Applicability of rapid intraoperative parathyroid hormone assay through fine needle aspiration to identify parathyroid tissue in thyroid surgery

Abstract

Hypoparathyroidism is a frequent and serious complication of thyroid surgery. Identification and preservation of the parathyroid glands are key factors in managing hypoparathyroidism. The aim of the present study was to investigate the efficacy of rapid intraoperative parathyroid hormone (rIO-PTH) assay levels through fine needle aspiration (FNA) in identifying parathyroids as a parameter in thyroid surgery. rIO-PTH assay through FNA and frozen section examination were performed on 194 suspected parathyroids anatomical structures from 50 consecutive patients undergoing thyroidectomy (rIO-PTH group). The association between the rIO-PTH values and histological results were analyzed. Clinical effects were compared between the rIO-PTH and control groups from 50 patients undergoing a similar standard surgery. rIO-PTH levels from 93/194 aspirated anatomical structures certified as parathyroid tissues by histological analysis were demonstrated to have a mean of 3,369 pg/ml (range, 145.2-5,000 pg/ml). These values were significantly increased compared with the mean value of 25.7 pg/ml from non-parathyroids tissues significantly (P<0.001). The mean number of 3.76 on the recognized parathyroids was obtained by naked eye measurements combined with rIO-PTH assay through FNA, was significantly higher than compared with only naked eye measurements (P<0.05). Postoperative permanent or transient hypoparathyroidism was not detected in the rIO-PTH groups. The difference between the postoperative serum calcium level and blood PTH values of rIO-PTH and control groups was not statistically significant (P>0.05). The value of rIO-PTH assay through FNA demonstrated that it is a good parameter for differentiating parathyroids and non-parathyroids tissues. The technique is a highly reliable, quick, simple and non-invasive method with a short learning curve in thyroid surgery, which is particularly valuable for inexperienced surgeons. This method may replace frozen section examination, which relies on a surgeon's personal experience on the basis of topographic or morphologic criteria for recognizing parathyroids.

Twin pregnancy with triple parathyroid adenoma: A case report and review of literature

“…More importantly, visualization of lesions depends on the surgeon’s experience and careful exploration during surgery, especially in patients like the one in this case who was not able to undergo 99mTc-sestamibi scintigraphy. In addition, the immediate detection of changes in PTH levels during surgery is also an important measure for improving the success of the surgery[ 15 ]. PTH is metabolized by the liver and kidneys in vivo.…”

Intraoperative Probe-Based Confocal Endomicroscopy to Histologically Differentiate Thyroid From Parathyroid Tissue Before Resection

“…Biochemical methods such as tissue aspiration for quick parathyroid hormone assay were also tested and had excellent accuracy. However, they necessitated tissue resection 20 or puncture 21 first.…”

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

“…Rapid intraoperative measurement of PTH in FNA aspirates of suspicious tissue has been reported to be a reliable and simple method of differentiating parathyroid and non-parathyroid tisuue. 88,94,95 This could provide an alternative to FS examination, dodging the injurious effect of the bioptic process and achieving similar or even more accurate results. 96 A recently reported modification of the IOPTH assay achieved 100% sensitivity and 100% specificity in distinguishing parathyroid from non-parathyroid tissues within ultra-short turnaround time (60 seconds) and could potentially replace frozen-section assessment.…”