A 15-year experience: intraoperative parathyroid hormone assay for the management of primary hyperparathyroidism in a UK endocrine surgical unit

被引:4
|
作者
Patel, N. [1 ]
Whittet, C. [1 ]
Zhao, D. [1 ]
Rees, J. [2 ]
Stechman, M. J. [1 ]
Scott-Coombes, D. M. [1 ]
机构
[1] Univ Hosp Wales, Dept Endocrine & Gen Surg, Heath Pk Way, Heath Pk, Cardiff CF14 4XW, Wales
[2] Univ Hosp Wales, Dept Radiol, Heath Pk Way,Heath Pk, Cardiff CF14 4XW, Wales
关键词
Intraoperative parathyroid hormone assay; Hyperparathyroidism; Parathyroidectomy; Normocalcaemia; MINIMALLY INVASIVE PARATHYROIDECTOMY; SURGERY; LOCALIZATION; EXPLORATION; ANESTHESIA; OUTCOMES; RATES; CURE;
D O I
10.1007/s00423-023-02848-x
中图分类号
R61 [外科手术学];
学科分类号
摘要
PurposeThis study aims to evaluate the outcomes of first-time parathyroidectomy for primary hyperparathyroidism using intraoperative PTH (IOPTH) assay in the light of the UK National Institute for Health and Care Excellence (NICE) guidelines for the management of primary hyperparathyroidism.MethodThis is a retrospective cohort analysis of a prospectively maintained database of endocrine surgery in a tertiary centre. Preoperative radiological localisation (concordance and accuracy), intraoperative PTH parameters and adjusted serum calcium at minimum 6-month follow-up were analysed. The accuracy of IOPTH to predict post-operative normocalcaemia and the number needed to treat (NNT) within the cohort when IOPTH was utilised were determined. Differences between groups were evaluated with Chi-squared and Fisher's exact test.ResultsBetween January 2004 and September 2018, 849 patients (75.4% women), median age 64 years (IQR 54-72), were analysed. The median preoperative adjusted serum calcium was 2.80mmol/l (IQR 2.78-2.90), and the median preoperative PTH was 14.20pmol/l (IQR 10.70-20.25). The overall first-time cure (normocalcaemia) rate was 96.4%. The sensitivity, specificity, positive predictive value and negative predictive values of IOPTH were 96.8%, 83.2%, 97.6% and 78.8%, respectively, with an accuracy of 95.1%. For patients with concordant scans (48.3%), a targeted approach without IOPTH would have achieved a cure rate of 94.1% compared with 98.0% using IOPTH (p<0.01)ConclusionThe use of IOPTH assay significantly improved the rate of normocalcaemia at 6 months. The low NNT to benefit from IOPTH, particularly those patients with a single positive scan, and the inevitable reduction in the potential costs incurred from failure and reoperation justify its utilisation.
引用
收藏
页数:7
相关论文
共 50 条
  • [21] Stricter criteria increase the validity of a quick intraoperative parathyroid hormone assay in primary hyperparathyroidism
    Lupoli, Gelsy Arianna
    Fonderico, Francesco
    Panico, Annalisa
    Del Prete, Michela
    Marciello, Francesca
    Granieri, Luciana
    Manguso, Francesco
    Misso, Claudio
    Marzano, Luigi Antonio
    Lupoli, Giovanni
    MEDICAL SCIENCE MONITOR, 2009, 15 (03): : CR111 - CR116
  • [22] Validation of a Rapid Parathyroid Hormone Assay and Intraoperative Measurement of Parathyroid Hormone in Dogs with Benign Naturally Occurring Primary Hyperparathyroidism
    Ham, Kathleen
    Greenfield, Cathy L.
    Barger, Anne
    Schaeffer, David
    Ehrhart, Eugene J.
    Pinkerton, Marie
    Valli, Victor E. O.
    VETERINARY SURGERY, 2009, 38 (01) : 122 - 132
  • [23] Reply to Letter to Editor regarding "Economic impact of intraoperative parathyroid hormone assay in primary hyperparathyroidism?"
    Badii, Benedetta
    Staderini, Fabio
    Foppa, Caterina
    Tofani, Lorenzo
    Skalamera, Ileana
    Fiorenza, Giulia
    Qirici, Etleva
    Cianchi, Fabio
    Perigli, Giuliano
    HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, 2018, 40 (02): : 446 - 446
  • [24] INTRAOPERATIVE MEASUREMENTS OF TOTAL PLASMATIC PARATHYROID-HORMONE IN THE MANAGEMENT OF SURGERY FOR PRIMARY HYPERPARATHYROIDISM
    DUQUENNE, M
    ROCHE, O
    DETALANCE, N
    DURIEZ, T
    BISCHOFF, N
    AVILA, J
    WERYHA, G
    MATHIEU, P
    LECLERE, J
    ANNALES D ENDOCRINOLOGIE, 1992, 53 (03) : 102 - 106
  • [25] Usefullness of intraoperatory parathyroid hormone measurement in surgical management of primary hyperparathyroidism due to a parathyroid adenoma
    Obiols, G
    Catalán, R
    Alasà, C
    Baena, JA
    Fort, JM
    Gémar, E
    Mesa, J
    MEDICINA CLINICA, 2003, 121 (08): : 287 - 291
  • [26] A 10-Year Experience in Intraoperative Parathyroid Hormone Measurements for Primary Hyperparathyroidism: A Prospective Study of 91 Previous Unexplored Patients
    Neves, M. C.
    Ohe, M. N.
    Rosano, M.
    Abrahao, M.
    Cervantes, O.
    Lazaretti-Castro, M.
    Vieira, J. G. H.
    Kunii, I. S.
    Santos, Andr. O.
    JOURNAL OF OSTEOPOROSIS, 2012, 2012
  • [27] Accuracy of Preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma
    Haciyanli, M
    Lal, G
    Morita, E
    Duh, QY
    Kebebew, E
    Clark, OH
    JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2003, 197 (05) : 739 - 746
  • [28] Intraoperative parathyroid hormone (IOPTH) assay might be better than the second-generation assay in parathyroidectomy for primary hyperparathyroidism
    Lang, Brian Hung-Hin
    Fung, Matrix Man Him
    SURGERY, 2021, 169 (01) : 109 - 113
  • [29] Management and surgical treatment of parathyroid carcinoma: a 6-year experience of a single centre of endocrine surgery unit
    Laforgia, Rita
    Tomasicchio, Giovanni
    Cavalera, Federica
    Sblendorio, Maria
    Spadone, Annamaria
    Anelli, Ferdinando Massimiliano
    Lobascio, Pierluigi
    Marzaioli, Rinaldo
    Panebianco, Annunziata
    Pezzolla, Angela
    FRONTIERS IN ENDOCRINOLOGY, 2023, 14
  • [30] Surgical management and outcome of tuberculous atlantoaxial dislocation: A 15-year experience
    Sinha, S
    Singh, AK
    Gupta, V
    Singh, D
    Takayasu, M
    Yoshida, J
    NEUROSURGERY, 2003, 52 (02) : 331 - 338