scholarly journals Intraoperative Fine Needle Aspiration Parathyroid Hormone Assay Can Be Used as an Alternative to Frozen Section Analysis for the Identification of Parathyroid Tissue

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S43-S44
Author(s):  
A D Olivas ◽  
X M van Wijk ◽  
P Angelos
Keyword(s):  
Parathyroid Hormone ◽  
Fine Needle Aspiration ◽  
Frozen Section ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Fisher Exact Test ◽  
Tissue Samples ◽  
Fine Needle ◽  
Frozen Section Analysis ◽  
Section Analysis

Abstract Introduction/Objective Histologic frozen section analysis is typically used for parathyroid tissue identification during parathyroidectomy when needed, in conjunction with a rapid intraoperative plasma parathyroid hormone (PTH) assay to confirm falling levels of circulating PTH after parathyroid excision. As an alternative to frozen section consults, we hypothesize that automated analysis of intraoperative fine needle aspiration (ioFNA) tissue samples using a rapid PTH immunoassay can accurately identify parathyroid tissue and reduce the need for frozen section consults. Methods A rapid PTH immunoassay (Elecsys PTH STAT; Roche Diagnostics, Indianapolis, IN), currently used for intraoperative plasma samples, was validated for FNA samples on a Cobas® e411 using tissue aspirates of ex vivo parathyroid and control specimens rinsed in 1mL saline. ioFNA PTH results during parathyroidectomy were then prospectively assessed for accuracy over a 4-month period by comparing values to final histopathologic diagnoses. The number of frozen section consults requested was compared to a 5-month period prior to the availability of the ioFNA PTH assay. Results Ninety patients underwent parathyroidectomy (128 excised parathyroids) during the study period, performed by a single experienced endocrine surgeon. Indications included primary (81/90), tertiary (5/90), and recurrent (4/90) hyperparathyroidism. Thirty-nine cases (55.5 excised parathyroids) were performed after the availability of the ioFNA PTH assay. ioFNA samples were sent for PTH analysis in 7/39 cases (18%; 12 samples total) and had a sensitivity/specificity of 100% (parathyroid [n=7] PTH values 1968 - >5000pg/mL; non-parathyroid [n=5] PTH values <2 - 16pg/mL). Parathyroidectomies requiring frozen section consult significantly decreased from 41% (21/51 cases; 40 specimens) to 10% (4/39 cases; 9 specimens) with the availability of the ioFNA PTH assay (p< 0.05, Fisher exact test). Conclusion Analysis of ioFNA tissue samples using an automated rapid PTH immunoassay can accurately identify parathyroid tissue and can be used as an alternative to frozen section consult when needed.

Role of Fine-Needle Aspiration Biopsy and Frozen Section Analysis in the Surgical Management of Thyroid Tumors

2001 ◽  
Vol 8 (2) ◽  
pp. 92-100 ◽  
Author(s):  
Ari D. Brooks ◽  
Ashok R. Shaha ◽  
Wilson DuMornay ◽  
Andrew G. Huvos ◽  
Maureen Zakowski ◽  
...  
Keyword(s):  
Surgical Management ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Frozen Section ◽  
Needle Aspiration ◽  
Thyroid Tumors ◽  
Fine Needle ◽  
Frozen Section Analysis ◽  
Section Analysis

scholarly journals Spindle epithelial tumour with thymus-like differentiation: report of two cases

2020 ◽  
Vol 102 (2) ◽  
pp. e33-e35
Author(s):  
S Karaisli ◽  
M Haciyanli ◽  
S Gücek Haciyanli ◽  
C Tavusbay ◽  
EO Gur ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Fine Needle Aspiration Biopsy ◽  
Frozen Section ◽  
Needle Aspiration ◽  
Medullary Thyroid ◽  
Fine Needle ◽  
Frozen Section Analysis ◽  
Epithelial Tumour ◽  
Section Analysis

Spindle epithelial tumour with thymus-like differentiation (SETTLE) is a very rare neck malignancy arising from thymic tissue or branchial pouch, mostly seen in the early decades of life. SETTLE is thought to be a low-grade neoplasm but distant metastases have been reported. Fewer than 50 cases have been reported in the PubMed database. We report on the four-year follow-up for a 13-year-old boy, with no signs of recurrence or distant metastasis. In addition, a 45-year-old woman was admitted to hospital with neck mass. Fine-needle aspiration biopsy was compatible with medullary thyroid carcinoma but serum levels of calcitonin were normal. Total thyroidectomy and central compartment lymph node dissection was planned with an initial diagnosis of medullary thyroid carcinoma. At surgery, frozen section analysis converted our diagnosis to SETTLE and the intraoperative strategy was changed. SETTLE should be considered in a patient with normal serum calcitonin levels in the presence of suspicious medullary thyroid carcinoma at fine-needle aspiration biopsy. Frozen section analysis may help to manage the intraoperative strategy. This report describes the first case of SETTLE successfully diagnosed by frozen section analysis.

