Rapid intraoperative parathyroid hormone assay--more than just a comfort measure.

Hdl Handle:
http://hdl.handle.net/10147/208872
Title:
Rapid intraoperative parathyroid hormone assay--more than just a comfort measure.
Authors:
Hanif, F; Coffey, J C; Romics, L Jr; O'Sullivan, K; Aftab, F; Redmond, H P
Affiliation:
Department of Surgery, National University of Ireland, Cork, and Cork University , Hospital, Cork, Ireland.
Citation:
World J Surg. 2006 Feb;30(2):156-61.
Journal:
World journal of surgery
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/208872
DOI:
10.1007/s00268-005-0293-5
PubMed ID:
16425080
Abstract:
BACKGROUND: Minimally invasive radio-guided parathyroidectomy (MIRP) has been embraced as an acceptable therapeutic approach to primary hyperparathyroidism. Preoperative sestamibi scanning has facilitated this technique. Here we evaluate the addition of a rapid intraoperative parathyroid hormone (iPTH) assay for patients undergoing MIRP. METHODS: A series of 51 patients underwent sestamibi localization of parathyroid glands followed by MIRP for primary hyperparathyroidism. Using peripheral venous samples, iPTH levels were measured prior to gland excision, as well as post-excision at 5, 10, and 15 minutes, taking a 50% reduction in iPTH level as indicative of complete excision. Next, changes in serum iPTH were compared with preoperative and postoperative changes in serum calcium, as well as levels of intraoperative ex-vivo radiation counts taken by hand-held gamma probe. RESULTS: In this series, a drop of greater than 50% in iPTH levels was observed in 94% of patients (n=48). Moreover, a significant drop in iPTH occurred within 10 minutes of excision in the majority (n=42) of cases (P<0.004). Changes in iPTH were comparable with the therapeutic reduction in calcium levels, as well as with the change in intraoperative ex-vivo gamma counts. CONCLUSIONS: This study demonstrates that the addition of an iPTH assay to MIRP provides a quick and reliable intraoperative diagnostic modality in confirming correct adenoma removal. Moreover, it precludes the requirement of frozen section.
Language:
eng
MeSH:
Adult; Aged; Cohort Studies; Female; Follow-Up Studies; Humans; Hyperparathyroidism/blood/radionuclide imaging/*surgery; Male; Middle Aged; Monitoring, Intraoperative/*methods; Parathyroid Hormone/*analogs & derivatives/blood; Parathyroidectomy/*methods; Preoperative Care; Probability; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Statistics, Nonparametric; Surgical Procedures, Minimally Invasive/methods; Technetium Tc 99m Sestamibi/diagnostic use; Treatment Outcome
ISSN:
0364-2313 (Print); 0364-2313 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorHanif, Fen_GB
dc.contributor.authorCoffey, J Cen_GB
dc.contributor.authorRomics, L Jren_GB
dc.contributor.authorO'Sullivan, Ken_GB
dc.contributor.authorAftab, Fen_GB
dc.contributor.authorRedmond, H Pen_GB
dc.date.accessioned2012-02-03T15:06:04Z-
dc.date.available2012-02-03T15:06:04Z-
dc.date.issued2012-02-03T15:06:04Z-
dc.identifier.citationWorld J Surg. 2006 Feb;30(2):156-61.en_GB
dc.identifier.issn0364-2313 (Print)en_GB
dc.identifier.issn0364-2313 (Linking)en_GB
dc.identifier.pmid16425080en_GB
dc.identifier.doi10.1007/s00268-005-0293-5en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208872-
dc.description.abstractBACKGROUND: Minimally invasive radio-guided parathyroidectomy (MIRP) has been embraced as an acceptable therapeutic approach to primary hyperparathyroidism. Preoperative sestamibi scanning has facilitated this technique. Here we evaluate the addition of a rapid intraoperative parathyroid hormone (iPTH) assay for patients undergoing MIRP. METHODS: A series of 51 patients underwent sestamibi localization of parathyroid glands followed by MIRP for primary hyperparathyroidism. Using peripheral venous samples, iPTH levels were measured prior to gland excision, as well as post-excision at 5, 10, and 15 minutes, taking a 50% reduction in iPTH level as indicative of complete excision. Next, changes in serum iPTH were compared with preoperative and postoperative changes in serum calcium, as well as levels of intraoperative ex-vivo radiation counts taken by hand-held gamma probe. RESULTS: In this series, a drop of greater than 50% in iPTH levels was observed in 94% of patients (n=48). Moreover, a significant drop in iPTH occurred within 10 minutes of excision in the majority (n=42) of cases (P<0.004). Changes in iPTH were comparable with the therapeutic reduction in calcium levels, as well as with the change in intraoperative ex-vivo gamma counts. CONCLUSIONS: This study demonstrates that the addition of an iPTH assay to MIRP provides a quick and reliable intraoperative diagnostic modality in confirming correct adenoma removal. Moreover, it precludes the requirement of frozen section.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshCohort Studiesen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshFollow-Up Studiesen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHyperparathyroidism/blood/radionuclide imaging/*surgeryen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshMonitoring, Intraoperative/*methodsen_GB
dc.subject.meshParathyroid Hormone/*analogs & derivatives/blooden_GB
dc.subject.meshParathyroidectomy/*methodsen_GB
dc.subject.meshPreoperative Careen_GB
dc.subject.meshProbabilityen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshRisk Assessmenten_GB
dc.subject.meshSensitivity and Specificityen_GB
dc.subject.meshStatistics, Nonparametricen_GB
dc.subject.meshSurgical Procedures, Minimally Invasive/methodsen_GB
dc.subject.meshTechnetium Tc 99m Sestamibi/diagnostic useen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleRapid intraoperative parathyroid hormone assay--more than just a comfort measure.en_GB
dc.contributor.departmentDepartment of Surgery, National University of Ireland, Cork, and Cork University , Hospital, Cork, Ireland.en_GB
dc.identifier.journalWorld journal of surgeryen_GB
dc.description.provinceMunster-

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