Elsevier

Surgery

Volume 138, Issue 6, December 2005, Pages 1143-1151
Surgery

American Association of Endocrine Surgeon
Use of surgeon-performed office ultrasound and parathyroid fine needle aspiration for complex parathyroid localization

https://doi.org/10.1016/j.surg.2005.08.030Get rights and content

Abstract

Background

This study investigates the utility of ultrasound guided parathyroid fine needle aspiration (FNA) as a localizing technique in patients with hyperparathyroidism (HPT) undergoing re-operative neck surgery or with unusually appearing or ectopically located glands.

Methods

Selected patients with HPT underwent surgeon-performed FNA with ultrasound guidance. Aspirate contents were sent for cytology and parathyroid hormone (PTH) levels. All patients subsequently underwent parathyroid exploration.

Results

54 patients underwent 57 ultrasound guided parathyroid biopsies. Indications for FNA included prior parathyroid (n = 29), thyroid (n = 11), or other neck surgery (n = 2), or unusual parathyroid appearance or location (n = 12). A true positive was defined as a site where the PTH aspirate was >40 pg/mL and a hypercellular gland was removed at surgery. Based on this, there were 44 true positives, 10 true negatives, and 3 false negatives; there were no false positives. The median PTH level in positive aspirates was 11,665 pg/mL. Cytology was primarily helpful in excluding other diagnoses.

Conclusion

Ultrasound guided FNA is a highly specific localization test for parathyroid tumors. This procedure can be successfully performed by surgeons in the office setting and is extremely valuable for directing parathyroid exploration in challenging cases. We recommend incorporating ultrasound and FNA as a pre-operative localization strategy for selected patients with HPT.

Section snippets

Methods

Patients presenting for surgical evaluation of hyperparathyroidism were initially evaluated with a full history, physical examination, and review of the relevant laboratory studies. In patients who had had prior neck surgery, operative notes and pathology reports were reviewed whenever possible. The diagnosis of HPT was established by calcium and parathyroid hormone levels. Patients were considered to have HPT if their calcium and PTH levels were above normal, or if their calcium level was in

Results

From 2000 – present, 908 patients underwent parathyroidectomy at our institution. Of these, 54 (6%) patients underwent 57 ultrasound guided parathyroid biopsies. There were 3 patients who underwent FNA of 2 separate areas identified on ultrasound as suspected parathyroid lesions. The average age was 55 ± 13 years (range 25-77) and there were 39 females and 15 males. There were 49 patients with 10 HPT, and 5 with a history of renal failure resulting in tertiary HPT. Two of the 49 patients with 10

Discussion

An increasing number of endocrine surgeons are using ultrasound as an imaging modality in the office and operating room in the evaluation of patients with HPT.12 The performance of ultrasound by the surgeon may be particularly relevant in patients presenting for re-operative parathyroid surgery, where knowledge of the location of prior parathyroid resections from operative notes and pathology reports is essential in interpreting ultrasound findings. In addition, real-time examination of the

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