Utility of ultrasound-guided fine-needle aspiration of parathyroid adenomas for localization before minimally invasive parathyroidectomy.
Endocr Pract
; 13(4): 333-7, 2007.
Article
en En
| MEDLINE
| ID: mdl-17669707
ABSTRACT
OBJECTIVE:
To determine the sensitivity and specificity of ultrasound (US)-guided fine-needle aspiration (FNA) and measurement of parathyroid hormone (PTH) in the aspirate (FNA/PTH) as a preoperative localization procedure.METHODS:
The study group consisted of 34 consecutive patients with primary hyperparathyroidism. The FNA/PTH estimations in these patients were compared with those from 13 proven thyroid nodules. All patients underwent US study of the neck, which suggested the presence of a solitary adenoma in 30 patients and of hyperplasia in 2; no adenoma or hyperplasia could be visualized in 2 patients. Thirty-two patients underwent FNA/PTH, which yielded a mean PTH level of 22,060.0 +/- 6,653.0 pg/mL. This result was significantly different (P<0.001) from the mean PTH level in 13 thyroid nodules (9.0 +/- 1.0 pg/mL).RESULTS:
On the basis of the FNA/PTH results, 28 patients with suspected adenomas underwent minimally invasive parathyroidectomy (MIP), and 2 patients are awaiting a surgical procedure. Of these 28 patients, 27 had more than a 50% decline in intraoperative PTH level after removal of the suspected adenoma, confirming surgical success. In 1 patient, multigland hyperplasia was discovered during the operation. The 2 study subjects with US findings of suspected hyperplasia underwent 4-gland surgical procedures. All patients treated surgically continued to have normal serum calcium levels 6 to 18 months postoperatively.CONCLUSION:
Primary hyperparathyroidism is caused most commonly by a solitary adenoma and less commonly by multigland hyperplasia of the parathyroid glands. Surgical resection is the only curative therapy. MIP has become a frequently used strategy, but there are limitations to current preoperative localization techniques. We conclude that US-guided FNA is a useful technique that facilitates MIP, with a high degree of specificity (95%) and sensitivity (91%).
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias de las Paratiroides
/
Adenoma
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Paratiroidectomía
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Ultrasonografía Intervencional
/
Biopsia con Aguja Fina
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
Límite:
Adolescent
/
Adult
/
Aged
/
Child
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Endocr Pract
Asunto de la revista:
ENDOCRINOLOGIA
Año:
2007
Tipo del documento:
Article
País de afiliación:
Estados Unidos