Parathyroid fine‐needle aspiration with parathyroid hormone washout as a preoperative localisation of parathyroid adenoma—A retrospective study

Abstract

Objective: The use of parathyroid lesion aspiration in preoperative adenoma localisation is controversial. Concerns have been raised regarding both immediate safety (hematoma, infection, alterations on a subsequent histologic preparate) and long-term safety (seeding).We aimed to evaluate the short-and long-term safety, and the efficacy, of parathyroid fine-needle aspiration with parathyroid hormone washout as a localisation modality of parathyroid adenoma in patients with primary hyperparathyroidism.Design: A retrospective study. Patients:The sample comprised 29 patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy at a tertiary referral centre, following localisation with parathyroid hormone washout. Measurements:We reviewed all parathyroid hormone washout procedures performed during 2011-2021. Clinical, biochemical, and imaging information; and cytology, surgery, and pathology reports were extracted from electronic medical records.Results: Parathyroid hormone levels from the needle wash were 2.1-112.5 times the upper limit of the serum norm. Other than mild neck discomfort, no immediate procedure complications were documented. Fibrotic changes and necrosis were reported in two patients, with no effect on the final pathologic diagnosis or surgery course. No long-term complications (seeding, or parathyromatosis) were found. A total of 26 (90%) patients who were operated following a positive parathyroid hormone washout result were normocalcemic at the end of a mean 38.1-month follow-up period.Conclusions: Parathyroid fine-needle aspiration with parathyroid hormone washout was accurate. Immediate, surgical, or delayed complications were not demonstrated in our series. This approach might be considered for selected patients.

Parathyroid fine needle aspiration with PTH washout: Can it lead to parathyroid cell seeding in primary hyperparathyroidism?

“…Although there is a consensus on the effectiveness of traditional imaging techniques, an ongoing debate surrounds the use of PFNA with PTH washout for the preoperative localization of parathyroid adenomas. [ 10 ] Immediate safety concerns associated with P-FNA, such as hematoma formation, infection risk, and potential alterations in histological examination, along with long-term risks such as cell spread and seeding, have been critically evaluated in recent studies. [ 10 ] Güneş et al [ 11 ] and Wenbo et al [ 12 ] highlighted the reliability of PTH washout in identifying parathyroid lesions, particularly in preoperative settings and in patients with negative preoperative sestamibi scans.…”

“…[ 10 ] Immediate safety concerns associated with P-FNA, such as hematoma formation, infection risk, and potential alterations in histological examination, along with long-term risks such as cell spread and seeding, have been critically evaluated in recent studies. [ 10 ] Güneş et al [ 11 ] and Wenbo et al [ 12 ] highlighted the reliability of PTH washout in identifying parathyroid lesions, particularly in preoperative settings and in patients with negative preoperative sestamibi scans. However, potential risks associated with the procedure, such as inflammatory responses, parathyroid abscesses, and hematoma, have also been documented.…”

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

“…An alternative to the mentioned pre-operatory imaging methods was proposed to be ultrasound-guided parathyroid fine-needle aspiration (with PTH washout), but so far, there are not so many large studies to address this issue, which is not conventionally approved in many centres [55]. However, one study from 2023 showed a similar positive predictive value with 99m-Tc sestamibi scintigraphy; thus, it might become a first-line imaging modality in a selective subgroup of subjects with PHP [56].…”