Preoperational Fine Needle Aspiration of Pathological Parathyroid Gland
Preoperational Fine Needle Aspiration of Pathological Parathyroid Gland
Identification and localization of pathological parathyroid gland before parathyroidectomy is
 traditionally done by a combination of two methods: ultrasound and sestamibi scan. The
 investigators would like to show that one exam that includes ultrasound and fine needle
 aspiration of the parathyroid gland for parathyroid hormone level is as accurate as the
 traditional method.
A prospective, open label, single arm trial that includes participants that suffer
 hypercalcemia due to primary hyperparathyroidism and are candidates for parathyroidectomy.

 participants visit the investigator's head and neck clinic. the investigator confirms that
 the participant has an indication for parathyroidectomy according to the official criteria.
 Later on, the investigator looks at the localization tests that have already been done (neck
 ultrasound and MIBI [methoxyisobutyllisonitrile] scan) in order to plan the surgery. In case
 participant has not made those tests- the investigator fills a written request to do so.
 then, the investigator will perform a neck ultrasound and identifies the pathological
 parathyroid gland. The suspected pathological gland is aspirated using a 27 gauge needle
 attached to a 5 cc syringe fills with 1 cc saline (0.9% NaCL) under the guidance of the
 ultrasound. The aspirated material is sent for 2 examinations:

 1. parathyroid hormone level: the aspirated material is injected into a
 ethylenediaminetetraacetic acid (EDTA) vial and send to the hospital's endocrine
 laboratory. the parathyroid hormone level is processed using chemiluminescence method
 and represented in Pg/ml units.

 2. cytology examination. The aspirated material is spread on a glassed slide and prepared
 with a Giemsa stain for a cytologic examination. cytologic features such as cell type,
 cytoplasmic characteristics,cell block structure and chromatin appearance is addressed
 by the pathologist.

 After completion of the ultrasound - guided needle aspiration the participant is given an
 exact date for the surgery.

 The surgery is carried out routinely with the same surgical steps that the investigator is
 familiar with. At the end of surgery, after the pathological parathyroid gland was extracted
 from the neck, it is aspirated with a 27Gy needle attached to a 5 cc, syringe filled with a 1
 cc saline (0.9% NaCL).

 The aspirated material is sent to the same, above mentioned, examinations (parathyroid
 hormone level and cytology).

 After the investigator receives the final pathological result of the suspected gland and
 confirm that the excised tissue was indeed a pathological parathyroid one, the investigators
 are able to answer 2 important questions:

 1. Is high level of parathyroid hormone which was aspirated from a suspected pathological
 parathyroid tissue is a good indicator that the tissue is indeed a pathological
 parathyroid.

 2. Is there a difference between parathyroid cytology of a tissue aspirated
 transcutaneously to a parathyroid cytology of material aspirated directly from the
 parathyroid gland.
Inclusion Criteria:

 -  above 18 years old

 -  participants that suffer from primary hyperparathyroidism with an indication for
 parathyroidectomy

 Exclusion Criteria:

 -  Chronic renal failure

 -  kidney transplant participant

 -  MEN (multiple endocrine neoplasia) syndrome

 -  pregnancy