The CaPTHUS score as predictor of multiglandular primary hyperparathyroidism in a European population

Mogollón-González, Mónica; Notario-Fernández, P.; Domínguez‐Bastante, Mireia; Molina-Raya, A.; Serradilla-Martín, Mario; Pérez, Nuria Muñoz; Arcelus-Martínez, Juan Ignacio; Villar-del-Moral, Jesús; Jiménez-Ríos, José Antonio

doi:10.1007/s00423-016-1426-z

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…In 2015, Elfenben et al [ 20 ] and, the following year, Mogollon-Gonzalez et al [ 21 ] conducted two studies with the aim of validating the CaPTHUS score. The first [ 20 ] included, in the evaluation of CaPTHUS score, also patients who had undergone only scintigraphy or only neck ultrasound.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, without measuring ioPTH for patients with high CaPTHUS scores, the cure rate was 89% at 6 months, compared with 98% when the assay was performed. In the second study, Mogollon-Gonzalez et al [ 21 ] chose a follow-up of at least six months but decided to include only patients who had performed both tests. In this case as well, the CaPTHUS test was found to be a model that even though it accurately predicts multiglandular disease, it does not allow to correctly classify 100% of patients, therefore allowing to reduce the use of ioPTH.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience

Pasquale

Lori

Bulfamante

et al. 2021

International Journal of Endocrinology

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Background. The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80–85% of the cases) or by a multiglandular disease (15–20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the literature, to perform focused parathyroidectomy, avoiding intraoperative parathormone assay (ioPTH). The most known are the CaPTHUS test and the Wisconsin index. We applied them to our experience. Methods. A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. Only patients affected with benign PHPT and neck ultrasound performed at our institution were included. Both patients for whom preoperative imaging agreed with the localization of a single diseased parathyroid and those with only ultrasound or scintigraphy positive for parathyroid localization underwent Mini-Invasive Video-assisted parathyroidectomy. In all cases, ioPTH assay was performed. The conversion to bilateral neck exploration was decided based on the drop in ioPTH. CaPTHUS score and the Wisconsin index (Win) were applied to the series. CaPTHUS score ≥3 and Win index >1600, according to the original studies of the literature, were considered at high probability of monoglandular disease. Outcomes in these two groups were examined. Results. 236 patients were eligible for the study. The pathology resulted in multiglandular disease in 24 patients (10.2%). Among these, 18 (75.0%) obtained a CaPTHUS score ≥3, and 20 (83.3%) had a Win index>1600. Intraoperative PTH allowed to identify multiglandular disease in 16 of 18 cases with CaPTHUS ≥3 and in 18 of 20 cases with win >1600, who could have been lost, based only on the results of these 2 tests. Conclusion. Based on our experience, CaPTHUS test and Wisconsin index were not so useful in predicting multiglandular disease as ioPTH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience

Pasquale

Lori

Bulfamante

et al. 2021

International Journal of Endocrinology

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“…Preoperative identification of MGD remains a major concern in PHPT surgery. Despite the profusion of preoperative localization tests and intraoperative adjuncts, non-curative treatment is not exceptional, and some patients will suffer persistent disease due to incomplete intraoperative detection (1,20,21).…”

Section: Discussionmentioning

confidence: 99%

“…Primary hyperparathyroidism (PHPT) is a calcium metabolism disorder derived from excessive secretion of parathyroid hormone (PTH), leading to abnormally high levels of serum calcium (1)(2)(3). It is the most common cause of hypercalcemia in outpatients (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population

Serradilla-Martín¹,

Palomares-Cano²,

Cantalejo-Díaz³

et al. 2021

Gland Surg

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Background: Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single-and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population.Methods: Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P<0.05 was accepted as significant.Results: Two hundred and eighty-one patients who underwent successful surgery from January 2001 to December 2018 were included. Single-gland disease was detected in 92.5%, and 73.7% had a CaPTHUS score of ≥3. The sensitivity, specificity, positive and negative predictive values of this model for predicting singlegland disease with a score of ≥3 were 76.9%, 66.7%, 96.6%, and 18.9% respectively. The area under the curve value of the CaPTHUS score for predicting single-gland disease was 0.74. A Wisconsin Index >2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%.Conclusions: Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed.

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A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease

Lawrence,

Johri,

Dave

et al. 2023

Langenbecks Arch Surg

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Background Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity. Methods We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy. Conclusion Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.

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The CaPTHUS score as predictor of multiglandular primary hyperparathyroidism in a European population

Abstract: Despite good test performance, a CaPTHUS score ≥3 does not discard MGD definitely. Intraoperative adjuncts are still needed to further reduce the risk of missing MGD during selective parathyroidectomy.

Cited by 7 publications

References 21 publications

Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience

Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience

Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population

A contemporary analysis of the pre- and intraoperative recognition of multigland parathyroid disease

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