Intraoperative PTH monitoring during parathyroidectomy: the need for stricter criteria to detect multiglandular disease.
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.
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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
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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
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ABSTRACT: Hyperparathyroidism is a well known disease group, with extensive surgical application. In the last two decades, preoperative imaging investigations and surgical approach to primary hyperparathyroidism have changed. While bilateral neck exploration was the former standard procedure, minimally invasive parathyroidectomy has become the present standard procedure for most surgeons. Quick parathormone assay is an effective method that aids the decision to terminate the surgery. However, there is no consensus about which criterion should be used while giving the decision of termination. In this report, we reviewed trials in which different quick parathormon assay criteria have been used.Journal of Dialog in Endocrinology. 01/2012; 9(1):27-30.