Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

Abstract

Continuous development of quick parathyroid hormone assays has resulted in a corresponding expansion of their applications in the practical landscape. In-theatre measurement of the parathyroid hormone has long been recognized as a valuable adjunct in parathyroid surgery, with other applications being incorporated in thyroid surgery and out-of-theatre uses. Such widespread utilization of these assays has also brought the concept of point-of-care testing to the endocrine surgical patient. We have herein summarized the established and potential applications of these assays, emphasizing their importance in the point-of-care setting, highlighting the proper selection of the assay type for intraoperative hormone monitoring and spotlighting those applications which should be validated for use in the clinical setting and those which need to be investigated further.

Evaluation of Autofluorescence in Identifying Parathyroid Glands by Measuring Parathyroid Hormone in Fine-Needle Biopsy Washings

“…The innovation of this study is the introduction of aIOPTH as a con rmatory method for PGs. The application of aIOPTH may provide an alternative to frozen section examination, dodging the injurious effect of the bioptic process and achieving similar or even more accurate results [15][16][17]. However, the application of aIOPTH is not widespread, many endocrine surgeons are not familiar with this technology, and traditional PTH detection methods take much time [18].…”

Evaluation of switch from satellite laboratory to central laboratory for testing of intraoperative parathyroid hormone

“…The capabilities and analytical times for PTH immunoassays have evolved considerably in the last three decades [ [7] , [8] , [9] ]. Early generation immunoradiometric assays (IRMA) required an overnight incubation with results taking up to 24 ​h [ 1 , 3 ].…”

“…Early generation immunoradiometric assays (IRMA) required an overnight incubation with results taking up to 24 ​h [ 1 , 3 ]. Nowadays, a number of commercially available immunoassays targeting the “intact” PTH molecule (amino acids 1–84) can achieve analytical times of approximately 10–20 ​min, making intraoperative measurements feasible if specimens can be transported quickly for analysis [ 7 , 8 , 10 ]. Lengthy TATs increase the amount of time that the patient is in the operating room (OR) and delay throughput [ 8 , 10 ].…”

“…TAT has also been found to be affected by the level of experience of the surgeon and laboratory technician [ 13 , 14 ]. The actual analytical time needed for the assay to run, regardless of whether it is performed in a central laboratory or a point of care site near to or within the ORs, will also impact the overall TAT [ 8 , 12 , 16 ]. While near point of care or point of care testing can theoretically lead to shorter TATs, having separate instrumentation and testing personnel next to the OR may lead to suboptimal use of resources and time.…”

A Novel Immuno Chromatography Based Rapid Intraoperative PTH Detection Device Reduce the Time for Identifying Parathyroid Tissue from Thyroid Nodules

“…During parathyroidectomy, it is at times difficult for surgeons to visually differentiate parathyroid tissue from non-parathyroid tissue, including thyroid nodule, lymph node, and fat tissue. Although intra-operative frozen section analysis is the gold standard to distinguish different tissue type, more surgeons nowadays choose to aspirate the suspected parathyroid tissue and detect the PTH value in the puncture fluent to solve the problem [1][2][3]. This approach has a turnaround time about 15-30 minutes, much frequent than frozen section analysis [4].…”