Use of intraoperative parathyroid hormone assay in primary hyperparathyroidism: A selective approach
Abstract
Aim
The routine use of intraoperative parathyroid hormone assay (IOPTH) in minimally-invasive parathyroidectomy (MIP) for primary hyperparathyroidism has been questioned. In the present study, we selectively employed IOPTH only to cases that did not show concordant results in sestamibi scan, ultrasound and operative findings.
Patients and Methods
A total of 100 patients received MIP with selective use of IOPTH for primary hyperparathyroidism from March 2006 to June 2015 (selective IOPTH group). These patients were compared with a historical cohort of 57 patients who received MIP with mandatory IOPTH between March 2002 and February 2006 (mandatory IOPTH group). For the selective IOPTH group, all cases had preoperative sestamibi scan and ultrasound performed. If there were concordant results in the sestamibi scan, ultrasound and operative findings, IOPTH would not be performed. The surgical cure rate and operative time of the two groups were compared.
Results
We found no significant difference in the surgical cure rate between the selective IOPTH group and the mandatory IOPTH group (short-term, 6-month postoperative cure rate: 99 vs 100 per cent, respectively, P = 1.0; long-term cure rate: 99.0 vs 98.2 per cent, P = 1.0). However, the operative time was significantly shorter in the selective IOPTH group when compared with the mandatory IOPTH group (64 vs 92 min, respectively, P < 0.05).
Conclusion
MIP can be performed with selective use of IOPTH, which can be limited to cases where there are discordant results between sestamibi scan, ultrasound and operative findings.