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Intraoperative Determination of PTH Concentrations in Fine Needle Tissue Aspirates to Identify Parathyroid Tissue During Parathyroidectomy

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Abstract

Background

Exact tissue identification during parathyroidectomy is essential to successfully cure hyperparathyroidism. PTH level determination from tissue aspirates has been advocated as a “biochemical frozen section” for parathyroid tissue identification. We investigated the sensitivity and specificity of this method in a large cohort of consecutive patients who underwent parathyroidectomy in a tertiary referral center.

Methods

PTH levels of 359 tissue aspirates were measured intraoperatively in 223 consecutive patients from March 2006 to December 2008. Suspected parathyroid and control tissues were aspirated with a standardized technique immediately after their excision. Samples were processed for quick-PTH assay with peripheral blood samples before and after excision. PTH levels from tissue aspirates were correlated with pathological diagnosis. The Mann–Whitney test was used to determine statistical significance (P < 0.05).

Results

A total of 255 parathyroid (196 adenoma, 30 hyperplasia, 4 carcinoma, 25 normal parathyroid) and 104 nonparathyroid tissue (88 thyroid, 16 lymph node, thymus, or fat) aspirates were compared. A highly significant difference was found between PTH levels of parathyroid (8,120 ± 2,711 pg/ml; interquartile range (IQR): 4,949–9,075) and nonparathyroid (0.8 ± 9.29 pg/ml; IQR: 0.4–1.4) tissue aspirates (P < 0.005). This test is 100% sensitive and 100% specific to identify parathyroid tissue for values >84 pg/ml. Furthermore, PTH levels of pathological parathyroid aspirates (8,169 ± 2,597; IQR: 5,634–9,109) were higher than that of normal parathyroid aspirates (4,130 ± 2,952; IQR: 2,569–8,284; P = 0.0011).

Conclusions

PTH level determination from tissue aspirates is a highly reliable, quick, and simple method to differentiate parathyroid and nonparathyroid tissues during parathyroidectomy. This method can obviate frozen sections in patients undergoing surgery for hyperparathyroidism.

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References

  1. Lo CY, Chan WF, Leung P et al (2005) Applicability of tissue aspirate for quick parathyroid hormone assay to confirm parathyroid tissue identity during parathyroidectomy for primary hyperparathyroidism. Arch Surg 140:146–149

    Article  PubMed  Google Scholar 

  2. Hanif F, Coffey JC, Romics L Jr et al (2006) Rapid intraoperative parathyroid hormone assay—more than just a comfort measure. World J Surg 30:156–161

    Article  CAS  PubMed  Google Scholar 

  3. McGreal G, Winter DC, Sookhai S et al (2001) Minimally invasive, radioguided surgery for primary hyperparathyroidism. Ann Surg Oncol 8:856–860

    Article  CAS  PubMed  Google Scholar 

  4. Westra WH, Pritchett DD, Udelsman R (1998) Intraoperative confirmation of parathyroid tissue during parathyroid exploration: a retrospective evaluation of frozen section. Am J Surg Pathol 22:538–544

    Article  CAS  PubMed  Google Scholar 

  5. Shidham VB, Asma Z, Rao RN et al (2002) Intraoperative cytology increases the diagnostic accuracy of frozen sections for the confirmation of various tissues in the parathyroid region. Am J Clin Pathol 118:895–902

    Article  PubMed  Google Scholar 

  6. Hessman O, Stålberg P, Sundin A et al (2008) High success rate of parathyroid reoperation may be achieved with improved localization diagnosis. World J Surg 32:774–781

    Article  PubMed  Google Scholar 

  7. Murphy C, Norman J (1999) The 20% rule: a simple, instantaneous radioactivity measurement defines cure and allows elimination of frozen sections and hormone assays during parathyroidectomy. Surgery 126:1023–1029

    Article  CAS  PubMed  Google Scholar 

  8. Horányi J, Duffek L, Kemenes M et al (2005) New intraoperative diagnostic methods in parathyroid surgery. Adenoma localization by gamma probe. Orv Hetil 146:1443–1446

    PubMed  Google Scholar 

  9. Prescott JD, Udelsman R (2009) Remedial operation for primary hyperparathyroidism. World J Surg 17 Mar [Epub ahead of print]

  10. Pradeep PV, Mishra A, Agarwal G et al (2008) Long-term outcome after parathyroidectomy in patients with advanced primary hyperparathyroidism and associated vitamin D deficiency. World J Surg 32:829–835

    Article  CAS  PubMed  Google Scholar 

  11. Kiblut NK, Cussac JF, Soudan B et al (2004) Fine needle aspiration and intraparathyroid intact parathyroid hormone measurement for reoperative parathyroid surgery. World J Surg 28:1143–1147

