Parathyroidectomy monitored by intra-operative PTH: The relevance of the 20 min end-point

Stasio, Enrico Di; Carrozza, Cinzia; Lombardi, Celestino Pio; Raffaelli, Marco; Traini, Emanuela; Bellantone, Rocco Domenico Alfonso; Zuppi, Cecilia

doi:10.1016/j.clinbiochem.2006.12.007

Cited by 39 publications

(36 citation statements)

References 28 publications

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“…Accordingly, operations were performed under local or general anesthesia, through a 2 to 4-cm transverse neck incision, with or without the use of video assistance. Intraoperative PTH levels were determined as described elsewhere, and a decrease of circulating PTH level by 50%, 20 minutes after excision of the enlarged parathyroid gland(s) was considered indicative of successful parathyroidectomy [14]. Most patients were discharged home the next day of surgery.…”

Section: Surgical Techniquementioning

confidence: 99%

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign

et al. 2015

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Aims: To review the detailed gray-scale and Doppler ultrasonography features of histologically proven parathyroid adenomas (PAs) evaluated with high-end ultrasonography devices and to present a novel ultrasonography finding called the dual concentric echo sign in PA with histopathologic correlation which was encountered during detailed analysis. Material and methods: Fifty-six PAs with histopathological result were enrolled. The longest dimension, shape, distance to skin surface, internal echo and Doppler US features obtained with high-end US devices were evaluated. Results: PAs had variable range of shape including oval, irregular, fusiform, lobulated, crescent-shaped, and nodular configuration. In nine patients the lesions were shown to have cystic components and calcifications were seen in four cases. Dual concentric echo sign was detected in 18% PAs. Histological reevaluation of this subgroup demonstrated significantly increased edema (p<0.01), and ectatic vessels (p=0.02) in the central part of the lesion compared to the rest of the PAs. Conclusions: The results of the study led to the conclusion that PAs have variable gray-scale and Doppler findings. Typical sonographic features like ovoid shape, homogeneously hypoechoic pattern may not be present in all PAs. Dual concentric echo sign which is a novel sonographic pattern may be suggestive of a PA.

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Section: Surgical Techniquementioning

confidence: 99%

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign

et al. 2015

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“…When the CV of duplicates exceeded 10%, the sample was reanalyzed. In our previous study, the RI-PTH assay was evaluated by comparing RI-PTH results with the Roche assay for routine intact PTH, using the automatic analyzer MODULAR E170® (Roche Diagnostics, Indianapolis, IN, USA) [24]. The two assays yielded similar results (r=0.94; n=85), but the RI-PTH assay showed a proportional negative bias relatively to the Roche assay, presumably due to different cross-reactions in the detection of (1-84) PTH as well as non-(1-84) fragments as by different analytical procedures [24].…”

Section: Methodsmentioning

confidence: 99%

“…In our previous study, the RI-PTH assay was evaluated by comparing RI-PTH results with the Roche assay for routine intact PTH, using the automatic analyzer MODULAR E170® (Roche Diagnostics, Indianapolis, IN, USA) [24]. The two assays yielded similar results (r=0.94; n=85), but the RI-PTH assay showed a proportional negative bias relatively to the Roche assay, presumably due to different cross-reactions in the detection of (1-84) PTH as well as non-(1-84) fragments as by different analytical procedures [24]. Basing on the results of the previously published paper, an appropriate correcting factor (0.67) was applied to convert RI-PTH to routine Roche PTH values (normal range 10-65 ng/L), so as to standardize interpretation criteria [24].…”

Section: Methodsmentioning

confidence: 99%

“…In a previously published study [24], we demonstrated that to obtain a higher specificity with RI-PTH it is necessary to extend the sampling period to 20 min after gland excision and to consider the residual PTH concentration. We found that the best predictors of operative failure and persistent (multiglandular) disease are a PTH drop of <50% at 20 min and/or a residual (at 20 min) PTH level above the normal range and/or a significant increase of the PTH levels between the sample obtained 20 min after gland excision with the respect to the 10-min sample.…”

Section: Introductionmentioning

confidence: 97%

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

Lombardi

Raffaelli

Traini

et al. 2008

Langenbecks Arch Surg

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“…In particular, blood collection timing appears to be a critical step (17). The widely used Miami criterion (rapid IOPTH value drop >50% from the highest levels either pre-incision or at 10 min after gland excision) is reported to have a high overall accuracy.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Liu

2016

Oncology Letters

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Abstract. The aim of this study was to highlight our experience over a 15-year period in dealing with primary hyperparathyroidism (PHPT) due to a parathyroid tumor. Parathyroidectomy is the standard therapy for patients with PHPT. Our study included all patients with PHPT treated by parathyroidectomy at the Affiliated Cancer Hospital of Zhengzhou University, China. Between 1998 and 2013, a total of 107 patients were recruited. Their clinical data, presentation, laboratory examinations, imageological diagnoses and surgical approaches were analyzed retrospectively. Eighty-four cases (78.5%) were followed up. During a median follow-up period of 5.7 years, a total of 80 patients were without recurrence and metastasis. The main symptoms of PHPT patients were palpable neck mass, joint pains and pathological fracture. The high levels of preoperative parathyroid hormone (PTH) and serum calcium in PHPT patients decreased to below the normal upper limit within 3 days of surgery. The sensitivity of neck ultrasonography, sestamibi scanning, CT, MRI and the combination of three or four types of test were 86.0%, 90.4%, 80.8%, 79.6% and 96.1%, respectively. A 50% or greater drop in PTH levels within 20 min compared with the highest PTH levels before surgery occurred in 95/107 cases (88.8%). Transient hypocalcemia was the most common surgical complication. The ultra sonography and sestamibi scan is the most effective examination for parathyroid tumor. The 20 min PTH measurement appears to be extremely useful, and avoids unnecessary bilateral exploration.

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Parathyroidectomy monitored by intra-operative PTH: The relevance of the 20 min end-point

Cited by 39 publications

References 28 publications

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign

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

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

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