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

Abstract

Despite the higher rate of unnecessary bilateral exploration, our criteria results in a lower FP, markedly reducing the risk of missing multiglandular disease.

Evaluation of Halle, Miami, Rome, and Vienna intraoperative iPTH assay criteria in guiding minimally invasive parathyroidectomy

“…Such an increase in the number of FN predictions has been described by many investigators, including our own data analysis. Lombardi et al was able to decrease the rate of FP results of IOPTH from 2.4% when using Miami criterion to 0.5% when using Rome criterion, which means an improved success rate of primary operation, but at the cost of the FN results rate increased by 11% [14]. This implies a potential increase in operative time, overall costs, and morbidity rate.…”

“…Rome criterion An iPTH decay greater than 50% from the highest preexcision level, and/or iPTH concentration within the reference range at 20 min postexcision, and/or ≤7.5 ng/L lower than the value at 10 min postexcision predicts cure from the hyperparathyroid state [14].…”

“…This operation termed minimally invasive parathyroidectomy (MIP) has successfully replaced conventional bilateral neck exploration in the treatment of most patients with sporadic primary hyperparathyroidism (pHPT) and positive preoperative parathyroid imaging result in many endocrine surgery centers worldwide [6][7][8][9][10][11]. Several investigators have reported their results using the various interpretation criteria of IOPTH levels after parathyroidectomy, and some of them have already been compared in a few retrospective institutional series [12][13][14][15][16]. These interpretation criteria were found not to be equivalent in detection of multiglandular disease (MGD) and predicting cure [16][17][18].…”

Surgical treatment of primary hyperparathyroidism due to parathyroid tumor: A 15-year experience

“…However, other authors have reported error rates as high as 16% due to false-negative and false-positive results (18). They suggested that 20 min of PTH monitoring should be performed (19). In this study, we performed IOPTH monitoring after 10 min if a >50% drop of PTH levels was not observed.…”

Utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone testing in guiding patients with a negative sestamibi scan for minimally invasive parathyroidectomy—a randomized controlled trial

“…In addition, selective venous sampling with iPTH estimation was found useful in regionalization of hypersecreting parathyroid tissue in cases of recurrent or persistent disease [15,16]. Moreover, it has become possible to intraoperatively monitor the quality of surgical treatment by intraoperative serum parathormone assay (IOPTH) [17][18][19][20]. Several groups have also tested the utility of intraoperative bilateral internal jugular venous (BIJV) sampling with IOPTH in lateralizing the side of the neck harboring a parathyroid adenoma with promising results [13,21].…”