Intraoperative PTH monitoring during parathyroidectomy: the need for stricter criteria to detect multiglandular disease.

Division of Endocrine Surgery, Università Cattolica del S. Cuore, Policlinico A. Gemelli, L.go A Gemelli 8, 00168, Rome, Italy.
Langenbeck s Archives of Surgery (Impact Factor: 1.89). 09/2008; 393(5):639-45. DOI: 10.1007/s00423-008-0384-5
Source: PubMed

ABSTRACT Usefulness of rapid intraoperative parathyroid hormone assay (RI-PTH) for diagnosis of multiglandular disease during parathyroidectomy is still debated.
Two hundred seven patients were selected for focused parathyroidectomy for a suspicious single adenoma. RI-PTH results were interpreted on the basis of our criteria for prediction of multiglandular disease (a < 50% drop from the highest pre-excision level and/or a T20 concentration higher than reference range and/or >7.5 ng/L higher than the T10). The results of these criteria were compared with the Miami Criterion (MC).
One hundred ninety-seven uniglandular disease and ten multiglandular disease were found. Our criteria identified all but one patient with multiglandular disease (false positive (FP) rate 0.5%; specificity 90%). On the basis of MC, RI-PTH monitoring would have resulted in five FP results, with a specificity of 50%.
Despite the higher rate of unnecessary bilateral exploration, our criteria results in a lower FP, markedly reducing the risk of missing multiglandular disease.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Minimally-invasive procedures for parathyroidectomy have revolutionized the surgical treatment of primary hyperparathyroidism (pHPT). Coexistence of goitre is considered a major contraindication for these approaches, especially if unilateral. A specific advantage of video-assisted parathyroidectomy (VAP) compared to other endoscopic techniques is the possibility to combine it with thyroidectomy when necessary and when the selection criteria for video-assisted thyroidectomy (VAT) are met. We evaluated the role of VAP in a region with a high prevalence of goitre. The medical records of all patients who underwent parathyroidectomy and concomitant thyroid resection in our Division, between May 1998 and June 2012, were reviewed. Patients who underwent VAP and concomitant VAT were included in this study. Overall, in this period, 615 patients were treated in our Division for pHPT and 227 patients (36.9%) underwent concomitant thyroid resection. Among these, 384 patients were selected for VAP and 124 (32.3%) underwent concomitant VAT (lobectomy in 26 cases, total thyroidectomy in 98). No conversion to conventional surgery was registered. Mean operative time was 66.6 ± 43.6 min. Transient hypocalcaemia was observed in 42 cases. A transient recurrent nerve lesion was registered in one case. No other complications occurred. Final histology showed parathyroid adenoma in all but two cases of parathyroid carcinoma, benign goitre in 119 cases and papillary thyroid carcinoma in the remaining 5 patients. After a mean follow-up of 33.2 months, no persistent or recurrent disease was observed. In our experience, a video-assisted approach for the treatment of synchronous thyroid and parathyroid diseases is feasible, effective and safe at least considering short-term follow-up.
    Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 12/2013; 33(6):388-392. · 0.79 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To update the Diagnostic-Therapeutic-Healthcare Protocol (Protocollo Diagnostico-Terapeutico-Assistenziale, PDTA) created by the U.E.C. CLUB (Association of the Italian Endocrine Surgery Units) during the I Consensus Conference in 2008. In the preliminary phase, the II Consensus involved a selected group of experts; the elaboration phase was conducted via e-mail among all members; the conclusion phase took place during the X National Congress of the U.E.C. CLUB. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. The PDTA for parathyroid surgery approved by the II Consensus Conference (June 2013) is the official PDTA of the U.E.C. CLUB.
    Journal of endocrinological investigation 02/2014; 37(2):149-65. · 1.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives:To assess the feasibility of a simplified approach for the use of a rapid intraoperative parathyroid hormone assay (IOPTH) based on a single 10 min post-excisionlevel using the work-up parathyroid hormone level (wPTH) as the baseline in minimally invasive parathyroid surgery (MIP) and to compare the predictive value of this criterion with other recommended criteria. Study design: Case series with chart review Methods:A single surgeon's prospectively maintained parathyroidectomy database at an academic center was reviewed over a 2 year period from June 2009 through June 2011. Results: A total of 102 patients undergoing MIP met the inclusion criteria. An IOPTH threshold of ≥50% drop at 10 minutes post-excision from the wPTH baseline resulted in acceptable false positive (1.9%) and false negative (0.9%) rates.The sensitivity, specificity, PPV, NPV and accuracy of this modified criterion was 98.9%, 71.4%, 98%, 83.3% and 97% respectively. Conclusion: In our patient cohort, the pre-incision and pre-excisionIOPTH levels did not seem to change the overall accuracy of predicting surgical success in MIP if a single 10 min post-excision IOPTH level is used along with the wPTH, and is commensurate with the commonly used Miami and Vienna criteria. A single intraoperative blood sample demonstrating a ≥ 50% drop from the wPTH at 10 minutes post-excision should be explored further as a feasible simplified criterion which avoids multiple IOPTH samples.
    The Laryngoscope 01/2014; · 1.98 Impact Factor