Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification

Citation
Nd. Perrier et al., Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification, WORLD J SUR, 24(11), 2000, pp. 1319-1322
Citations number
8
Categorie Soggetti
Surgery
Journal title
WORLD JOURNAL OF SURGERY
ISSN journal
03642313 → ACNP
Volume
24
Issue
11
Year of publication
2000
Pages
1319 - 1322
Database
ISI
SICI code
0364-2313(200011)24:11<1319:IPAAPH>2.0.ZU;2-X
Abstract
Most people would agree that successful parathyroidectomy depends on two im portant variables: the surgeon's recognition and excision of the abnormal p arathyroid gland(s) and the pathologist's confirmation that the removed tis sue is parathyroid tissue. Frozen section is usually employed to confirm th e identity of parathyroid tissue, but occasionally confirmation cannot be m ade without a permanent section, as with intrathyroidal glands. This study proposes a new method of expeditious and easy confirmation of parathyroid t issue utilizing the immunoassay for quick measurement of intraoperative par athyroid hormone (IOPTH), By directly aspirating the suspected adenoma, the assay becomes a rapid diagnostic tool that can be used as an alternative t o frozen section. In cases where the surgeon is already planning to employ the assay, the elimination of frozen section is cost-effective. Intraoperat ive aspiration of histologically confirmed parathyroid adenomas was perform ed on 12 consecutive patients undergoing parathyroid surgery. Parathyroid g lands were aspirated with a 22-gauge syringe after gland excision. Aspirate s were placed in 1 to 3 ml of buffered saline. A similar process was perfor med on 12 thyroid controls. Specimens were centrifuged, aliquotted, and sto red at -70 degreesC, The parathyroid hormone value was analyzed electively by rapid assay and the values recorded. For all parathyroid aspirates, the rapid assay value was a 1500 pg/ml, exceeding the uppermost limit of the di agnostic chart. Values for thyroid aspirates ranged from 58 to 85 pg/ml (me an 75.7 pg/ml), In all cases tissue confirmation was achieved with permanen t section. Values were 100% sensitive and specific. Measurement of PTH from intraoperative aspiration of suspected parathyroid adenomas is clinically useful in patients for whom frozen section would routinely be employed. Val ues > 1500 pg/ml secure the tissue diagnosis. There is no additional cost i n cases where IOPTH monitoring is already being utilized to confirm cure. T he elimination of frozen section could be cost-effective and, for some inst itutions, actually decrease the operating time as the IOPTH assay takes onl y 15 minutes. PTH assay is an accurate diagnostic technique and to date is 100% sensitive and specific for differentiating between parathyroid tumors and thyroid nodules.