Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism

Mark P. MacFarlane, Douglas L. Fraker, Thomas H. Shawker, Jeffrey A. Norton, John L. Doppman, Richard A. Chang, Monica C. Skarulis, Stephen J. Marx, Allen M. Spiegel, H. Richard Alexander

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background. Neck reexploration for primary hyperparathyroidism has a lower success rate and greater morbidity than initial exploration because of scarring and distortion of tissue planes and the possibility of a parathyroid neoplasm located in an ectopic or unusual position. Although the use of standard noninvasive imaging studies for reoperative parathyroid surgical procedure is well accepted, the use of invasive studies to localize parathyroid neoplasms, particularly percutaneous aspiration of potential lesions, is controversial. In this report we analyze the results and morbidity in patients undergoing fine-needle aspiration before neck reexploration. Methods. From 1982 to 1993, 255 patients underwent reexploration for persistent or recurrent hyperparathyroidism at the National Institutes of Health. Of these 255 patients 42 underwent 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 hormone content. Results. Of the 44 aspirations 26 (59%) were true positives with no false positives. Of 18 negative fine-needle aspirations, 11 (25%) were false negatives, and seven (16%) were true negatives. The specificity and sensitivity of percutaneous fine-needle aspiration were 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 avoiding further invasive workup when the aspirate is positive.

Original languageEnglish (US)
Pages (from-to)959-965
Number of pages7
JournalSurgery
Volume116
Issue number6
StatePublished - 1994
Externally publishedYes

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Primary Hyperparathyroidism
Fine Needle Biopsy
Reoperation
Parathyroid Neoplasms
Parathyroid Hormone
Neck
Morbidity
Hyperparathyroidism
National Institutes of Health (U.S.)
Cicatrix
Ultrasonography
Tomography
Sensitivity and Specificity

ASJC Scopus subject areas

  • Surgery

Cite this

MacFarlane, M. P., Fraker, D. L., Shawker, T. H., Norton, J. A., Doppman, J. L., Chang, R. A., ... Richard Alexander, H. (1994). Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism. Surgery, 116(6), 959-965.

Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism. / MacFarlane, Mark P.; Fraker, Douglas L.; Shawker, Thomas H.; Norton, Jeffrey A.; Doppman, John L.; Chang, Richard A.; Skarulis, Monica C.; Marx, Stephen J.; Spiegel, Allen M.; Richard Alexander, H.

In: Surgery, Vol. 116, No. 6, 1994, p. 959-965.

Research output: Contribution to journalArticle

MacFarlane, MP, Fraker, DL, Shawker, TH, Norton, JA, Doppman, JL, Chang, RA, Skarulis, MC, Marx, SJ, Spiegel, AM & Richard Alexander, H 1994, 'Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism', Surgery, vol. 116, no. 6, pp. 959-965.
MacFarlane MP, Fraker DL, Shawker TH, Norton JA, Doppman JL, Chang RA et al. Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism. Surgery. 1994;116(6):959-965.
MacFarlane, Mark P. ; Fraker, Douglas L. ; Shawker, Thomas H. ; Norton, Jeffrey A. ; Doppman, John L. ; Chang, Richard A. ; Skarulis, Monica C. ; Marx, Stephen J. ; Spiegel, Allen M. ; Richard Alexander, H. / Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism. In: Surgery. 1994 ; Vol. 116, No. 6. pp. 959-965.
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abstract = "Background. Neck reexploration for primary hyperparathyroidism has a lower success rate and greater morbidity than initial exploration because of scarring and distortion of tissue planes and the possibility of a parathyroid neoplasm located in an ectopic or unusual position. Although the use of standard noninvasive imaging studies for reoperative parathyroid surgical procedure is well accepted, the use of invasive studies to localize parathyroid neoplasms, particularly percutaneous aspiration of potential lesions, is controversial. In this report we analyze the results and morbidity in patients undergoing fine-needle aspiration before neck reexploration. Methods. From 1982 to 1993, 255 patients underwent reexploration for persistent or recurrent hyperparathyroidism at the National Institutes of Health. Of these 255 patients 42 underwent 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 hormone content. Results. Of the 44 aspirations 26 (59{\%}) were true positives with no false positives. Of 18 negative fine-needle aspirations, 11 (25{\%}) were false negatives, and seven (16{\%}) were true negatives. The specificity and sensitivity of percutaneous fine-needle aspiration were 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 avoiding further invasive workup when the aspirate is positive.",
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T1 - Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism

AU - MacFarlane, Mark P.

AU - Fraker, Douglas L.

AU - Shawker, Thomas H.

AU - Norton, Jeffrey A.

AU - Doppman, John L.

AU - Chang, Richard A.

AU - Skarulis, Monica C.

AU - Marx, Stephen J.

AU - Spiegel, Allen M.

AU - Richard Alexander, H.

PY - 1994

Y1 - 1994

N2 - Background. Neck reexploration for primary hyperparathyroidism has a lower success rate and greater morbidity than initial exploration because of scarring and distortion of tissue planes and the possibility of a parathyroid neoplasm located in an ectopic or unusual position. Although the use of standard noninvasive imaging studies for reoperative parathyroid surgical procedure is well accepted, the use of invasive studies to localize parathyroid neoplasms, particularly percutaneous aspiration of potential lesions, is controversial. In this report we analyze the results and morbidity in patients undergoing fine-needle aspiration before neck reexploration. Methods. From 1982 to 1993, 255 patients underwent reexploration for persistent or recurrent hyperparathyroidism at the National Institutes of Health. Of these 255 patients 42 underwent 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 hormone content. Results. Of the 44 aspirations 26 (59%) were true positives with no false positives. Of 18 negative fine-needle aspirations, 11 (25%) were false negatives, and seven (16%) were true negatives. The specificity and sensitivity of percutaneous fine-needle aspiration were 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 avoiding further invasive workup when the aspirate is positive.

AB - Background. Neck reexploration for primary hyperparathyroidism has a lower success rate and greater morbidity than initial exploration because of scarring and distortion of tissue planes and the possibility of a parathyroid neoplasm located in an ectopic or unusual position. Although the use of standard noninvasive imaging studies for reoperative parathyroid surgical procedure is well accepted, the use of invasive studies to localize parathyroid neoplasms, particularly percutaneous aspiration of potential lesions, is controversial. In this report we analyze the results and morbidity in patients undergoing fine-needle aspiration before neck reexploration. Methods. From 1982 to 1993, 255 patients underwent reexploration for persistent or recurrent hyperparathyroidism at the National Institutes of Health. Of these 255 patients 42 underwent 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 hormone content. Results. Of the 44 aspirations 26 (59%) were true positives with no false positives. Of 18 negative fine-needle aspirations, 11 (25%) were false negatives, and seven (16%) were true negatives. The specificity and sensitivity of percutaneous fine-needle aspiration were 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 avoiding further invasive workup when the aspirate is positive.

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