Parathyroid localization

Twenty-nine consecutive patients with suspected primary
hyperparathyroidism were examined preoperatively using ultrasound,
sonographically guided fine needle aspiration, and aspirate
immunostaining for PTH. In 25 patients, localization of enlarged
parathyroid glands was successful. In 2 patients, the tumors were
located retrosternally and, thus, could not be detected by
ultrasound. One patient had a multinodular goiter which impeded
localization. In 1 patient with renal osteodystrophy, 2 enlarged
parathyroid glands in the neck were not visualized preoperatively.
Cytology was not diagnostic, although some cytological features
were suggestive of parathyroid cells. Immunostaining of the
aspirated smears for PTH, however, correctly diagnosed all
preoperatively localized lesions. Ultrasound should be the routine
procedure of choice for preoperative localization of abnormal
parathyroid glands in primary hyperparathyroidism. Fine needle
aspiration and immunocytochemistry can supply confirmation, if
necessary.