    Article  PubMed  Google Scholar 

  12. Chan RK, Ibrahim SI, Pil P et al (2005) Validation of a method to replace frozen section during parathyroid exploration by using the rapid parathyroid hormone assay on parathyroid aspirates. Arch Surg 140:371–373

    Article  PubMed  Google Scholar 

  13. Conrad DN, Olson JE, Hartwig HM et al (2006) A prospective evaluation of novel methods to intraoperatively distinguish parathyroid tissue utilizing a parathyroid hormone assay. J Surg Res 133:38–41

    Article  CAS  PubMed  Google Scholar 

  14. Gold JS, Donovan PI, Udelsman R (2006) Partial median sternotomy: an attractive approach to mediastinal parathyroid disease. World J Surg 30:1234–1239

    Article  PubMed  Google Scholar 

  15. MacFarlane MP, Fraker DL, Shawker TH et al (1994) Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism. Surgery 116:959–965

    CAS  PubMed  Google Scholar 

  16. Bergenfelz A, Forsberg L, Hederstrom E et al (1991) Preoperative localization of enlarged parathyroid glands with ultrasonically guided fine needle aspiration for parathyroid hormone assay. Acta Radiol 32:403–405

    Article  CAS  PubMed  Google Scholar 

  17. Clark OH, Gooding GAW, Ljung BM (1981) Locating a parathyroid adenoma by ultrasonography and aspiration biopsy cytology. West J Med 135:154–158

    CAS  PubMed  Google Scholar 

  18. Gauger PG, Agarwal G, England BG et al (2001) Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience. Surgery 130:1005–1010

    Article  CAS  PubMed  Google Scholar 

  19. Yang GP, Levine S, Weigel RJ (2001) A spike in parathyroid hormone during neck exploration may cause a false-negative intraoperative assay result. Arch Surg 136:945–949

    Article  CAS  PubMed  Google Scholar 

  20. Horányi J, Duffek L, Szlávik R et al (2003) Parathyroid surgical failures with misleading falls of intraoperative parathyroid hormone levels. J Endocrinol Invest 26:1095–1099

    PubMed  Google Scholar 

  21. Levin KE, Clark OH (1989) The reasons for failure in parathyroid operations. Arch Surg 124:911–914

    CAS  PubMed  Google Scholar 

  22. Boggs JE, Irvin GL, Carneiro DM et al (1999) The evolution of parathyroidectomy failures. Surgery 126:998–1002

    CAS  PubMed  Google Scholar 

  23. Perrier ND, Ituarte P, Kikuchi S et al (2000) Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification. World J Surg 24:1319–1322

    Article  CAS  PubMed  Google Scholar 

  24. Marcocci C, Mazzeo S, Bruno-Bossio G et al (1998) Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates. Eur J Endocrinol 39:72–77

    Article  Google Scholar 

  25. Karstrup S, Glenthøj A, Hainau B et al (1989) Ultrasound-guided, histological, fine-needle biopsy from suspect parathyroid tumors. Success rate and reliability of histological diagnosis. Br J Radiol 62:981–985

    Article  CAS  PubMed  Google Scholar 

  26. Weber CJ, Russel J, Chryssochoos JT et al (1996) Parathyroid hormone content distinguishes true normal parathyroids from parathyroids of patients with primary hyperparathyroidism. World J Surg 20:1010–1015

    Article  CAS  PubMed  Google Scholar 

  27. Westerdahl J, Bergenfelz A (2006) Parathyroid surgical failures with sufficient decline of intraoperative parathyroid hormone levels: unobserved multiple endocrine neoplasia as an explanation. Arch Surg 141:589–594

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. 1st Department of Surgery, Semmelweis University, Üllői út 78, 1082, Budapest, Hungary

    János Horányi & Rezső Szlávik

  2. Department of Radiology and Oncotherapy, Semmelweis University, Üllői út 78/A, 1082, Budapest, Hungary

    László Duffek

  3. 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/A, 1083, Budapest, Hungary

    István Takács

  4. 2nd Department of Medicine, Semmelweis University, Szentkirályi u. 46, 1088, Budapest, Hungary

    Miklós Tóth

  5. Victoria Infirmary Glasgow, Langside Road, G42 9TY, Glasgow, UK

    László Romics Jr.

Authors
  1. János Horányi
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  2. László Duffek
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  3. Rezső Szlávik
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  4. István Takács
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  5. Miklós Tóth
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  6. László Romics Jr.
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Correspondence to János Horányi.

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Horányi, J., Duffek, L., Szlávik, R. et al. Intraoperative Determination of PTH Concentrations in Fine Needle Tissue Aspirates to Identify Parathyroid Tissue During Parathyroidectomy. World J Surg 34, 538–543 (2010). https://doi.org/10.1007/s00268-009-0351-5

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