Utility of ultrasound-guided fine-needle aspiration of parathyroid adenomas for localization before minimally invasive parathyroidectomy.
OBJECTIVE
To determine the sensitivity and specificity of ultrasound (US)-guided fine-needle aspiration (FNA) and measurement of parathyroid hormone (PTH) in the aspirate (FNA/PTH) as a preoperative localization procedure.


METHODS
The study group consisted of 34 consecutive patients with primary hyperparathyroidism. The FNA/PTH estimations in these patients were compared with those from 13 proven thyroid nodules. All patients underwent US study of the neck, which suggested the presence of a solitary adenoma in 30 patients and of hyperplasia in 2; no adenoma or hyperplasia could be visualized in 2 patients. Thirty-two patients underwent FNA/PTH, which yielded a mean PTH level of 22,060.0 +/- 6,653.0 pg/mL. This result was significantly different (P<0.001) from the mean PTH level in 13 thyroid nodules (9.0 +/- 1.0 pg/mL).


RESULTS
On the basis of the FNA/PTH results, 28 patients with suspected adenomas underwent minimally invasive parathyroidectomy (MIP), and 2 patients are awaiting a surgical procedure. Of these 28 patients, 27 had more than a 50% decline in intraoperative PTH level after removal of the suspected adenoma, confirming surgical success. In 1 patient, multigland hyperplasia was discovered during the operation. The 2 study subjects with US findings of suspected hyperplasia underwent 4-gland surgical procedures. All patients treated surgically continued to have normal serum calcium levels 6 to 18 months postoperatively.


CONCLUSIONS
Primary hyperparathyroidism is caused most commonly by a solitary adenoma and less commonly by multigland hyperplasia of the parathyroid glands. Surgical resection is the only curative therapy. MIP has become a frequently used strategy, but there are limitations to current preoperative localization techniques. We conclude that US-guided FNA is a useful technique that facilitates MIP, with a high degree of specificity (95%) and sensitivity (91%).
Division of Endocrinology, Department of Medicine, Veterans Affairs Medical Center and University of Utah, Salt Lake City, UT, USA. dev.abraham@hsc.utah.edu
Devaprabu
D
Abraham
Pramod K
PK
Sharma
Joel
J
Bentz
Paige M
PM
Gault
Leigh
L
Neumayer
Donald A
DA
McClain
D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010281:Parathyroid Hormone / Q000378:metabolism; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018084:Ultrasonography, Interventional
D010281:Parathyroid Hormone