Diagnostic pitfalls in parathyroid gland cytology [Dijagnostičke pogreške u citologiji adenoma paratiroidnih žlijezda]

Knežević-Obad, Anka and Tomić-Brzac, Hrvojka and Žarković, Kamelija and Dodig, Damir and Knežević Štromar, Ivana (2010) Diagnostic pitfalls in parathyroid gland cytology [Dijagnostičke pogreške u citologiji adenoma paratiroidnih žlijezda]. Collegium Antropologicum, 34 (1). pp. 25-29. ISSN 0350-6134

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Abstract

The aim of this study is to establish possibilities of using cytology in the diagnosis of parathyroid gland adenoma. 475 patients, all suspected to have parathyroid gland disease, were examined over a three-year period (from 1 of January 2006 to 31 of December 2008) in the Clinical Department of Nuclear Medicine and Radiation Protection, University Hospital Center Zagreb, Croatia. Ultrasound guided fine needle aspiration biopsy (UG-FNAB) of suspected occurrences determined by ultrasound was done. Samples obtained by UG-FNAB were air-dried and stained using the May-Grünwald-Giemsa (MGG) staining procedure. PTH levels were determined in all punctate and sera obtained on the day of UG-FNAB. Samples adequate for cytological analysis were obtained from 288 patients, while 187 punctates did not contain epithelial elements. The parathyroid hormone (PTH) analysis was made for all punctates. The adenoma was diagnosed via morphological characteristics in 71 out of 288 punctates that were proven adequate for cytological analysis. Increased PTH levels were later on established in all diagnosed adenomas. All patients with cytology-based diagnosis of parathyroid gland adenoma were sent to surgery, and the cytological diagnosis was confirmed by pathohistology. In three cases, the parathyroid gland adenoma was established by pathohistology, although in these cases the cytological diagnosis was negative. The cytological diagnosis of parathyroid gland adenoma can be considered reliable in 96% of cases, provided that the echosonographic structure and localisation of the punctured node is noted, and assuming that material adequate for cytological analysis is obtained by FNAB. Possible pitfalls are oncocytic types of parathyroid adenoma, intranuclear inclusions and papillary formation of epithelial cells, and cystic degeneration of nodules. These errors can be avoided by defining the PTH level on the same punctate.

Abstract in Croatian

Cilj ovog rada bio je utvrditi mogućnosti citologije u dijagnostici adenoma paratiroidnih žlijezda. U trogodišnjem periodu (01. siječnja 2006. – 31. prosinca 2008. godine) u Klinici za nuklearnu medicinu i zaštitu od zračenja, KBC Zagreb, pregledano je 475 bolesnika pod sumnjom na bolest paratiroidnih žlijezda. Ultrazvučno suspektne tvorbe su citološki punktirane pod kontrolom ultrazvuka (UZV). Razmazi dobiveni punkcijom sušeni su na zarku i bojeni metodom May-Grünwald-Giemsa (MGG). Adekvatan materijal za citološku analizu dobiven je kod 288 bolesnika, a 187 punktata nije sadržavalo epitelne elemente. Iz svih punktata vršena je analiza PTH. Od 288 punktata adekvatnih za citološku analizu u 71 bolesnika je citološki dijagnosticiran adenom temeljem morfoloških karakteristika. U svih dijagnosticiranih adenoma kasnije je potvrđena i povišena vrijednosti PTH u punktatu. Svi bolesnici sa citološki postavljenom dijagnozom adenoma paratoiroidne žlijezde upućeni su na operativni zahvat te je dijagnoza patohistološki potvrđena. U tri slučaja postavljena je patohistološka dijagnoza adenoma parotidne žlijezde, dok je citološka dijagnoza u tim slučajevima bila negativna. Citološki smo bili u mogućnosti na osnovu bojanja po MGG-u te bojanja na argirofilna zrnca po Grimeliusu dijagnosticirati adenom paratiroidne žlijezde u 96% slučajeva, pa čak i njegove subtipove: onkocitni adenom, atipični adenom i adenom glavnih stanica. Lažno negativnih nalaza je bilo 4% (3 slučaja). Citološku dijagnozu adenoma paretirodne žlijezde moguće je postaviti u 96% slučajeva uz naznaku ehografske strukture i lokalizacije punktiranog čvora te uz pretpostavku da smo punkcijom dobili adekvatan materijal za citološku analizu. Moguće pogreške u dijagnostici su onkocitni adenom, nalaz intranukleranih inkluzija i papilarnih formacija epitelnih stanica te cistična degeneracija čvora. U kombinaciji s nalazom PTH iz istog punktata i te se pogreške mogu izbjeći.

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