The validity of quick intraoperative parathyroid hormone assay: An evaluation in seventy-two patients based on gross morphologic criteria

Gordon, Lori L.; Snyder, William H.; Wians, Frank H.; Nwariaku, Fiemu E.; Kim, Lawrence T.

doi:10.1067/msy.2099.101833

Cited by 133 publications

(81 citation statements)

References 12 publications

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“…Nevertheless, due to the low prevalence of double adenomas, adopting other criteria to define a biochemical intraoperative cure would lead to make surgery more tedious for more than 95% of patients with single gland disease submitted to limited surgery (it prolongs the operating room waiting time too much and may lead to spurious reconversions into bilateral neck exploration). Gordon et al (1999) support these results; their group, on the validation of the quick ioPTHi assay, included 14 patients with double adenoma. These authors described that 4 of 14 patients with double adenoma cases showed a greater than 50% decrease in ioPTHi after resection of the first lesion, which was always heavier than the second.…”

Section: Causes Of Failures In the Iopthi Techniquesupporting

confidence: 56%

Radio-Guided Surgery and Intraoperative iPTH Determination in the Treatment of Primary Hyperparathyroidism

García-Talavera¹,

García-Talavera²

2012

Hyperparathyroidism

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Section: Causes Of Failures In the Iopthi Techniquesupporting

confidence: 56%

Radio-Guided Surgery and Intraoperative iPTH Determination in the Treatment of Primary Hyperparathyroidism

García-Talavera¹,

García-Talavera²

2012

Hyperparathyroidism

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“…Determining surgical cure based on the Miami criterion of a 50% decline in intraoperative PTH (ioPTH) from the highest preoperative baseline 10 minutes after excision [61,62] is of interest in the patients who have a normal preoperative parathyroid hormone level (NHHPT). There are five other criterion for surgical cure of pHPT that have been published [63], including: .50% decline in ioPTH after 10 minutes from preincision level [64], . 50% drop from the highest ioPTH level at 10 minutes after gland excision and a final ioPTH level less than the preincision value [65], .50% drop from the highest ioPTH level at 10 minutes after gland excision and a final ioPTH level within the reference range [66], .50% drop after 5 minutes from highest ioPTH [67], and .50% drop in ioPTH from the preexcision level after 10 minutes [68].…”

Section: Surgicalmentioning

confidence: 99%

Mild Primary Hyperparathyroidism: A Literature Review

Applewhite

Schneider

2014

The Oncologist

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The biochemical profile of classic primary hyperparathyroidism (pHPT) consists of both elevated calcium and parathyroid hormone levels. The standard of care is parathyroidectomy unless prohibited by medical comorbidities. Because more patients are undergoing routine bone density evaluation and neck imaging studies for other purposes, there is a subset of people identified with a biochemically mild form of the pHPT that expresses itself as either elevated calcium or parathyroid hormone levels. These patients often do not fall into the criteria for operation based on the National Institutes of Health consensus guidelines, and they can present a challenge of diagnosis and management. The purpose of this paper is to review the available literature on mild pHPT in an effort to better characterize this patient population and to determine whether patients benefit from parathyroidectomy. Evidence suggests that there are patients with mild pHPTwho have overt symptoms that are found to improve after parathyroidectomy. There is also a group of patients with biochemically mild pHPT who are found to progress to classic pHPT over time; however, it is not predictable which group of patients this will be. Early intervention for this group with mild pHPT may prevent progression of bone, psychiatric, and renal complications, and parathyroidectomy has proven safe in appropriately selected patients at high volume centers. The Oncologist 2014;19:919-929 Implications for Practice: Mild primary hyperparathyroidism (pHPT) is a disease that is being diagnosed with increased frequency; however, recommendations for treatment are not uniform. Current NIH guidelines do not recommend parathyroidectomy for these patients if they are asymptomatic; however, upon focused questioning, many of these patients are found to have subtle symptoms.The biochemically mild nature of the disease has been found to delay diagnosis and treatment, but after it is identified, surgery has shown to provide an improvement in quality of life and bone health. Although the current body of literature suggests that patients with mild pHPT benefit from parathyroidectomy, careful patient and surgeon selection is critical to ensuring safety and efficacy. Universal acceptance of parathyroidectomy in this subset of patients will require more high quality, prospective studies and improved definitions of long-term cure.

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“…Therefore, both false negative and false positive results have occurred in the interpretation of the intraoperative iPTH test. These pitfalls prompted the modification of the originally proposed methodology of evaluation [2,[4][5][6][7][8][9]. Table 1 reports the seven main criteria that have been proposed taking into account also PTH values during the pre-incision/ preexcision interval [10,11].…”

mentioning

confidence: 99%

Intraoperative PTH monitoring: a new approach based on the identification of the “true” time origin of the decay curve

et al. 2014

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Abstract. Some published criteria for intraoperative monitoring of PTH serum concentrations may cause misleading results, since the timing of samples measured between the pre-incision and pre-excision phase of surgery is often unrecorded. In our opinion this information is critical, as the time of an intermediate sample during surgical manipulation may represent the "true" beginning of the PTH decay. We modified the usual criterion of monitoring (cut-off at 10 minutes after clamping) proposing a further check at manipulation in case the primary check at clamping produces an apparently negative result. On the basis of a mathematical model, false negative curves were simulated by means of a time shift. This shift was assumed to be the interval between manipulation and clamping. Analysing the decay curve, we used the 50% cut-off at 10 minutes after the supposed "true" origin (clamping or manipulation). Using a rapid immunochemiluminometric assay (ICMA), data were collected from 22 patients successfully operated for parathyroid adenoma. The check at clamping correctly diagnosed 13 patients. Among the 9 false negative cases, 6 were correctly diagnosed considering the manipulation as the baseline value. In the remaining 3 patients, diagnosis required prolonged observation of the curves. In case the iPTH decay does not follow the expected curve, it can be useful to check the decay normalising to a pre-excision value. The advantages of our criterion are both the prompt recognition of false negative results and the construction of a "true" decay curve for each patient, supporting the surgeon during the excision of hyperfunctioning parathyroid tissue.

show abstract

The validity of quick intraoperative parathyroid hormone assay: An evaluation in seventy-two patients based on gross morphologic criteria

Cited by 133 publications

References 12 publications

Radio-Guided Surgery and Intraoperative iPTH Determination in the Treatment of Primary Hyperparathyroidism

Radio-Guided Surgery and Intraoperative iPTH Determination in the Treatment of Primary Hyperparathyroidism

Mild Primary Hyperparathyroidism: A Literature Review

Intraoperative PTH monitoring: a new approach based on the identification of the “true” time origin of the decay curve

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