USE OF PREOPERATIVE FINE-NEEDLE ASPIRATION IN PATIENTS UNDERGOING REOPERATION FOR PRIMARY HYPERPARATHYROIDISM

Background. Neck reexploration for primary hyperparathyroidism has a l ower success rate and greater morbidity than initial exploration becau se of scarring and distortion of tissue planes and the possibility of a parathyroid neoplasm located in an ectopic or unusual position. Alth ough the use of standard noninvasive imaging studies for reoperative p arathyroid surgical procedure is well accepted, the use of invasive st udies to localize parathyroid neoplasms, particularly percutaneous asp iration of potential lesions, is controversial. In this report we anal yze the results and morbidity in patients undergoing fine-needle aspir ation before neck reexploration. Methods. From 1982 to 1993, 255 patie nts underwent reexploration for persistent or recurrent hyperparathyro idism at the National Institutes of Health. Of these 255 patients 42 u nderwent 44 preoperative fine-needle aspirations by ultrasonography or computed tomography guidance in an attempt to localize a parathyroid neoplasm. The aspirated contents were then analyzed for parathyroid ho rmone content. Results. Of the 44 aspirations 26 (59%) were true posit ives with no false positives. Of 18 negative fine-needle aspirations, 11 (25%) were false negatives, and seven (16%) were true negatives. Th e specificity and sensitivity of percutaneous fine-needle aspiration w ere 100% and 70%, respectively. Conclusions. Percutaneous fine-needle aspiration for parathyroid hormone is a safe, well-tolerated technique that is highly specific and allows a directed surgical resection avoi ding further invasive workup when the aspirate is positive.