Use of preoperative parathyroid fine-needle aspiration and parathormone assay in the primary hyperparathyroidism with concomitant thyroid nodules

Background: Although the sensitivity of imaging studies is high in solitary parathyroid adenomas, negative results are inevitable. The aims of this prospective clinical study are to evaluate the impact of the presence of thyroid disease on the sensitivity and positive predictive value (PPV) of ultrasonography (US), sestamibi (MIBI), and parathyroid fine needle aspiration and parathormone assay (PTH-FNA). Patients: The patients were divided into 4 groups according to preoperative imaging studies: group A (n = 62) with US, group B (n = 62) with MIBI, group C (n = 62) with US + MIBI, and group D (n = 62) with PTH-FNA. These 4 groups were subdivided according to the presence (group 1) or absence (group 2) of thyroid nodule. Results: In the overall patients, the sensitivity and PPV of PTH-FNA to localize parathyroid adenoma was higher compared with US, MIBI, and US + MIBI (100% and 100% versus 96% and 91% versus 92% and 87% versus 95% and 94%, respectively, P <.05). The sensitivity and PPV of US, , and US + MIBI in the patients without thyroid nodule was higher compared with the patients with thyroid nodule (100% and 100%, 100% and 96%, 100% and 100% versus 93% and 84%, 85% and 80%, 96% and 86%, respectively, P <.05). The sensitivity and PPV of the PTH-FNA was 100% in the patients with and without a thyroid nodule. Conclusion: PTH-FNA can be performed safely for the confirmation of parathyroid adenoma localized by preoperative imaging studies. In patients with a concomitant thyroid nodule, PTH-FNA was more accurate to detect the parathyroid adenoma than the other imaging studies. (C) 2007 Excerpta Medica Inc. All rights reserved.