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- Title
Incidental Diagnosis of Parathyroid Lesions by Preoperative Use of Next-Generation Molecular Testing.
- Authors
Bo, Wu; Schoedel, Karen E.; Carty, Sally E.; Radkay, Lisa A.; Ohori, N. Paul; Nikiforov, Yuri E.; Nikiforova, Marina N.; Yip, Linwah
- Abstract
Background: Parathyroid glands can mimic thyroid follicular lesions on fine-needle aspiration (FNA) cytology and can lead to unnecessary or incorrect surgery. Newer molecular panel tests using next-generation sequencing (NGS) include analysis of cell type-specific gene expression profiles such as parathyroid. The study aim is to determine the frequency and clinical implications of parathyroid tissue identification by molecular testing in cytologically indeterminate “thyroid” lesions.Methods: Molecular analysis of indeterminate thyroid FNA specimens is obtained routinely and relies on amplification-based NGS inclusive of PTH-specific expression profiles. For this study, we retrospectively examined the clinical data and management of patients with molecular results positive for PTH expression from May 2014 until May 2016.Results: Among 4765 consecutive patients with indeterminate cytology for a presumed thyroid nodule, NGS instead indicated a parathyroid lesion in 20 patients (0.42%). The clinical data of 15 patients were available, and the subsequent clinical management was altered in 93% (14/15 patients), including five (33%) eucalcemic patients who could avoid unnecessary surgery. Primary hyperparathyroidism was not suspected in seven patients until the molecular analysis results, and primary hyperparathyroidism was diagnosed in one (14%). During parathyroid exploration, most patients (6/8, 75%) required concurrent thyroidectomy or lobectomy, but thyroid preservation was still possible in two patients. A parathyroid gland was histologically confirmed in 89%.Conclusions: In 0.42% of patients with indeterminate cytology results, next-generation molecular results will indicate the presence of a parathyroid lesion. When this occurs, it is accurate and can robustly impact clinical management (93%).
- Subjects
PARATHYROID glands; NEEDLE biopsy; GENE expression; CYTOLOGY; HYPERPARATHYROIDISM
- Publication
World Journal of Surgery, 2018, Vol 42, Issue 9, p2840
- ISSN
0364-2313
- Publication type
Article
- DOI
10.1007/s00268-018-4548-3