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.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a condition characterized by disorders of calcium-phosphate metabolism and bone metabolism caused by pathological overproduction of parathyroid hormone (PTH). The diagnosis of overt PHPT is based on the presence of clinical symptoms and laboratory abnormalities typical of this condition: hypercalcemia, hypercalciuria and elevated iPTH levels. Imaging studies are not used for diagnostic purposes; they are performed to localize the parathyroid glands prior to potential surgical treatment. Technetium 99 m sestamibi scintigraphy (Tc99 m-MIBI) is the gold standard in the assessment of pathologically altered parathyroid glands. Other diagnostic options include cervical ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). Parathyroid biopsy (P-FNAB) with iPTH washout concentration (iPTH-WC) assessment is still an underestimated method of preoperative parathyroid gland localization. Few studies have reported the utility of US-guided P-FNAB in preoperative assessment of parathyroid lesions. The aim of the study was to present our experience with 143 P-FNAB with iPTH-WC assessment. MATERIAL AND METHODS: Laboratory results, US findings, P-FNAB complications and comparison with other imaging techniques were described and analyzed. RESULTS: In 133 (93.0) patients, iPTH washout-to-serum ratio exceeded threshold level 0.5 and were classified as positive results. Median iPTH-WC in this group was 16,856 pg/mL, and the iPTH-WC to serum iPTH ratio was 158. There was no correlation between iPTH-WC and serum PTH, serum calcium, parathyroid gland volume and shape index. In the group of 46 operated patients, 44 demonstrated positive iPTH-WC results, which corresponds to a sensitivity of 95.6%. In Tc99-MIBI, radiotracer retention was found in 17 cases (in 24 MIBI performed), which corresponds to a sensitivity of 52.2%. P-FNAB did not cause any major side effects -92.5% of all patients had no or mild adverse events after this procedure. CONCLUSIONS: P-FNAB with iPTH-WC is a reliable method in parathyroid adenoma localization during PHPT. Its sensitivity for diagnosis of PHPT is much higher than that of Tc99-MIBI, and in some situations, P-FNAB with iPTH-WC may even replace that method. Furthermore, cost-effectiveness of iPTH-WC is at least similar to that of Tc99-MIBI. Complications of P-FNAB are mild and we can describe this method as a safe procedure.

Comparison of perioperative stress in patients undergoing thyroid surgery with and without neuromonitoring-a pilot study.

PURPOSE: A comprehensive psychological comparison of preoperative stress in patients scheduled for thyroidectomy with versus without intraoperative neurophysiologic monitoring (IONM) has never been reported. The aim of this study was to assess whether a planned utilization of IONM had any effect on the reduction of stress and anxiety level before and after thyroid surgery. METHODS: The outcomes of 32 patients scheduled for thyroidectomy with IONM were compared to the outcomes of a carefully matched control group of 39 patients operated on without IONM. All the patients were tested before the surgery and at 1-7 days postoperatively employing psychological self-report instruments: the Depression Anxiety Stress Scales (DASS), State-Trait Anxiety Inventory (STAI), 12-item General Health Questionnaire (GHQ), Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT H&N), and the visual analog scale (VAS). RESULTS: The examined groups were homogenous and carefully matched in terms of mental health (GHQ), the quality of life (FACT H&N), and the intensity of depression level (DASS). The IONM group showed a significantly lower level of "the state anxiety"(STAI) 1 day before the operation (p < 0.05), greater trust in the doctor (VAS) (p < 0.05), and greater confidence in the treatment method (VAS) as compared to the patients in the control group (p < 0.05), while no significant differences were found when the remaining items were compared. CONCLUSIONS: The planned use of IONM during thyroidectomy may reduce patient anxiety before surgery. However, further research in this area is necessary to confirm this preliminary finding in a larger population of patients.

Evaluation of selected cognitive functions before and after surgery for primary hyperparathyroidism.

BACKGROUND AND AIMS: Cognitive functions have been reported to be impaired in patient with primary hyperparathyroidism (pHPT). The aim of this psychological study was to evaluate cognitive disturbances in pHPT in relation to serum calcium levels before and after surgery. PATIENTS AND METHODS: A prospective, case-control study with 1-year follow-up of 35 pHPT patients versus 35 matched controls was undertaken. All patients were tested before surgery and at 12-18 months following surgery with a battery of selected cognitive function psychological tools: Benton Visual Retention Test (BVRT), Wisconsin Card Sorting Test (WCST), Memory Verbal Learning Test (DCS), The Rey's Auditory Verbal Learning Test (RAVLT), Trail Making Test A & B, Verbal Fluency Test, and Beck Depression Inventory. In addition to psychological testing, serum calcium, parathyroid hormone and phosphate levels were evaluated. RESULTS: The following cognitive functions of pHPT patients versus controls were deteriorated before surgery: impaired concentration, decreased nonverbal learning process, difficulties in using direct memory, verbal fluency and visual constructive abilities. However, no correlation was found between serum calcium levels and the results of neuropsychological tests. In longitudinal comparison of pHPT patients before and 1 year after surgery, there was a significant improvement in visual memory, visual-constructive abilities and direct memory. CONCLUSIONS: pHPT patients have significantly decreased concentration level, nonverbal learning process, access to verbal resources and constructional and visual memory ability. Thus, neuropsychological testing may be useful in the decision making for early surgery in patients with mild asymptomatic disease in order to avoid further deterioration of cognitive functions.

The profile of ErbB/Her family genes copy number assessed by real-time PCR in parathyroid adenoma and hyperplasia associated with sporadic primary hyperparathyroidism.

Hyperparathyroidism (pHPT) is a relatively frequent endocrinopathy, however, the molecular mechanisms of its etiology remain poorly understood. This disorder is mainly associated with benign tumours (adenoma) and hyperplasia of the parathyroid, hence, the focus is directed also to genes that are likely to be involved in carcinogenesis. Among such genes are ErbB/Her family genes already used in diagnosis of other tumours (e.g., breast carcinoma) and reported also to play a role in development of endocrine lesions. So far, ErbB-1/Her-1/EGFR expression has been detected in pHPT-associated adenomas and hyperplasia as opposed to no expression in normal parathyroid tissue. Moreover, losses or gains of the fragments of chromosomes where ErbB/Her genes are located have been reported. In this study, the gene dosage of ErbB/Her family genes were determined for the first time in parathyroid adenomas, hyperplasia and morphologically unchanged tissue in order to establish their putative role in the development of the disease. Genomic DNA was isolated from 33 patients with sporadic hyperparathyroidism and the gene copy numbers were assessed using real-time PCR. The ErbB/Her genes' profile was unaltered in most of the examined samples. Two low-level amplifications of ErbB-1/Her-1/EGFR gene, two deletions of ErbB-2/Her-2, and six deletions of ErbB-4/Her-4 were found. The ErbB-3/Her-3 gene remained unaffected. No correlation with clinical parameters was found for any gene. Both the low number of alterations and a lack of their associations with clinical parameters exclude the prognostic value of the ErbB/Her genes family in parathyroid tumourigenesis. Nevertheless, the ErbB-4/Her-4 deletions seem to be interesting for further investigations, especially in the context of PTH secretion.