title: Intraoperative ex vivo parathyroid aspiration: A point-of-care test to confirm parathyroid tissue.
abstract: Ex vivo aspiration of a parathyroid gland with intraoperative parathyroid hormone determination is a method for intraoperative confirmation of parathyroid tissue. The aim of this study was to describe the use and applicability of this technique at a single, high-volume institution.
  
  
  
  This is a retrospective review of patients who underwent parathyroidectomy and ex vivo aspiration of suspected, abnormal parathyroid tissue for intraoperative parathyroid hormone level (pg/mL). Sensitivity and specificity were calculated for aspirate intraoperative parathyroid hormone levels which were compared with the baseline serum aspirate intraoperative parathyroid hormone obtained prior to parathyroid excision in each patient.
  
  
  
  Of 921 tissue aspirates, 847 (92%) were confirmed as parathyroid on histopathology, with a mean ± standard deviation aspirate intraoperative parathyroid hormone of 3,838 ± 1,615 pg/mL. The 847 aspirates included 833 (98%) with aspirate intraoperative parathyroid hormone levels greater than the serum aspirate intraoperative parathyroid hormone and 14 (2%) with aspirate intraoperative parathyroid hormone levels less than the serum aspirate intraoperative parathyroid hormone; 74 (8%) aspirates were not parathyroid tissue, with a mean aspirate intraoperative parathyroid hormone level of 25 ± 12.7 pg/mL. An aspirate intraoperative parathyroid hormone ≥1.5 times the serum aspirate intraoperative parathyroid hormone represented the optimal threshold for confirmation of parathyroid tissue.
  
  
  
  Intraoperative ex vivo aspiration of presumed parathyroid gland is a sensitive and specific point-of-care method to confirm the presence of parathyroid tissue. An aspirate intraoperative parathyroid hormone ≥1.5 times greater than the baseline serum aspirate intraoperative parathyroid hormone minimizes the likelihood of misidentifying parathyroid tissue.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: coan.katy@gmail.com.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Coan
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Tina W F
authors.initials: TWF
authors.lastname: Yen
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Azadeh A
authors.initials: AA
authors.lastname: Carr
authors.affiliation: Wisconsin Diagnostic Laboratory, Milwaukee, WI.
authors.forename: Michael
authors.initials: M
authors.lastname: Bullock
authors.affiliation: Department of Pathology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Colon-Franco
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Wang
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods; D016208:Databases, Factual; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010280:Parathyroid Glands / Q000473:pathology; D010281:Parathyroid Hormone / Q000032:analysis*; D016105:Parathyroidectomy / Q000379:methods; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone