Abstract
The aim of the present study was to elucidate the diagnostic and prognostic implications of parafibromin immunohistochemistry (IHC) in parathyroid carcinoma (PC). We performed a meta-analysis to examine the rate of loss of parafibromin expression from 18 eligible studies. In addition, a diagnostic test accuracy review was conducted to investigate the diagnostic role of parafibromin in PC. The rates of loss of parafibromin expression were 0.522 (95% CI: 0.444–0.599), 0.291 (95% CI: 0.207–0.391), 0.027 (95% CI: 0.011–0.064), and 0.032 (95% CI: 0.008–0.119) in PC, atypical parathyroid adenoma (APA), parathyroid adenoma (PA), and parathyroid hyperplasia, respectively. In the diagnostic test accuracy review for diagnosis of PC, the pooled sensitivity and specificity of parafibromin IHC was 0.53 (95% CI: 0.46–0.59) and 0.96 (95% CI: 0.95–0.97), respectively. The diagnostic odds ratio and the area under curve on summary receiver operating characteristic curve was 25.31 (95% CI: 8.91–71.87) and 0.7954, respectively. In addition, the meta-analysis demonstrated that loss of parafibromin expression was significantly correlated with worse disease-free survival (hazard ratio: 2.832; 95% CI: 1.081–7.421). Loss of parafibromin IHC expression was significantly higher in PC than in APA, PA, and parathyroid hyperplasia. Parafibromin IHC could be useful for diagnosis and prediction of prognosis of PC in daily practice.
Highlights
Parathyroid carcinoma (PC) is a rare tumor amongst parathyroid tumors, which represents less than 1% of all cases [1]
We investigated the loss of parafibromin IHC expression in PC and compared this with various parathyroid lesions
Relevant articles were identified by a search of the PubMed and MEDLINE databases through 30 June 2018 using the key words ‘parathyroid’ and ‘parafibromin.’ The titles and abstracts of the articles were screened for exclusion
Summary
Parathyroid carcinoma (PC) is a rare tumor amongst parathyroid tumors, which represents less than 1% of all cases [1]. Histologic diagnostic criteria for PC include invasion into surrounding tissues, capsular invasion, perineural invasion, and vascular invasion [1,2,3]. Cytological features, such as nuclear monotony, nucleoli, abnormal mitoses, are helpful for differentiation of PC from other parathyroid lesions [1,2,3]. Atypical parathyroid adenoma (APA) is a tumor with atypical cytological and architectural features, which does not fulfill the criteria for PC. Fine-needle aspiration is not suitable method for differentiation between a benign and malignant tumor. It may be difficult to differentiate between PC and APA
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