥聯合委員會甲狀腺癌分期系統(第8版)修訂對甲狀腺乳頭狀癌分期的影響. 中國癌癥雜志, 2018, 28(7): 491-496.
8. 張于芝, 丁文波, 武心萍, 等. 細針穿刺洗脫液甲狀旁腺激素測定診斷原發性甲狀旁腺功能亢進病灶的臨床研究. 國際內分泌代謝雜志, 2024, 44(1): 14-18.
9. Obo?ończyk ?, Karwacka I, Wi?niewski P, et al. The current role of parathyroid fine-needle biopsy (P-FNAB) with iPTH-washout concentration (iPTH-WC) in primary hyperparathyroidism: a single center experience and literature review. Biomedicines, 2022, 10(1): 123. doi: 10.3390/biomedicines10010123.
10. Ketha H, Lasho MA, Algeciras-Schimnich A. Analytical and clinical validation of parathyroid hormone (PTH) measurement in fine-needle aspiration biopsy (FNAB) washings. Clin Biochem, 2016, 49(1-2): 16-21.
11. Zou X, Shi L, Zhu G, et al. Fine-needle aspiration with rapid parathyroid hormone assay to identify parathyroid gland in thyroidectomy. Medicine (Baltimore), 2020, 99(16): e19840. doi: 10.1097/MD.0000000000019840.
12. 劉瑾, 程若川, 蘇艷軍, 等. 術中識別甲狀旁腺光學技術的研究進展. 中國普外基礎與臨床雜志, 2019, 26(4): 498-502.
13. 賀晨宇, 姜可偉. 甲狀旁腺術中識別技術及臨床應用和研究現況. 西安交通大學學報(醫學版), 2024, 45(1): 49-54.
14. 李海鳳, 紀燕英, 周璐, 等. 甲狀旁腺病變細針穿刺標本的臨床病理分析. 中山大學學報(醫學科學版), 2022, 43(6): 1035-1040.
15. 樊菁, 魏洪亮, 黃美玲, 等. 快速細胞學檢測方法術中鑒別與保護甲狀旁腺的臨床意義. 現代腫瘤醫學, 2018, 26(7): 1020-1023.
16. Perrier ND, Ituarte P, Kikuchi S, et al. Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification. World J Surg, 2000, 24(11): 1319-1322.
17. Xia W, Zhang J, Shen W, et al. A rapid intraoperative parathyroid hormone assay based on the immune colloidal gold technique for parathyroid identification in thyroid surgery. Front Endocrinol (Lausanne), 2021, 11: 594745. doi: 10.3389/fendo.2020.594745.
18. 黃海燕, 李浩, 林少建, 等. 甲狀腺術中應用抽吸組織測定甲狀旁腺激素的臨床意義. 中華耳鼻咽喉頭頸外科雜志, 2013, 48(11): 934-938.
19. Lamont JP, McCarty TM, Kuhn JA. Validation study of intraoperative fine-needle aspiration of parathyroid tissue with measurement of parathyroid hormone levels using the rapid intraoperative assay. Proc (Bayl Univ Med Cent), 2005, 18(3): 214-216.
20. 徐元兵, 潘代, 牛文強, 等. 細針穿刺洗脫液檢測甲狀旁腺激素水平在甲狀腺癌根治術中的應用研究. 中國現代醫學雜志, 2022, 32(1): 91-96.
21. 鄒賢, 朱國華, 朱利國, 等. 穿刺洗脫液的甲狀旁腺激素檢測在甲狀腺術中鑒別甲狀旁腺的應用. 中國普通外科雜志, 2018, 27(11): 1446-1451.
22. 王松, 張方潔, 代文杰, 等. 甲狀腺全切除術后甲狀旁腺激素水平變化的相關因素分析. 現代腫瘤醫學, 2022, 30(12): 2150-2156.
23. 中華醫學會內分泌學分會, 中華醫學會外科學分會甲狀腺及代謝外科學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南(第二版). 國際內分泌代謝雜志, 2023, 43(2): 149-194.
24. 向俊. 甲狀旁腺自體移植術發展歷程及展望. 中國實用外科雜志, 2018, 38(6): 687-689, 700.
25. 呂春暉, 陳海珍, 沈曉卉, 等. 甲狀腺全切除術后甲狀旁腺功能減退的相關危險因素分析. 中華普通外科雜志, 2017, 32(10): 863-867.
26. 郝軍生. 甲狀腺全切術后甲狀旁腺功能減退的恢復時間分析(附13例). 現代腫瘤醫學, 2020, 28(11): 1867-1869.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application research of combined fine needle aspiration cytology smear and eluent detection of PTH in protecting parathyroid gland during radical thyroidectomy for thyroid cancer

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