Parathyroid Biopsies: Heavy Handed Technique Causes Complications
Kim J et al J.Otolary. Head and neck surgery 2017
A report of prior parathyroid biopsy causeing fibrosis of the adenoma to resemble carcinoma, and a needle tract seeding of the adenoma.
Comment: The endocrine neck team of teachers at AACE have described the method to do these biopsies safely. Parathyroid complications occur when a large bore needle is used, and more than one needle is used. The needle must be #27 and there will be no suction. The entrance into the gland should be followed by just spinning the needle 360 degress and withdraw. Adenomas are bloody “there will be blood”, so you should see blood on the needle as you do needle washout for PTH. The multiple stabs with large needle to get cytology is called “Parathyroid Death by Biopsy”.
DO NOT DO PARATHYROID BIOPSIES UNLESS YOU UNDERSTAND HOW DELICATE THE GLAND IS AND HOW YOU HAVE TO BE DELICATE TOO.
Richard Guttler MD,FACE,ECNU
Parathyroid biopsies are a necessary procedure in the work up of some cases of parathyroid adenomas. Have an expert in proper technique do the correct way if it is needed. Parathyroid evaluations available prior to surgery if needed at my center. We only refer to expert parathyroid surgeons if you are a candidate. Call 310-393-8860 and talk to Matt about our diagnostic and referral program for parathyroid disease surgery.
Image of a parathyroid adenoma next to the thyroid lobe.