title: Intraoperative PTH monitoring during parathyroidectomy: the need for stricter criteria to detect multiglandular disease.
abstract: 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.
authors.affiliation: Division of Endocrine Surgery, Università Cattolica del S. Cuore, Policlinico A. Gemelli, L.go A Gemelli 8, 00168, Rome, Italy.
authors.forename: Celestino Pio
authors.initials: CP
authors.lastname: Lombardi
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.forename: Emanuela
authors.initials: E
authors.lastname: Traini
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
authors.forename: Cinzia
authors.initials: C
authors.lastname: Carrozza
authors.forename: Carmela
authors.initials: C
authors.lastname: De Crea
authors.forename: Cecilia
authors.initials: C
authors.lastname: Zuppi
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
mesh_terms: 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
chemical_list: D010281:Parathyroid Hormone