Parathyroid Hormone, Fine-Needle Aspiration Biopsy (FNAB)-Needle Wash
An adjunct to cytology examination of fine-needle aspiration specimens to confirm or exclude presence of parathyroid tissue in the biopsied area
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Parathyroid hormone (PTH) is produced and secreted by the parathyroid glands, which are located along the posterior aspect of the thyroid gland. PTH analysis in rinse material obtained from fine-needle aspiration biopsies (FNAB) has gained popularity to discriminate thyroid tissues from enlarged parathyroid glands and also to facilitate parathyroid localization prior to surgery. Various groups have reported on the utility of this technique with specificity of 91% to100% and sensitivity of 91% to 100%. Measuring PTH in the rinse material proved very useful in cases of nondiagnostic cytology. Comparing the results of the PTH rinse material with serum PTH is highly recommended. An elevated PTH in the serum could falsely elevate PTH in the washings if the rinse is contaminated with blood. In these cases, only PTH values significantly higher than the serum should be considered as true positives.
Cytologic examination and measurement of PTH can be performed on the same specimen. To measure PTH, the fine-needle aspirate (FNA) needle is rinsed with a small volume of normal saline solution immediately after a specimen for cytological examination has been expelled from the needle for a smear or CytoTrap preparation. Specimen collection is critical for the performance of the assay and the needle should be rinsed with a minimal volume. Each FNA needle from a single biopsied area is washed with 0.1 to 0.5 mL of normal saline. The washes from a single area are pooled (final volume 1-1.5 mL). PTH levels are measured in the saline wash.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
Parathyroid hormone (PTH) values <100 pg/mL suggest the biopsied site does not contain PTH-secreting tissue.
PTH values > or =100 pg/mL are suggestive of the presence PTH-secreting tissue at the site biopsied or along the needle track.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test cannot distinguish between benign and malignant parathyroid tissue.
Immunometric assays can, in rare occasions, be subject to interferences such as "hooking" at very high analyte concentrations (false-low results) and heterophilic antibody interference (false-high results). If the clinical picture does not fit the laboratory result, these possibilities should be considered.
Results are dependent on accurate sampling and a maximum needle wash volume of < or =1.5 mL.
While the needle washes from several distinct needle passes or aspirations from a single area should be pooled, biopsies from different areas should be submitted as separate specimens.
A retrospective review of Mayo Clinic parathyroid hormone analysis in fine-needle aspiration biopsy washings ordered clinically between June 2008 and May 2011 identified 42 specimens with confirmed parathyroid tissue (n=19) and nonparathyroid tissue (n=23). The assay showed 100% specificity and 74% sensitivity for the detection of parathyroid tissue using a value > or =100 pg/mL as positive.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Erbil Y, Salmaslioglu A, Kabul E, et al: Use of preoperative parathyroid fine-needle asipiration and parathyroid hormone assay in primary hyperparathyroidism with concomitant thyroid nodules. Am J Surg 2007;193:665-671
2. Owens CL, Rekhtman N, Sokoll L, Ali SZ: Parathyroid hormone assay in fine-needle aspirate is useful in differentiating inadvertently sampled parathyroid tissue from thyroid lesions. Diagn Cytopathol 2008 Apr;36(4):227-331
3. Giusti M, Dolcino M, Vera L, et al: Institutional experience of PTH evaluation on fine-needle washing after aspiration biopsy to locate hyperfunctioning parathyroid tissue. J Zhejiang Univ Sci B 2009 May;10(5):323-330
4. Kiblut N, Cussac J, Soudan B, et al: Fine needle aspiration and intraparathyroid intact parathyroid hormone measurement for reoperative parathyroid surgery. World J Surg 2004 Nov;28(11):1143-1147