Ultrasound-guided fine-needle aspiration biopsy of parathyroid adenomas in patients undergoing parathyroidectomy does not lead to clinically significant fibrosis.

Abstract

Background: Preoperative localization of parathyroid adenomas (PAs) with ultrasound-guided fine-needle aspiration (USG-FNA) is a controversial subject due to concerns about fibrosis. This paper attempts to evaluate the impact of fine-needle aspiration (FNA) on PA fibrosis in patients with primary hyperparathyroidism (PHPT) undergoing surgical resection.

Methods: This retrospective review analyzed 70 patients who underwent parathyroidectomy for PHPT. Forty patients with unequivocal parathyroid lesions underwent USG-FNA using 25- or 27-gauge needles. Postoperatively, an independent pathologist assessed fibrosis in biopsied adenomas in a blinded fashion. Patients undergoing parathyroidectomy without biopsy served as controls. Surgical outcomes and fibrosis scores were compared between the two groups studied.

Results: No significant difference in fibrosis scores was observed between biopsied and non-biopsied adenomas by an independent pathologist in cytopathology evaluation (P=0.99). However, ultrasound (US) demonstrated superior localization accuracy (95.8%), in comparison to Single-Photon Emission Computed Tomography-Sestamibi (SPECT-Sestamibi) study (50%). Patients with positive FNA parathyroid hormone (PTH) washout had a higher cure rate (95%) compared to those without biopsy proven localization (67%).

Conclusions: Parathyroid FNA biopsy washout with 25- or 27-gauge needles does not cause clinically significant fibrosis. Preoperative localization with positive PTH washout using FNA improves surgical success rates in patients with PHPT.