The validity of quick intraoperative parathyroid hormone assay: An evaluation in seventy-two patients based on gross morphologic criteria

Background. Parathyroidectomy for primary hyperparathyroidism has conventio nally required identification of all parathyroid glands with excision of gr ossly abnormal glands. Using this approach, cure rates exceed 95 %. Directe d cervical exploration has been advocated using quick intraoperative parath yroid hormone (QPTH) assay with preoperative localization. Adoption of this approach requires validation of the accuracy of QPTH assay. Methods, Patients with primary hyperparathyroidism undergoing bilateral nec k exploration during a 31-month Period were reviewed. Uniglandular(UCD) or multiglandular (MGD) disease was determined by gross morphologic criteria. QPTH assays were performed before skin incision and at 5, 10, and 20 minute s after excision of each abnormal gland. A 10-minute QPTH decrease of 50 % from baseline levels indicated curative excision. These data were not used to guide extent of exploration or tissue resection. Results, Of 72 patients, 55 (76 %) had UGD and 17 (24 %) had MGD. QPTH assa y accurately predicted the disease state in 89 %. Four (7 %) UGD patients d id not have an appropriate QPTH decline at 10 minutes. Four (24 % ) MGD pat ients had an inappropriate QPTH decline at 10 minutes. Conclusions. Using QPTH guided exploration, 6 % (4 of 72) of patients would undergo unnecessary extended ex;exploration and 6 % (4 of 72) (95 % CI, I % to 13 % ) may require reoperation for unidentified MGD. These results val idate the accuracy of QPTH assay.