Parathyroid fine-needle aspiration cytology in the evaluation of parathyroid adenoma: cytologic findings from 53 patients

Abstract

This study was designed to assess the utility of fine-needle aspiration cytology (FNAC) in the preoperative localization of parathyroid adenoma (PA). Fifty-seven samples from fifty-three cases of PA (four patients had bilateral disease) were obtained by ultrasound (US)-guided fine-needle aspiration. Parathyroid hormone (PTH) estimation was performed on the supernatant of the aspirated fluid on all cases. Subsequently, all of them underwent cytologic evaluation. The cytology slides were evaluated using the following criteria: Cellularity, architectural patterns, bare nuclei in the background, nuclear morphology, and background features (colloid-like material or macrophages). Parathyroid cells were seen in 23 samples (40.4%). The cellularity of the smears was insufficient for interpretation in 16 samples (28.1%); and thyroid follicles and colloid were seen in 18 samples (31.5%). Majority of the samples with parathyroid cells showed moderate cellularity with monomorphous round to slightly oval cells predominantly arranged in loose two-dimensional clusters with occasional papillary fragments. Majority of them exhibited a stippled nuclear chromatin. No significant pleomorphism, mitotic activity, or prominent nucleoli were observed. Most samples showed bare nuclei in the background. In conclusion, US-guided FNAC has its limitations because of low sensitivity in primary localization of the parathyroid adenoma in cases of primary hyperparathyroidism and is not a useful mode of investigation in cases of PA.