Intraoperative PTH monitoring during parathyroidectomy: the need for stricter criteria to detect multiglandular disease.
OBJECTIVE
Usefulness of rapid intraoperative parathyroid hormone assay (RI-PTH) for diagnosis of multiglandular disease during parathyroidectomy is still debated.


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.
Lombardi
Celestino Pio
CP
Division of Endocrine Surgery, Università Cattolica del S. Cuore, Policlinico A. Gemelli, L.go A Gemelli 8, 00168, Rome, Italy.
Raffaelli
Marco
M
Traini
Emanuela
E
Di Stasio
Enrico
E
Carrozza
Cinzia
C
De Crea
Carmela
C
Zuppi
Cecilia
C
Bellantone
Rocco
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D018365:Neoplasm, Residual / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D009378:Neoplasms, Multiple Primary / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy; D011237:Predictive Value of Tests; D012086:Reoperation; D019564:Unnecessary Procedures; D020535:Video-Assisted Surgery; D055815:Young Adult
D010281:Parathyroid Hormone