Sonographically guided fine needle aspiration with rapid parathyroid hormone assay.
BACKGROUND
Persistent or recurrent primary hyperparathyroidism (1 degrees HPTH) is ideally treated with limited dissection, based on accurate localization, to minimize operative risks. To accurately localize parathyroid tissue, we employed ultrasound-guided fine needle aspiration (US FNA) with an on-site rapid parathyroid hormone (PTH) assay to confirm localization.


METHODS
Of the 272 patients evaluated for 1 degrees HPTH, 34 had persistent or recurrent disease. Standard localization was equivocal in 12, who were referred for US FNA. Suspicious tissue was identified on US and FNA was performed. Analysis with a rapid PTH assay provided on-site result within 12 min. Patients were monitored clinically, and then discharged after observation.


RESULTS
Twelve patients were referred for US FNA; eight were female. Ten patients had persistent disease, one had recurrent, and one had 1 degrees HPTH following thyroidectomy. Two of the 12 were excluded due to negative ultrasound examination. Of the remaining ten, positive aspirates were found in nine, and seven proceeded to surgery. In six patients there was 100% correlation between sonographic and operative findings. The remaining patient had no identifiable adenoma, but PTH normalized after arterial ligation. All patients received a limited directed surgical approach, employing cervical block anesthesia in three. Four were discharged on the day of surgery and all were cured. There was one infectious complication of US FNA.


CONCLUSIONS
The use of rapid PTH assay can be effectively utilized for localization of parathyroid tissue in remedial parathyroid surgery. Confirmation of localization markedly improves subsequent surgery and allows selective use of minimally invasive techniques.
Maser
Christina
C
Department of Surgery, Yale New Haven Hospital, Yale University School of Medicine, 330 Cedar Street, FMB 102, P.O. Box 208062, New Haven, CT 06520-8062, USA.
Donovan
Patricia
P
Santos
Florie
F
Donabedian
Richard
R
Rinder
Christine
C
Scoutt
Leslie
L
Udelsman
Robert
R
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D012008:Recurrence; D018084:Ultrasonography, Interventional
D010281:Parathyroid Hormone