Ultrasonography and needle aspiration cytology in the diagnosis and management of parathyroid lesions.
To elucidate the diagnostic value of fine needle aspiration (FNA) cytology of ultrasonically suspected parathyroid lesions, we reviewed a series of 17 cases seen over the past two years. Patients with biochemically proven primary or secondary hyperparathyroidism were examined by ultrasonography using a 7.5-MHz linear transducer. Ultrasound-guided FNA cytologic examinations with Riu's stain were performed on 13 patients who had questionable ultrasonographic patterns. The aspirates were considered adequate in nine out of 13 cases (69%). The cytologic patterns, characterized by tight cohesion of naked nuclei with indistinct cell border showing hypermonomorphism and overlapping of nuclei, were noted in adenomatous and hyperplastic lesions. There were several different findings noted in the case of parathyroid carcinoma, including loose cohesion of nuclei, larger nuclear size, and prominent anisokaryosis. One patient with secondary hyperparathyroidism who previously had a neck exploration, received an ultrasonically-guided percutaneous alcohol injection to the parathyroid lesion after cytologic verification. The result was remarkable both in volume reduction and in clinical improvement. The results suggest that ultrasound-guided FNA cytologic examination with Riu's stain is safe, simple and helpful in the localization of parathyroid lesions prior to surgery or percutaneous alcohol ablation therapy.