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Focused parathyroidectomy without intra-operative parathormone monitoring: The value of PTH assay in preoperative ultrasound guided fine needle aspiration washout

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Background: The accurate identification of hyperfunctioning parathyroid (HP) gland is the only issue for
definitive surgical treatment in primary hyperparathyroidism (pHPT). Various imaging and operative
techniques have been proposed to confirm the localization of the diseased gland. Nevertheless, none of
these methods proved to be the gold standard. The presented study aimed to assess the value of parathyroid
hormone assay in preoperative ultrasound guided fine needle aspiration (FNA)-PTH washout
fluid to verify the correct localisation for focused parathyroidectomy without intra-operative PTH
monitoring.

Material and Methods: The retrospective analysis of 57 patients with pHPT who underwent FNA-PTH was
conducted from a prospective database. Biochemical assessment together with radiological (ultrasonography)
and nuclear (MIBI scan) imaging was reviewed. Associations between FNA-PTH washout
values and localization technics were evaluated and compared in terms of operative findings.

Results: Focused parathyroidectomy without intraoperative PTH monitoring was performed to 45 patients
with high FNA-PTH values. The median largest diameter of the target parathyroid lesion identified
by ultrasonography was 13 mm (range, 6 to 36). The median serum PTH level was 190 pg/mL (range, 78
to 1709; reference range, 15 to 65) whereas the median washout PTH was 2500 pg/mL (range, 480 to
3389). According to operative findings high FNA-PTH levels correctly identified parathyroid adenoma in
40 cases (89% of sensitivity and 100% of specificity and positive predictive value) whereas MIBI scan
localized the lesion in 36 of these cases (80% of sensitivity).

Conclusions: The higher level of PTH in preoperative ultrasound guided FNA washout is a considerable
data to predict the correct localization of HP, particularly in circumstances of greater values than the
serum PTH level. However, although its specificity is high, in cases of coexisting nodular thyroid disease,
associated additional HP might be missed at focused parathyroidectomy without PTH monitoring,
leading to recurrent disease.

Keywords:
Parathyroid
Washout
Parathyroidectomy

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Informasi Detail

Judul Seri

Annals of Medicine and Surgery

No. Panggil

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Penerbit

New York : Elsevier Ltd on behalf of IJS Publishing Group Limited., 2016

Deskripsi Fisik

Annals of Medicine and Surgery 6 (2016) 64-67

Bahasa

English

ISBN/ISSN

http://dx.doi.org/10

Klasifikasi

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Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

6 (2016)

Subjek

KEDOKTERAN

Info Detail Spesifik

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Pernyataan Tanggungjawab

agus

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