Faculty Collaboration Database

Intraoperative ex vivo parathyroid aspiration: A point-of-care test to confirm parathyroid tissue. Surgery 2016 Oct;160(4):850-857

Date

08/23/2016

Pubmed ID

27545996

DOI

10.1016/j.surg.2016.06.036

Scopus ID

2-s2.0-84994759769 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: Ex vivo aspiration of a parathyroid gland with intraoperative parathyroid hormone determination is a method for intraoperative confirmation of parathyroid tissue. The aim of this study was to describe the use and applicability of this technique at a single, high-volume institution.

METHODS: This is a retrospective review of patients who underwent parathyroidectomy and ex vivo aspiration of suspected, abnormal parathyroid tissue for intraoperative parathyroid hormone level (pg/mL). Sensitivity and specificity were calculated for aspirate intraoperative parathyroid hormone levels which were compared with the baseline serum aspirate intraoperative parathyroid hormone obtained prior to parathyroid excision in each patient.

RESULTS: Of 921 tissue aspirates, 847 (92%) were confirmed as parathyroid on histopathology, with a mean ± standard deviation aspirate intraoperative parathyroid hormone of 3,838 ± 1,615 pg/mL. The 847 aspirates included 833 (98%) with aspirate intraoperative parathyroid hormone levels greater than the serum aspirate intraoperative parathyroid hormone and 14 (2%) with aspirate intraoperative parathyroid hormone levels less than the serum aspirate intraoperative parathyroid hormone; 74 (8%) aspirates were not parathyroid tissue, with a mean aspirate intraoperative parathyroid hormone level of 25 ± 12.7 pg/mL. An aspirate intraoperative parathyroid hormone ≥1.5 times the serum aspirate intraoperative parathyroid hormone represented the optimal threshold for confirmation of parathyroid tissue.

CONCLUSION: Intraoperative ex vivo aspiration of presumed parathyroid gland is a sensitive and specific point-of-care method to confirm the presence of parathyroid tissue. An aspirate intraoperative parathyroid hormone ≥1.5 times greater than the baseline serum aspirate intraoperative parathyroid hormone minimizes the likelihood of misidentifying parathyroid tissue.

Author List

Coan KE, Yen TWF, Carr AA, Bullock M, Colon-Franco JM, Evans DB, Wang TS

Authors

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Biopsy, Needle
Databases, Factual
Female
Hospitals, High-Volume
Humans
Hyperparathyroidism, Primary
Male
Middle Aged
Monitoring, Intraoperative
Parathyroid Glands
Parathyroid Hormone
Parathyroidectomy
Point-of-Care Systems
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Treatment Outcome
Young Adult