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Original Article |
1 Department of Surgery, Yale New Haven Hospital, Yale University School of Medicine, 330 Cedar Street, FMB 102, P.O. Box 208062, New Haven, CT 06520-8062, USA
2 Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
3 Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
4 Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, CT, USA
Correspondence: Address correspondence and reprint requests to: Robert Udelsman, MD, MBA, FACE; E-mail: robert.udelsman{at}yale.edu
Background: Persistent or recurrent primary hyperparathyroidism (1° HPTH) is ideally treated with limited dissection, based on accurate localization, to minimize operative risks. To accurately localize parathyroid tissue, we employed ultrasound-guided fine needle aspiration (US FNA) with an on-site rapid parathyroid hormone (PTH) assay to confirm localization.
Methods: Of the 272 patients evaluated for 1° HPTH, 34 had persistent or recurrent disease. Standard localization was equivocal in 12, who were referred for US FNA. Suspicious tissue was identified on US and FNA was performed. Analysis with a rapid PTH assay provided on-site result within 12 min. Patients were monitored clinically, and then discharged after observation.
Results: Twelve patients were referred for US FNA; eight were female. Ten patients had persistent disease, one had recurrent, and one had 1° HPTH following thyroidectomy. Two of the 12 were excluded due to negative ultrasound examination. Of the remaining ten, positive aspirates were found in nine, and seven proceeded to surgery. In six patients there was 100% correlation between sonographic and operative findings. The remaining patient had no identifiable adenoma, but PTH normalized after arterial ligation. All patients received a limited directed surgical approach, employing cervical block anesthesia in three. Four were discharged on the day of surgery and all were cured. There was one infectious complication of US FNA.
Conclusions: The use of rapid PTH assay can be effectively utilized for localization of parathyroid tissue in remedial parathyroid surgery. Confirmation of localization markedly improves subsequent surgery and allows selective use of minimally invasive techniques.
Key Words: Hyperparathyroidism • Parathyroidectomy • Localization • Remedial surgery • Parathyroid hormone assay
This article has been cited by other articles:
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  R. Udelsman, J. L. Pasieka, C. Sturgeon, J. E. M. Young, and O. H. Clark Surgery for Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 366 - 372. [Abstract] [Full Text] [PDF]
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