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

Celestino Pio Lombardi, Marco Raffaelli, Emanuela Traini, Enrico Di Stasio, Cinzia Carrozza, Carmela De Crea, Cecilia Zuppi, Rocco Domenico Alfonso Bellantone

Risultato della ricerca: Contributo in rivistaArticolo in rivista

50 Citazioni (Scopus)

Abstract

Purpose. Usefulness of rapid intraoperative parathyroid hormone assay (RI-PTH) for diagnosis of multiglandular disease during parathyroidectomy is still debated. Materials and methods. 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). Results. 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%. Conclusions. Despite the higher rate of unnecessary bilateral exploration, our criteria results in a lower FP, markedly reducing the risk of missing multiglandular disease.
Lingua originaleEnglish
pagine (da-a)639-645
Numero di pagine7
RivistaLangenbeck's Archives of Surgery
Stato di pubblicazionePubblicato - 2008

Keywords

  • Focused parathyroidectomy
  • Multiglandular disease
  • Parathyroid adenoma
  • Quick PTH assay

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