EFFECTIVENESS OF INTRAOPERATIVE EXPRESS-HISTOLOGICAL INVESTIGATION FOR DETECTION OF ADENOMAS OF THE PARATHYROID GLANDS IN ASYMPTOMATIC «NON-CLASSIC» FORMS OF PRIMARY HYPERPARATHYROISIS

Karachentsev Y.I., Dubovyk V.M., Gopkalova I.V., Khaziev V.V., Sokolova S.S., Sazonov M.E., Gerasimenko L.V

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The main goal of our work was to evaluate the effectiveness of intraoperative rapid histological examination (RHE) for the diagnosis of parathyroid adenomas in asymptomatic forms of primary hyperparathyroidism. A comparative analysis of intraoperative RHE with a final histological examination was performed in 25 patients with parathyroid neoplasms that were detected accidentally during surgery for thyroid disease. Diagnosis of «single-node goiter» before surgery was made in 11 patients, «multinodular goiter» (MG) in 9 patients, recurrence of diffuse toxic goiter in one, recurrence of nodular goiter in two 2, follicular neoplasia in one, thyroid cancer in one. The mean age of the operated patients ranged between 22 and 69 years, and was (53,7±2.41) years. There were 23 women and 2 men (11,5:1 male to female ratio). Most parathyroid adenomas were found in patients aged 51 to 60 years. The level of total calcium was (2,46±0,076) mmol/l, which corresponds to normocalcemia. The volume removed parathyroid adenomas was (2,39±0,492) cm3 . Correlation analysis did not reveal a significant relationship between the level of total calcium in the blood and the volume of removed thyroid adenomas (R=0,190, P>0,05). According to the results of comparative analysis of rapid intraoperative histological examination with the final histological examination, the different effectiveness of intraoperative RHE for the detection of parathyroid adenomas was determined. In the diagnosis of single-node goiter proved 100 % feasibility of intraoperative RHE, in multinodular goiter, recurrence of nodular goiter and thyroid cancer, the efficiency of RHE ranged from 33,3 to 88,8 %. It was recommended in the detection or assumption of the presence of parathyroid adenoma, according to RHE, intraoperative revision of all areas of possible localization of the parathyroid glands during surgery for thyroid disease.

intraoperative rapid histological examination, parathyroid neoplasm, hyperparathyroidism

1. Khan A, Hanley D, Rizzoli R, Bollerslev J, Young J, Rejnmark L, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1–19. DOI: 10.1007/s00198–016–3716–2.
2. Clarke BL. Asymptomatic Primary Hyperparathyroidism, in Parathyroid Disorders. Front Horm Res. Basel Karger. 2019;51:13–22. DOI: https://doi.org/10.1159/000491035.
3. Cusano, NE, Maalouf NM, Wang PY, Zhang C, Cremers SC, Haney EM, et al. Normocalcemic hyperparathyroidism and hypoparathyroidism in two community-based nonreferral populations. The Journal of Clinical Endocrinology & Metabolism. 2013;98(7):2734–2741. DOI: 10.1210/jc. 2013–1300.
4. Bilezikian JP, Bandeira L, Khan A, Cusano N. Hyperparathyroidism. Lancet. 2018 Jan 13;391(10116):168–178. DOI: 10.1016/S 0140–6736(17)31430–7.
5. Julie AS. How Best to Approach Surgery for Primary Hyperparathyroidism -Can We All Agree? JAMA Surg. 2016;151(10):969. DOI: 10.1001/jamasurg. 2016.2360.
6. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016 Oct 1;151(10):959–968. DOI: 10.1001/ jamasurg.2016.2310.
7. NICE. Hyperparathyroidism (primary): diagnosis, assessment and initial management. NICE guideline; 2019. Available from: www. nice.org.uk/ guidance/ng132.
8. Obiarinze R, Chen H, Lindeman B, Fazendin J, Ramonell KM. Parathyroid Imaging Practices for Primary Hyperparathyroidism Without Previous Operations Among Endocrine Surgery Program Directors. Am Surg. 2021 May 31;31348211023440. DOI: 10.1177/00031348211023440.
9. Šiprová H, Fryšák Z. Souček mprimary hyperparathyroidism, with a focus on management of the normocalcemic form: to treat or not to treat? Endocr Pract. 2016 Mar;22(3):294–301. DOI: 10.4158/EP15704.OR.
10. Romanchishen A, Matveeva 3. Sochetanie zabolevaniy schitovidnoy zhelezyi i bessimptomnyih adenom okoloschitovidnyih zhelez. Vestnik hirurgii. 2006;165(1):40–2. [in Russian].
11. Erbil Y, Barbaros U, Yanik BT, Salmaslioğlu A, Tunaci M, Adalet I, et al. Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas. Laryngoscope. 2006;116(4):580–5. DOI: 10.1097/01.MLG.0000203411.53666. AD.
12. Romanchishen A, Matveeva 3. Klinicheskie proyavleniya giperparatireoza i razmeryi opuholey okoloschitovidnyih zhelez. Vestnik hirurgii im Grekova. 2006;165(2):37–41. [in Russian].
13. Kamali D, Sharpe A, Nagarajan S, Elsaify W. Non-functioning parathyroid adenoma: a rare differential diagnosis for vocal-cord paralysis. Ann R Coll Surg Engl. 2016 Jul; 98(6):94–6. DOI: 10.1308/rcsann.2016.0137.

«Bulletin of problems biology and medicine» Issue 2 Part 1 (164), 2022 year, 174-183 pages, index UDK 616.441, 616.447–008.6:616–07

10.29254/2077-4214-2022-2-1-164-174-183