Citation Information :
Cvasciuc T, Lansdown M, Fraser S. Focused Parathyroidectomy without Intraoperative Parathyroid Hormone Testing: Acceptability after Preoperative Localization with SPECT-CT. World J Endoc Surg 2019; 11 (1):1-5.
Introduction: Intraoperative parathyroid hormone (IOPTH) monitoring is used to confirm the success of parathyroidectomy for primary hyperparathyroidism (PHPT). The aim of this study is to find out if IOPTH is useful during parathyroidectomy for patients with PHPT and positive single photon emission computed tomography (SPECT-CT) imaging.
Materials and methods: A retrospective study of parathyroidectomies for PHPT between 2011 and 2016 in a teaching hospital was performed. Patients\' characteristics (demographics and gender), biochemistry, imaging [ultrasound parathyroids (USSs) and SPECT-CT], type of operation, histology, and persistent disease were identified. Patients were divided into four subgroups according to preoperative imaging, use of IOPTH, and failure rate.
Results: Two hundred and fifty-eight patients were enrolled. About 44.6% of patients had positive and concordant preoperative imaging. Multi-gland disease (MGD) was found in 13.18% of patients on histology. Patients were divided into four subgroups: group 1 (140 patients): positive imaging and focused parathyroidectomy (FP); group 2 (53 patients): positive imaging and nonfocused approach; group 3 (6 patients): disconcordant imaging [negative SPECT-CT but positive ultrasound (US)] and FP; group 4 (57 patients): negative imaging and no FP. The cure rates were 97.86, 94.34, 100, and 87.71%. The overall cure rate was 95%. Within groups 1 and 2, the failure rate was similar if IOPTH was used. IOPTH was used in all patients in groups 3 and 4.
Conclusion: The selective use of IOPTH is an effective operative strategy. Positive SPECT-CT imaging can guide an FP without the need for IOPTH. IOPTH is useful for SPECT-CT-negative patients who are at risk of multi-gland disease (MGD) or to guide FP if single positive imaging.
Clinical significance: Our results and suggestions can guide the use of IOPTH in clinical practice. The selective use of IOPTH suggested by preoperative imaging can be cost-effective and reduce unnecessary time in theater.
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