Risks and benefits of parathyroid fine-needle aspiration with parathyroid hormone washout.
OBJECTIVE
To describe the experience with parathyroid fine-needle aspiration (FNA) and parathyroid hormone (PTH) washout at Mayo Clinic Rochester, Rochester, Minnesota.


METHODS
We retrospectively reviewed all parathyroid FNA procedures performed at Mayo Clinic Rochester between January 2000 and December 2007. Clinical, biochemical, and imaging information, parathyroid FNA procedure, and cytology, surgical, and pathology reports were reviewed, and descriptive statistics, sensitivity, specificity, and positive predictive values are presented.


RESULTS
During the study period, 75 parathyroid FNAs were performed on 74 patients. Cytology results were available for 74 of 75 procedures, with only 31% interpreted as parathyroid cells. PTH washout was performed in 67 patients (91%). Parathyroid FNA with PTH washout had a sensitivity of 84%, specificity of 100%, positive predictive value of 100%, and accuracy of 84%. At the time of surgical treatment, 2 patients were noted to have an inflammatory response from the parathyroid FNA biopsy, 1 had a parathyroid abscess, and 2 had a hematoma. In 3 of these 5 patients, the necessary conversion of a minimally invasive surgical procedure to the standard surgical approach prolonged the surgical time.


CONCLUSIONS
Parathyroid FNA with PTH washout had a superior performance in comparison with parathyroid scanning or ultrasonography alone. The main limitations of parathyroid FNA with PTH washout are (1) the need for initial identification of a potential parathyroid adenoma by ultrasonography and (2) the number of false-negative results. Parathyroid FNA resulted in complications affecting the surgical procedure in 3 patients.
Department of Endocrinology, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA. bancos.irina@mayo.edu
Irina
I
Bancos
Clive S
CS
Grant
Sarah
S
Nadeem
Marius N
MN
Stan
Carl C
CC
Reading
Thomas J
TJ
Sebo
Alicia
A
Algeciras-Schimnich
Ravinder J
RJ
Singh
Diana S
DS
Dean
D000236:Adenoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D001826:Body Fluids / Q000378:metabolism; D002277:Carcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D003940:Diagnostic Techniques, Endocrine / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism*; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014463:Ultrasonography
C470125:PTH protein, human; D010281:Parathyroid Hormone