Risk of parathyromatosis after fine-needle aspiration

Reoperative surgery for hyperparathyroidism (HPT) is fraught with hazard. W hen preoperative imaging studies are inconclusive or patient comorbidities are extensive fine needle-aspiration (FNA) is helpful to confirm the presen ce of suspected parathyroid tissue in the neck. Some surgeons refrain from using FNA because of the concern of tissue implantation (parathyromatosis). A retrospective review (1984-1996) of all patients diagnosed with HPT unde rgoing FNA of suspected parathyroid tissue was performed to document whethe r a correlation exists between FNA of suspected parathyroid tissue and subs equent development of parathyromatosis. Parathyromatosis was considered to have occurred when proven by histology or suspected on the basis of clinica l studies. Of 81 patients with HPT undergoing ultrasound-guided FNA to asse ss abnormalities in the neck 41 patients with confirmed parathyroid tissue were identified. The indications for FNA in these 41 patients were: prior f ailed cervical exploration (n = 33), prior neck surgery and/or radiation (n = 2), inconclusive noninvasive imaging studies (n = 15), and severe comorb idities (n = 8). Mean follow-up was 5.8 years. No case of FNA-induced parat hyromatosis was identified. FNA is useful to confirm the presence of parath yroid tissue in very select patients with hyperparathyroidism. FNA often el iminates the need for other imaging studies, may prevent a needless or like ly fruitless re-exploration, and does not cause parathyromatosis.