The validity of quick intraoperative parathyroid hormone assay: an evaluation in seventy-two patients based on gross morphologic criteria.
BACKGROUND
Parathyroidectomy for primary hyperparathyroidism has conventionally required identification of all parathyroid glands with excision of grossly abnormal glands. Using this approach, cure rates exceed 95%. Directed cervical exploration has been advocated using quick intraoperative parathyroid hormone (QPTH) assay with preoperative localization. Adoption of this approach requires validation of the accuracy of QPTH assay.


METHODS
Patients with primary hyperparathyroidism undergoing bilateral neck exploration during a 31-month period were reviewed. Uniglandular (UGD) or multiglandular (MGD) disease was determined by gross morphologic criteria. QPTH assays were performed before skin incision and at 5, 10, and 20 minutes after excision of each abnormal gland. A 10-minute QPTH decrease of 50% from baseline levels indicated curative excision. These data were not used to guide extent of exploration or tissue resection.


RESULTS
Of 72 patients, 55 (76%) had UGD and 17 (24%) had MGD. QPTH assay accurately predicted the disease state in 89%. Four (7%) UGD patients did not have an appropriate QPTH decline at 10 minutes. Four (24%) MGD patients had an inappropriate QPTH decline at 10 minutes.


CONCLUSIONS
Using QPTH guided exploration, 6% (4 of 72) of patients would undergo unnecessary extended exploration and 6% (4 of 72) (95% CI, 1% to 13%) may require reoperation for unidentified MGD. These results validate the accuracy of QPTH assay.
Gordon
L L
LL
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9156, USA.
Snyder
W H
WH
Wians
F
F
Nwariaku
F
F
Kim
L T
LT
D002118:Calcium / Q000097:blood; D002624:Chemistry, Clinical / Q000592:standards*; D003951:Diagnostic Errors; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D007432:Intraoperative Period; D009333:Neck / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017211:Treatment Failure
D010281:Parathyroid Hormone; D002118:Calcium