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

  • Current Concepts in Endocrine Surgery
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Abstract

Purpose

Usefulness of rapid intraoperative parathyroid hormone assay (RI-PTH) for diagnosis of multiglandular disease during parathyroidectomy is still debated.

Materials and methods

Two hundred seven patients were selected for focused parathyroidectomy for a suspicious single adenoma. RI-PTH results were interpreted on the basis of our criteria for prediction of multiglandular disease (a < 50% drop from the highest pre-excision level and/or a T20 concentration higher than reference range and/or >7.5 ng/L higher than the T10). The results of these criteria were compared with the Miami Criterion (MC).

Results

One hundred ninety-seven uniglandular disease and ten multiglandular disease were found. Our criteria identified all but one patient with multiglandular disease (false positive (FP) rate 0.5%; specificity 90%). On the basis of MC, RI-PTH monitoring would have resulted in five FP results, with a specificity of 50%.

Conclusions

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

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Authors and Affiliations

  1. Division of Endocrine Surgery, Università Cattolica del S. Cuore, Policlinico A. Gemelli, L.go A Gemelli 8, 00168, Rome, Italy

    Celestino Pio Lombardi, Marco Raffaelli, Emanuela Traini, Carmela De Crea & Rocco Bellantone

  2. Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del S. Cuore, Policlinico A. Gemelli, L.go A Gemelli 8, 00168, Rome, Italy

    Enrico Di Stasio, Cinzia Carrozza & Cecilia Zuppi

  3. Divisione di Chirurgia Endocrina, Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy

    Marco Raffaelli

Authors
  1. Celestino Pio Lombardi
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  2. Marco Raffaelli
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  3. Emanuela Traini
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  4. Enrico Di Stasio
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  5. Cinzia Carrozza
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  6. Carmela De Crea
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  7. Cecilia Zuppi
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  8. Rocco Bellantone
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Corresponding author

Correspondence to Marco Raffaelli.

Additional information

Best of Endocrine Surgery in Europe 2008

No competing interest is declared for this paper

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Lombardi, C.P., Raffaelli, M., Traini, E. et al. Intraoperative PTH monitoring during parathyroidectomy: the need for stricter criteria to detect multiglandular disease. Langenbecks Arch Surg 393, 639–645 (2008). https://doi.org/10.1007/s00423-008-0384-5

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  • DOI: https://doi.org/10.1007/s00423-008-0384-5

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