title: Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker?
abstract: OBJECTIVE
  Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical histopathologic features and don't fulfill criteria for carcinoma are classified as atypical adenomas (APA). The purpose of this study was to determine a biochemical or ultrasonographic feature that can predict aggressive disease requiring more extensive surgery and closer follow-up.
  
  
  METHODS
  Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients) or carcinoma (5 patients) were enrolled in this study. The control group consisted of 102 patients operated between the same dates and diagnosed with classical PA. Classical adenomas, atypical adenomas, and carcinomas were compared according to their biochemical and ultrasonographic parameters.
  
  
  RESULTS
  Serum Ca levels were significantly higher in the PC group compared with the APA and classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the APA and carcinoma groups compared to the classical PA group. ROC analysis was made to determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05 pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic appearance were independent predictors for aggressive disease.
  
  
  CONCLUSIONS
  Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally invasive surgery.
authors.affiliation: Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey.
authors.forename: Bekir
authors.initials: B
authors.lastname: Cakir
authors.affiliation: Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey.
authors.forename: Sefika Burcak
authors.initials: SB
authors.lastname: Polat
authors.affiliation: Yildirim Beyazit University, Ataturk Education and Research Hospital, General Surgery Department, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kilic
authors.affiliation: Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey.
authors.forename: Didem
authors.initials: D
authors.lastname: Ozdemir
authors.affiliation: Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey.
authors.forename: Cevdet
authors.initials: C
authors.lastname: Aydin
authors.affiliation: Yildirim Beyazit University, Ataturk Education and Research Hospital, Pathology Department, Ankara, Turkey.
authors.forename: Nuran
authors.initials: N
authors.lastname: Süngü
authors.affiliation: Yildirim Beyazit University, Ataturk Education and Research Hospital, Endocrinology and Metabolism Department, Ankara, Turkey.
authors.forename: Reyhan
authors.initials: R
authors.lastname: Ersoy
mesh_terms: D000236:Adenoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D002118:Calcium / Q000097:blood / Q000652:urine; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D014463:Ultrasonography / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor; D010281:Parathyroid Hormone; D000469:Alkaline Phosphatase; D002118:Calcium