Fine-Needle Aspiration with Immunohistochemistry Using a Modified Scrape Cell Block Technique for the Diagnosis of Thyroid and Parathyroid Nodules

2016 ◽  
Vol 60 (2) ◽  
pp. 118-130 ◽  
Author(s):  
Franz G. Wuertz ◽  
Ewald Kresnik ◽  
Philipp Malle ◽  
Martin Hyden ◽  
Peter Lind ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Fine Needle Aspiration ◽  
Chromogranin A ◽  
Parathyroid Tissue ◽  
Needle Aspiration ◽  
Cell Block ◽  
Primary Tumors ◽  
Fine Needle ◽  
3 Dimensional ◽  
Parathyroid Adenomas

Objective: To evaluate the diagnostic accuracy of a modified scrape cell block (SCB) technique in a large series of patients. The technique was especially developed and tested for fine-needle aspiration of thyroid and parathyroid nodules. Study Design: Eighty-two ultrasound-guided fine-needle aspiration specimens with the sonographic aspect of a thyroid (n = 33) or a possible parathyroid nodule (n = 49) were studied. Immunohistochemistry (IHC) was used on cell blocks containing plasma, thromboplastin, and selected 3-dimensional cell aggregates scraped off Papanicolaou-stained smears. Antibodies for chromogranin A, thyroglobulin, parathyroid hormone, calcitonin, and carcinoembryonic antibody (CEA) were used. In cases of reduced immunosensitivity or suspected metastases or rare primary tumors, additional IHC markers were employed. Results: Chromogranin A was expressed in all 28 parathyroid adenomas (PA), in 7 of 8 hyperplastic parathyroid glands, and in 13 of 14 medullary thyroid carcinomas (MTC). When combining positivity for chromogranin A and calcitonin/CEA, the specificity for the detection of MTC was 100%. Parathyroid hormone was expressed in 26 of 36 parathyroid nodules (72.2%). When combining follicular microarchitecture and expression of chromogranin A, the specificity for the detection of parathyroid tissue was 97%. Conclusion: With the modified SCB technique, accurate cytological diagnoses were obtained in 97.6% of 82 patients.

Management of Thyroid Nodules in Deceased Donors With Comparison Between Fine Needle Aspiration and Intraoperative Frozen Section in the Setting of Transplantation

2019 ◽  
Vol 29 (4) ◽  
pp. 316-320 ◽  
Author(s):  
Albino Eccher ◽  
Ilaria Girolami ◽  
Antonia D’Errico ◽  
Gianluigi Zaza ◽  
Amedeo Carraro ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Frozen Section ◽  
Clinical History ◽  
Needle Aspiration ◽  
Transmission Risk ◽  
Fine Needle ◽  
Intraoperative Frozen Section ◽  
History Of ◽  
Deceased Donors

Introduction: Newly discovered thyroid nodules in deceased donors are investigated to rule out cancer that can be transmitted, but there are no established protocols. The aim of the study was to compare fine needle aspiration versus intraoperative frozen section in the donor management with limited time. Methods: Data were extracted only from the records of Italian second opinion consultation service in the years 2016 to 2017 and included donor details, pathology diagnoses, complications, transmission risk profile, and impact on transplantation. Results: Among 31 deceased donors with thyroid nodules, we documented 4 with a clinical history of cancer and 27 with a newly discovered nodule. The latter was evaluated by thyroidectomy with frozen section in 22 and fine needle aspiration in 5. Among all donors, 7 had papillary thyroid carcinoma with negligible transmission risk, whereas 8 with unacceptable risk. Two donors presented major bleeding after thyroidectomy, with organ discard in 1 case. Transplantation was delayed in 4 cases that were evaluated with frozen section. Discussion: There was no uniform approach for the investigation of thyroid nodules. Our results showed that fine needle aspiration was more accurate and useful than frozen section. Fine needle aspiration had minor economic impact and a far less rate of bleeding/hemodynamic complications, potentially delaying and compromising organ recovery. Our results suggested considering fine needle aspiration as a first step in the evaluation of thyroid nodules in donors.

Diminished Dose Minimally Invasive Radioguided Parathyroidectomy: A Case for Radioguidance

2007 ◽  
Vol 73 (7) ◽  
pp. 669-672 ◽  
Author(s):  
Christopher J. You ◽  
John L. Zapas
Keyword(s):  
Parathyroid Hormone ◽  
Minimally Invasive ◽  
Frozen Section ◽  
Standard Dose ◽  
Intraoperative Mapping ◽  
Parathyroid Hormone Monitoring ◽  
Frozen Section Analysis ◽  
Radioguided Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Section Analysis

Minimally invasive radioguided parathyroidectomy (MIRP) has been established as an alternative to bilateral neck exploration (BNE) for primary hyperparathyroidism. We investigate whether a diminished dose of technetium-99m sestamibi gives similar results to the standard dose. One hundred one patients were offered MIRP or diminished-dose MIRP (ddMIRP). Patients received intravenous Tc-99m sestamibi at a dose of either 25 mCi 1.5 hours or 5 mCi 1 hour preoperatively. The procedure was terminated when the 20 per cent rule was satisfied. All tissue was confirmed to be parathyroid tissue by frozen section analysis. In addition, intraoperative parathyroid hormone levels were measured in a majority of patients. Patients who failed IOM underwent BNE. Frozen section analysis and intraoperative parathyroid hormone monitoring were also performed in the BNEs. Postoperatively, serum calcium levels were measured at 1 week and 6 months. Fifteen per cent of patients were male and 85 per cent were female. The median age was 63 years (range, 25–89 years). The first 58 patients had the standard dose of 25 mCi, whereas 43 patients had ddMIRP. Six patients (10%) failed intraoperative mapping in the MIRP group and were found to have single-gland disease. Five patients (12%) failed intraoperative mapping in the ddMIRP group. However, two patients were identified to have multigland disease making the true failure rate of intraoperative mapping 7 per cent (three patients). Median operative times for MIRP, ddMIRP, and BNE were 40 minutes, 46 minutes, and 105 minutes, respectively. The 20 per cent rule was satisfied in 96 per cent of patients undergoing MIRP and 98 per cent of patients undergoing ddMIRP. Frozen section analysis and intraoperative parathyroid hormone monitoring did not result in a change in management. Median follow up was 193 days and serum calcium levels at 6 months were normal. Diminished-dose MIRP is a feasible alternative to standard-dose MIRP without compromising surgical outcomes.

Sign in / Sign up

Export Citation Format

Share Document