Intraoperative parathyroid hormone (IOPTH) assay might be better than the second-generation assay in parathyroidectomy for primary hyperparathyroidism

It is unclear whether the third-generation intraoperative parathyroid hormone assay can improve surgical outcomes over second-generation assay in primary hyperparathyroidism. We aimed to compare the rate of decrease and diagnostic accuracy between the two assays after parathyroid adenoma excision. C...

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Bibliographic Details
Published in:Surgery 2021-01, Vol.169 (1), p.109-113
Main Authors: Lang, Brian Hung-Hin, Fung, Matrix Man Him
Format: Article
Language:English
Subjects:
Aged
Calcium - blood
False Negative Reactions
False Positive Reactions
Female
Follow-Up Studies
Humans
Hyperparathyroidism, Primary - blood
Hyperparathyroidism, Primary - diagnosis
Hyperparathyroidism, Primary - etiology
Hyperparathyroidism, Primary - surgery
Male
Middle Aged
Monitoring, Intraoperative - instrumentation
Monitoring, Intraoperative - methods
Parathyroid Hormone - blood
Parathyroid Neoplasms - blood
Parathyroid Neoplasms - complications
Parathyroid Neoplasms - surgery
Parathyroidectomy - methods
Postoperative Period
Predictive Value of Tests
Prospective Studies
Retrospective Studies
Treatment Outcome
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Summary:It is unclear whether the third-generation intraoperative parathyroid hormone assay can improve surgical outcomes over second-generation assay in primary hyperparathyroidism. We aimed to compare the rate of decrease and diagnostic accuracy between the two assays after parathyroid adenoma excision. Consecutive patients undergoing parathyroidectomy with intraoperative parathyroid hormone were analyzed. Blood was drawn before and 10 minutes and 20 minutes after excision of the adenoma. The same blood sample was run simultaneously in the second-generation assays (Elecsys PTH STAT) and third-generation assays (Elecsys 1–84 PTH). Biochemical cure meant >50% intraoperative parathyroid hormone decrease at 10 minutes. Cure meant normocalcemia 6 months after operation. Relative to the second-generation assay, the value of the intraoperative parathyroid hormone level was less in the third-generation assay before excision (P < .001), at 10 minutes (P < .001), and at 20 minutes (P < .001). The intraoperative parathyroid hormone rate of decrease and the proportion of normalized post-excision intraoperative parathyroid hormone were greater in the third-generation assay (P < .001), but the prediction accuracy appeared similar between the 2 (91.5% vs 91.0%). Patients with worse renal function (estimated glomerular filtration rate
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2020.03.024