title: Point-of-care rapid intraoperative parathyroid hormone assay of needle aspirates from parathyroid tissue: a substitute for frozen sections.
abstract: BACKGROUND
  The intraoperative parathyroid hormone (IOPTH) assay is an important tool that facilitates targeted parathyroidectomy and may increase surgical cure rates. We sought to evaluate the utility of a point-of-care assay to distinguish parathyroid adenomas from nonparathyroid tissues, which can sometimes pose a challenge during parathyroidectomy and is commonly achieved with the use of frozen sections. We hypothesized that point-of-care rapid IOPTH assays of needle aspirates from suspected adenomas would be faster and equal in accuracy to frozen sections.
  
  
  METHODS
  Parathyroid and nonparathyroid lesions were excised, and the tissues were needle aspirated, diluted in saline, and submitted to a rapid IOPTH assay located in the operating room. Frozen sections were simultaneously sent for analysis. The time intervals to result availability were tracked and compared using a paired t test.
  
  
  RESULTS
  Point-of-care IOPTH assays of needle aspirates were available in a mean (±SD) of 11.6 ± 1.5 minutes compared to 18.7 ± 4.0 minutes for frozen sections (P = .005). The findings were concordant 100% of the time for both parathyroid (mean parathyroid hormone [PTH] > 3338.9 pg/mL) and parathyroid tissues (mean PTH = 8.7 pg/mL).
  
  
  CONCLUSIONS
  Point-of-care IOPTH assay of needle aspirates is an accurate method of distinguishing parathyroid from nonparathyroid tissues. It is suggested that this would be particularly useful in instances where use of IOPTH is planned for assessment of a drop in serum PTH.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Medical College of Georgia, Augusta, USA.
authors.forename: Tarik
authors.initials: T
authors.lastname: Farrag
authors.forename: Paul
authors.initials: P
authors.lastname: Weinberger
authors.forename: Melanie
authors.initials: M
authors.lastname: Seybt
authors.forename: David J
authors.initials: DJ
authors.lastname: Terris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005629:Frozen Sections / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000032:analysis*; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D019095:Point-of-Care Systems; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone