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, 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 surgery. Methods A total of 108 patients who underwent thyroid cancer radical surgery 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 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.

1.	姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 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, 吕纬苓, 陈宏, 等. 优化细针穿刺细胞学技术对甲状腺髓样癌的诊断价值. 中国组织化学与细胞化学杂志, 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.	张磊, 董云伟, 胡神保, 等. 美国癌症联合委员会甲状腺癌分期系统(第8版)修订对甲状腺乳头状癌分期的影响. 中国癌症杂志, 2018, 28(7): 491-496.
8.	张于芝, 丁文波, 武心萍, 等. 细针穿刺洗脱液甲状旁腺激素测定诊断原发性甲状旁腺功能亢进病灶的临床研究. 国际内分泌代谢杂志, 2024, 44(1): 14-18.
9.	Obołończyk Ł, Karwacka I, Wiśniewski 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.	刘瑾, 程若川, 苏艳军, 等. 术中识别甲状旁腺光学技术的研究进展. 中国普外基础与临床杂志, 2019, 26(4): 498-502.
13.	贺晨宇, 姜可伟. 甲状旁腺术中识别技术及临床应用和研究现况. 西安交通大学学报(医学版), 2024, 45(1): 49-54.
14.	李海凤, 纪燕英, 周璐, 等. 甲状旁腺病变细针穿刺标本的临床病理分析. 中山大学学报(医学科学版), 2022, 43(6): 1035-1040.
15.	樊菁, 魏洪亮, 黄美玲, 等. 快速细胞学检测方法术中鉴别与保护甲状旁腺的临床意义. 现代肿瘤医学, 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.	黄海燕, 李浩, 林少建, 等. 甲状腺术中应用抽吸组织测定甲状旁腺激素的临床意义. 中华耳鼻咽喉头颈外科杂志, 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, 牛文强, 等. 细针穿刺洗脱液检测甲状旁腺激素水平在甲状腺癌根治术中的应用研究. 中国现代医学杂志, 2022, 32(1): 91-96.
21.	邹贤, 朱国华, 朱利国, 等. 穿刺洗脱液的甲状旁腺激素检测在甲状腺术中鉴别甲状旁腺的应用. 中国普通外科杂志, 2018, 27(11): 1446-1451.
22.	王松, 张方洁, 代文杰, 等. 甲状腺全切除术后甲状旁腺激素水平变化的相关因素分析. 现代肿瘤医学, 2022, 30(12): 2150-2156.
23.	中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版). 国际内分泌代谢杂志, 2023, 43(2): 149-194.
24.	向俊. 甲状旁腺自体移植术发展历程及展望. 中国实用外科杂志, 2018, 38(6): 687-689,700.
25.	吕春晖, 陈海珍, 沈晓卉, 等. 甲状腺全切除术后甲状旁腺功能减退的相关危险因素分析. 中华普通外科杂志, 2017, 32(10): 863-867.
26.	郝军生. 甲状腺全切术后甲状旁腺功能减退的恢复时间分析(附13例). 现代肿瘤医学, 2020, 28(11): 1867-1869.

1. 姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 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, 吕纬苓, 陈宏, 等. 优化细针穿刺细胞学技术对甲状腺髓样癌的诊断价值. 中国组织化学与细胞化学杂志, 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. 张磊, 董云伟, 胡神保, 等. 美国癌症联合委员会甲状腺癌分期系统(第8版)修订对甲状腺乳头状癌分期的影响. 中国癌症杂志, 2018, 28(7): 491-496.
8. 张于芝, 丁文波, 武心萍, 等. 细针穿刺洗脱液甲状旁腺激素测定诊断原发性甲状旁腺功能亢进病灶的临床研究. 国际内分泌代谢杂志, 2024, 44(1): 14-18.
9. Obołończyk Ł, Karwacka I, Wiśniewski 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. 刘瑾, 程若川, 苏艳军, 等. 术中识别甲状旁腺光学技术的研究进展. 中国普外基础与临床杂志, 2019, 26(4): 498-502.
13. 贺晨宇, 姜可伟. 甲状旁腺术中识别技术及临床应用和研究现况. 西安交通大学学报(医学版), 2024, 45(1): 49-54.
14. 李海凤, 纪燕英, 周璐, 等. 甲状旁腺病变细针穿刺标本的临床病理分析. 中山大学学报(医学科学版), 2022, 43(6): 1035-1040.
15. 樊菁, 魏洪亮, 黄美玲, 等. 快速细胞学检测方法术中鉴别与保护甲状旁腺的临床意义. 现代肿瘤医学, 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. 黄海燕, 李浩, 林少建, 等. 甲状腺术中应用抽吸组织测定甲状旁腺激素的临床意义. 中华耳鼻咽喉头颈外科杂志, 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, 牛文强, 等. 细针穿刺洗脱液检测甲状旁腺激素水平在甲状腺癌根治术中的应用研究. 中国现代医学杂志, 2022, 32(1): 91-96.
21. 邹贤, 朱国华, 朱利国, 等. 穿刺洗脱液的甲状旁腺激素检测在甲状腺术中鉴别甲状旁腺的应用. 中国普通外科杂志, 2018, 27(11): 1446-1451.
22. 王松, 张方洁, 代文杰, 等. 甲状腺全切除术后甲状旁腺激素水平变化的相关因素分析. 现代肿瘤医学, 2022, 30(12): 2150-2156.
23. 中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版). 国际内分泌代谢杂志, 2023, 43(2): 149-194.
24. 向俊. 甲状旁腺自体移植术发展历程及展望. 中国实用外科杂志, 2018, 38(6): 687-689,700.
25. 吕春晖, 陈海珍, 沈晓卉, 等. 甲状腺全切除术后甲状旁腺功能减退的相关危险因素分析. 中华普通外科杂志, 2017, 32(10): 863-867.
26. 郝军生. 甲状腺全切术后甲状旁腺功能减退的恢复时间分析(附13例). 现代肿瘤医学, 2020, 28(11): 1867-1869.

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