Confirmation of Parathyroid Tissue: Are Surgeons Aware of New and Novel Techniques?

J Surg Res. 2020 Feb;246:139-144. doi: 10.1016/j.jss.2019.08.006. Epub 2019 Sep 27.

Abstract

Background: Ex vivo aspiration of parathyroid glands for the measurement of intraoperative parathyroid hormone (IOPTH) levels is a rapid point-of-care method to confirm parathyroid tissue during parathyroidectomy and an alternative to frozen section (FS). This study sought to determine the awareness and utilization of this technique among endocrine surgeons.

Materials and methods: A de-identified 12-question survey regarding techniques for intraoperative identification/confirmation of parathyroid tissue and the use of IOPTH monitoring was distributed to all 608 members of the American Association of Endocrine Surgeons.

Results: Among the 182 (30%) respondents, FS was the most common primary technique utilized by 115 (63%) respondents to confirm parathyroid tissue; only 12 (7%) utilized ex vivo aspiration, although 78 (42%) were familiar with the technique. Availability and familiarity were the principal reasons for use of the primary technique; the most common barrier was time. Serum IOPTH monitoring was routinely used by 124 (74%). Of respondents who utilized FS, serum IOPTH monitoring was routinely used by 75% (86/115), including 71% (45/63) who reported time as a barrier to FS. Of these 45, only 15 (33%) were familiar with ex vivo parathyroid aspiration. Only 48% of surgeons knew how PTH samples were charged.

Conclusions: FS was the most common method of identification/confirmation of parathyroid tissue. Although most respondents routinely performed IOPTH monitoring, relatively few utilized ex vivo aspiration as a technique for parathyroid identification and less than 50% were familiar with this technique. Broader dissemination about novel techniques such as ex vivo aspiration and cost awareness are recommended.

Keywords: Endocrine surgeons; Ex vivo parathyroid aspiration; Intraoperative parathyroid hormone monitoring; Parathyroid confirmation; Parathyroidectomy.

MeSH terms

  • Biopsy, Needle / statistics & numerical data
  • Clinical Competence / statistics & numerical data
  • Frozen Sections / statistics & numerical data
  • Humans
  • Hyperparathyroidism / surgery*
  • Intraoperative Care / methods*
  • Intraoperative Care / statistics & numerical data
  • Monitoring, Intraoperative / methods*
  • Monitoring, Intraoperative / statistics & numerical data
  • Parathyroid Glands / pathology*
  • Parathyroid Glands / surgery
  • Parathyroid Hormone / blood
  • Parathyroidectomy / methods*
  • Parathyroidectomy / statistics & numerical data
  • Point-of-Care Systems / statistics & numerical data
  • Surgeons / statistics & numerical data
  • Surveys and Questionnaires / statistics & numerical data
  • Time Factors

Substances

  • Parathyroid Hormone