Diagnosis of parathyroid incidentaloma detected during thyroid ultrasound: the role of fine-needle aspiration cytology and washout parathyroid hormone measurement
Boeun Lee1 , Sae Rom Chung2 , Young Jun Choi2 , Tae-Yon Sung2 , Dong Eun Song2 , Tae Yong Kim2 , Jeong Hyun Lee2 , Jung Hwan Baek2
1College of Medicine, Ewha Womans University, Ewha Womans University Seoul Hospital, Seoul , Korea
2Asan Medical Center, Seoul , Korea
Corresponding Author: Sae Rom Chung ,Tel: 010-4726-4842, Fax: 82-2-3010-4348, Email: jserom@naver.com
Received: June 22, 2022;  Accepted: August 28, 2022.  Published online: September 6, 2022.
To assess the diagnostic role of fine-needle aspiration cytology (FNAC) and analyze factors associated with false-negative FNAC results in patients with parathyroid incidentaloma who were referred for ultrasonography (US)-guided fine-needle aspiration (FNA) of thyroid nodules.
We enrolled 121 patients with suspected parathyroid lesions. The patients underwent US-guided FNAC with measurement of washout parathyroid hormone (PTH) between January 2015 and May 2020. The diagnostic performance of FNAC for the diagnosis of parathyroid lesion was assessed using surgical results and elevated washout PTH as a reference standard. The clinical and radiologic features associated with the false-negative results on FNAC for the diagnosis of parathyroid lesions were evaluated.
Among the 121 nodules assessed, 38 were parathyroid lesions (31.4%), and 83 were non-parathyroid lesions (68.6%). The diagnostic performance of FNAC for parathyroid incidentaloma showed a sensitivity of 31.6% (12/31), specificity of 100% (83/83), positive predictive values of 100% (12/12), negative predictive values of 76.1% (83/109), and accuracy of 78.5% (95/121). The FNAC results of non-parathyroid lesions included thyroid nodules, lymph nodes, neurogenic tumors, and fat tissue. The true-positive results on FNAC were significantly associated with performing FNA twice (58.3% vs. 23.1%, p=0.0434).
Considering the low sensitivity of FNAC, measuring washout PTH in addition to FNAC may help accurately diagnose parathyroid incidentaloma on thyroid US. Further, the false-negative rate for FNAC can be reduced by obtaining two or more FNA samples.
Keywords: Parathyroid incidentaloma ; neck US ; fine-needle aspiration cytology ; parathyroid hormone ; false negative
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