Fine‐needle aspiration of parathyroid adenomas: Indications as a diagnostic approach

Abstract

Background We aimed to determine the indication of fine‐needle aspiration (FNA) for parathyroid adenoma (PA)‐suspected nodules and the cytological features of PA, and to discuss the ancillary techniques for diagnostic confirmation. Method Clinical, cytological, and histological examinations of 15 PA patients (4.0% of all PA resected patients) were conducted through FNA on 16 nodules. We also examined the cytological preparations of 10 follicular neoplasms (FNs) and 10 poorly differentiated thyroid carcinomas (PDTCs). Results FNA was performed to detect PA in nine (56.3%) nodules. The remaining seven (43.8%) nodules underwent FNA for lesions considered as thyroid nodules or lymph nodes. The levels of parathyroid hormone (PTH) in the aspiration needle washout fluid were observably high, except for that from one nodule with unsatisfactory FNA. Cytologically, the incidences of wedge pattern (86.7%) and salt and pepper chromatin (86.7%) in PAs were significantly higher than in FNs and PDTCs. In contrast, the appearance of colloid globules and nuclear grooves was less frequent than that of FNs and PDTCs. GATA‐3 expression was intense in all PAs that immunocytochemistry were performed. Histologically, capsular invasion and/or laceration, tumor seeding, granulation tissue, and fibrosis were observed. Conclusions When PA localization is unusual or inconclusive despite extensive imaging, FNA may be performed. We asserted that wedge pattern, salt and pepper chromatin, and the absence of colloid globules and nuclear grooves are diagnostic cytological indicators of PA rather than of FN or PDTC. We recommend PTH measurements using needle washout fluid for PA‐suspected nodules, and immunocytochemistry with the GATA‐3 antibody for cytologically PA‐suspected nodules.

Parathyroid Carcinoma All-In-One, a Rare Life-Threatening Case With Multiple Systemic Manifestations: Case Report and Review of the Literature

“…As recently confirmed, when PA localization is unusual or inconclusive despite extensive imaging, PTH measurements using needle washout fluid and immunocytochemistry with GATA-3 antibody for PA-suspected nodules may be a very useful tool ( 16 ). Otherwise, according to the guidelines of the American Association of Endocrine Surgeons ( 17 ), preoperative parathyroid FNA is not recommended if PC is suspected and was not performed in our case.…”

Histological alterations following fine‐needle aspiration for parathyroid adenoma: Incidence and diagnostic problems

“…Therefore, preoperative parathyroid FNA should be avoided when possible, and should not be performed if parathyroid carcinoma is suspected 17,20 . On histological alterations following FNA of the parathyroid, some findings including fibrotic or inflammatory reactions, cytological atypia, pseudo‐invasive trapping, and parathyromatosis have been documented 12,14–17 …”

“…Fine‐needle aspiration is not recommended for parathyroid adenoma (PA)‐suspected nodules owing to the possibility of serious complications, such as massive hematomas, parathyromatosis, and misdiagnoses of malignancies during histological diagnoses 8,9 . However, when the localization is unusual or the PA is mistaken for a thyroid nodule, FNA may be indicated or performed erroneously 10–13 . Reports on histological alterations following FNA of the parathyroid are few 12,14–17 .…”

“…However, when the localization is unusual or the PA is mistaken for a thyroid nodule, FNA may be indicated or performed erroneously 10–13 . Reports on histological alterations following FNA of the parathyroid are few 12,14–17 . Therefore, this study aimed to clarify the histological alterations following FNA ffor parathyroid adenoma (HAFFAP) by comparing the histological findings of PA cases with and without preoperative FNA, and evaluating their incidence.…”

Diagnosis of parathyroid incidentaloma detected on thyroid ultrasonography: the role of fine-needle aspiration cytology and washout parathyroid hormone measurements

“…Because the role of US examination in the evaluation of patients with hyperparathyroidism is in the localization of the lesion, FNA is not essential. Furthermore, FNA for parathyroid adenomas has potential risks, including tumor seeding, massive hemorrhage, parathyromatosis, recurrence, or histological alterations following FNA [21][22][23][24][25][26][27].…”