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Parathyroid incidentalomas detected on routine ultrasound-directed fine-needle aspiration biopsy in patients referred for thyroid nodules and the role of parathyroid hormone analysis in the samples

 Jin Young Kwak  ;  Eun-Kyung Kim  ;  Hee Jung Moon  ;  Min Jung Kim  ;  Sung Soo Ahn  ;  Eun Ju Son  ;  Yu-Mee Sohn 
 THYROID, Vol.19(7) : 743-748, 2009 
Journal Title
Issue Date
Adenoma/diagnostic imaging* ; Adenoma/epidemiology ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle* ; Female ; Humans ; Incidental Findings ; Male ; Middle Aged ; Parathyroid Glands/diagnostic imaging ; Parathyroid Hormone/analysis* ; Parathyroid Neoplasms/diagnostic imaging* ; Parathyroid Neoplasms/epidemiology ; Prevalence ; Retrospective Studies ; Thyroid Nodule/diagnostic imaging* ; Ultrasonography
BACKGROUND: The widespread use of high-resolution ultrasound (US) has allowed the detection of not only nonpalpable thyroid nodules but also parathyroid incidentalomas in the general population. We sought to determine the prevalence of parathyroid incidentalomas in a large group of patients referred for US-guided fineneedle aspiration biopsy (FNAB) of suspected thyroid nodules and to investigate the role of additional parathyroid hormone (PTH) analysis in the washouts of FNAB of suspicious papathyroid nodules in these patients. METHODS: Between June 2006 and December 2007, US-guided FNAB (US-FNAB) was performed in 6469 patients. Among them, 112 patients (1.7%) underwent additional PTH analysis in FNAB washouts (FNA-PTH) due to suspected parathyroid lesions. A retrospective review of clinical, radiologic, cytologic, and pathologic records was conducted. We evaluated the prevalence of parathyroid adenomas that were detected on thyroid US incidentally as well as the results of FNAB and FNA-PTH in parathyroid adenomas that were confirmed histopathologically. RESULTS: Parathyroid incidentalomas were identified in 14 patients based on pathology and 10 patients based on elevated FNA-PTH. The occurrence of parathyroid incidentalomas was 0.4% (24=6496) on thyroid US. For the detection of the incidentalomas, the positive predictive value (PPV) of thyroid US was 21.4% (24=112). When an inadequate specimen was considered as being of nonparathyroid origin, the sensitivity of FNAB was 41.7%, specificity was 97.7%, accuracy was 85.7%, PPV was 83.3%, and negative predictive value (NPV) was 86% in 112 patients. The diagnostic performance of FNA-PTH in 18 operated nodules showed a sensitivity of 92.9%, specificity of 100%, accuracy of 94.4%, PPV of 100%, and NPV of 80%. Four patients noticed symptoms related to hyperparathyroidism after FNA-PTH analysis. CONCLUSIONS: The prevalence of parathyroid incidentaloma was 0.4% (24=6496) in a large series of patients referred for suspected thyroid nodules. The use of FNA-PTH combined with FNAB can help clinicians accurately diagnose parathyroid incidentalomas at the time of US-guided FNAB
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0003-4949-1237
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Sohn, Yu Mee(손유미)
Son, Eun Ju(손은주) ORCID logo https://orcid.org/0000-0002-7895-0335
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-0503-5558
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