Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population

Abstract

Background: Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single-and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population.Methods: Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P<0.05 was accepted as significant.Results: Two hundred and eighty-one patients who underwent successful surgery from January 2001 to December 2018 were included. Single-gland disease was detected in 92.5%, and 73.7% had a CaPTHUS score of ≥3. The sensitivity, specificity, positive and negative predictive values of this model for predicting singlegland disease with a score of ≥3 were 76.9%, 66.7%, 96.6%, and 18.9% respectively. The area under the curve value of the CaPTHUS score for predicting single-gland disease was 0.74. A Wisconsin Index >2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%.Conclusions: Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed.

Use of Parathyroid Function Index and Wisconsin Index to Differentiate Primary Hyperparathyroidism From Secondary Hyperparathyroidism: A Case-Control Study

“…However, in this study, the Wisconsin Index was designed to decide whether to expect an intraoperative PTH value during parathyroidectomy and whether a more comprehensive exploration would be needed in parathyroidectomy, rather than the differential diagnosis of PHPT. In addition, two studies published in 2021 evaluated the usefulness of WIN in predicting monoglandular and multiglandular disease in PHPT, and it was shown that it is not as helpful as intraoperative PTH in predicting the multiglandular disease [ 18 , 19 ]. In this study, WIN was used for the first time for differential diagnosis.…”

A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease

“…It can predict MGPD in those with positive imaging but is unreliable in patients with mild disease and low adenoma weight which are more common presentations of MGPD [15,31]. Whilst useful, [32], both the Wisconsin index and CaPTHUS score have been found to have variable sensitivity, specificity, positive and negative predictive values [33][34][35][36] and thus have not found universal acceptance and do not feature in national guidelines on the surgical management of hyperparathyroidism [37][38][39].…”

Prediction of multiglandular parathyroid disease in primary hyperparathyroidism using ultrasound and clinical features

“…The Wisconsin Index (WIN) predicts the probability of additional hyperfunctioning glands during surgery and uses preoperative parathyroid hormone (PTH) levels and lesion weight during surgery ( 13 ). Their clinical values have been validated ( 14 , 15 ). However, neither of them can be used to improve the efficacy of MGD diagnosis preoperatively.…”