Interpretation of intraoperative parathyroid hormone monitoring according to the Rome criterion in primary hyperparathyroidism

Abstract

Intraoperative parathyroid hormone dosage allows real-time monitoring of the decrease in PTH levels during parathyroidectomy and verify procedure’s efficacy. Currently, none of the interpretative criteria used has absolute accuracy. The aim of this study is to evaluate diagnostic accuracy of the Rome criterion verifying diagnostic significance of the individual assays. A total of 205 patients with primary hyperparathyroidism from a single adenoma were retrospectively evaluated and monitored with baseline PTH, PTH at 10 min and PTH at 20 min after adenoma excision. The accuracy of the latter two assays compared with baseline was compared by ROC curves. In addition, was evaluated the influence on these data of localization diagnostics (ultrasounds and scintigraphy), definitive histology, and type of surgery performed. The ratio of 20-min sampling to baseline in the Rome criterion showed highest diagnostic significance. This finding was not influenced by the type of surgery performed, definitive histologic examination, or intraoperative localization of the adenoma. The Rome criterion has shown its high reliability in detecting persistence. The ratio of sampling at 20 min to baseline is by far the best performing. Further studies are needed to evaluate whether sampling at 10 min after adenoma excision can be considered not mandatory.

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

“…This is higher than that reported in other studies (97–98%) [ 9 , 17 ] and may largely be explained by having a highly experienced, dedicated parathyroid surgeon. However, IO-PTH was only done in one third of the surgical group, highlighting the need to confirm this in a larger group and to evaluate emerging alternate criteria [ 9 , 17 – 19 ].…”

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

“…This is higher than that reported in other studies (97-98%) (9,17) and may largely be explained by having a highly experienced dedicated parathyroid surgeon. However, IO-PTH was only done in one third of the surgical group, highlighting the need to con rm this in a larger group and to evaluate emerging alternate criteria (9,(17)(18)(19).…”

Investigating the effectiveness of intraoperative rapid parathyroid hormone assay in parathyroidectomy surgery in patients with secondary hyperparathyroidism

“…Io-PTH measurement's effectiveness in managing the parathyroid gland in the context of primary hyperparathyroidism, both adenoma and hyperplasia, have been reported [ 13 , 14 ]. Direct unilateral neck exploration based on preoperative evaluation and localization, along with Io-PTH assessment, can be beneficial in decreasing surgery time, costs, and morbidity.…”