Rapid intraoperative parathyroid hormone assay in fine needle aspiration for differential diagnosis in thyroid and parathyroid surgery.
BACKGROUND
The purpose of our study was to investigate the efficacy of rapid intraoperative parathyroid hormone (rIO-PTH) analysis performed using material collected by fine needle aspiration as a parameter to distinguish anatomical structures which the surgeon is not able to identify clearly as parathyroid or lymph node during thyroid/parathyroid surgery. Before surgery, all patients gave written, informed consent.


METHODS
We measured the rIO-PTH on 50 anatomical structures, 32 presumed parathyroids and 18 presumed lymph nodes from 22 patients, who underwent thyroid/parathyroid surgery between May and September 2009.


RESULTS
The rIO-PTH values obtained on parathyroids ranged from 85.4 pmol/L to more than 2106 pmol/L, with a rIO-PTH median of 263.25 pmol/L. Results obtained on lymph nodes ranged from <0.52 pmol/L up to 20.4 pmol/L, with a rIO-PTH median equal to 1.31 pmol/L. Results of the Mann-Whitney test showed a rIO-PTH median significantly different (p<0.0001) between samples obtained from parathyroid glands and lymph node tissue.


CONCLUSIONS
We demonstrated that rapid intraoperative measurement of parathyroid hormone is a good parameter for the differential diagnosis of parathyroid vs. lymph node tissue. We suggest extending the use of this technique to the field of parathyroid preservation during thyroid/parathyroid surgery in those cases where the parathyroids prove difficult to recognize on the basis of topographic or morphologic criteria.
Pelizzo
Maria Rosa
MR
Institution of Medical and Surgical Sciences, Department of Surgical Pathology, University Hospital of Padova, Padova, Italy.
Losi
Andrea
A
Boschin
Isabella Merante
IM
Toniato
Antonio
A
Pennelli
Gianmaria
G
Sorgato
Nadia
N
Faggian
Diego
D
Plebani
Mario
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000737:chemistry* / Q000473:pathology*; D010281:Parathyroid Hormone / Q000032:analysis*; D016105:Parathyroidectomy; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013965:Thyroidectomy; D013997:Time Factors
D010281:Parathyroid Hormone