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

• DOI: 10.1007/s00423-008-0384-5
• Publication Date: 2008-07-23T10:46:11Z
• Authors: Celestino Pio Lom...; Marco Raffaelli; Emanuela Traini; Enrico Di Stasio; Cinzia Carrozza; Carmela De Crea; Cecilia Zuppi; Rocco Bellantone
• Keywords: Multiglandular disease; Adult; Male; Reoperation; Neoplasm, Residual; Video-Assisted Surgery; Unnecessary Procedures; parathyroidectomy; Neoplasms, Multiple Primary; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Monitoring, Intraoperative; Humans; Intraoperative Complications; Quick PTH; Aged; Focused parathyroidectomy; Aged, 80 and over; Parathyroidectomy; Hyperparathyroidism; Parathyroid adenoma; Middle Aged; 3. Good health; Parathyroid Neoplasms; Parathyroid Hormone; parathyroid surgery; Female; Quick PTH assay; PTH

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.