Intra-operative parathyroid hormone monitoring in patients with parathyroid cancer

C. C. Solórzano, D. M. Carneiro-Pla, John Lew, Steven Rodgers, R. Montano, G. L. Irvin

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Intra-operative parathyroid hormone (PTH) monitoring (IPM) is 97% accurate in predicting postoperative eucalcemia in sporadic primary hyperparathyroidism (SPHPT). However, its usefulness in parathyroid cancer has not been demonstrated. This study reports IPM accuracy during surgical resections for parathyroid cancer. Methods: Eight of 556 consecutive patients with SPHPT underwent parathyroidectomy using IPM and had parathyroid cancer. Operative success was defined as eucalcemia > six months and operative failure/persistent cancer as hypercalcemia within six months of parathyroidectomy. The IPM criterion for operative success was defined as a >50% decrease of peripheral PTH levels from the highest either pre-incision or pre-excision values, 10 minutes after resection. Results: In eight patients, 11 operations were performed. Ten operations (91%) resulted in >50% intra-operative PTH decrease. However, in only seven (70%) of these resections, eucalcemia was achieved for >6 months with five of these seven (71%) procedures being initial en bloc resections. The remaining 3/10 (30%) operations with >50% intra-operative PTH decrease resulted in operative failures. In the last operation, intraoperative parathormone monitoring (IPM) correctly predicted operative failure. IPM sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in predicting outcome were 100, 40, 70, 100, and 75%, respectively. Conclusions: IPM with the criterion of >50% PTH drop from the highest level is less accurate in predicting operative success in parathyroid cancer when compared to SPHPT. A >50% intra-operative PTH level decrease in patients with parathyroid cancer, particularly in reoperative cases, is less predictive of complete resection. The initial recognition of this disease followed by proper resection remains essential in the treatment of parathyroid cancer.

Original languageEnglish
Pages (from-to)3216-3222
Number of pages7
JournalAnnals of Surgical Oncology
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2007

Fingerprint

Parathyroid Neoplasms
Physiologic Monitoring
Parathyroid Hormone
Intraoperative Monitoring
Primary Hyperparathyroidism
Parathyroidectomy
Hypercalcemia

Keywords

  • Cancer
  • Hormone
  • Intra-operative
  • Parathyroid
  • PTH

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Intra-operative parathyroid hormone monitoring in patients with parathyroid cancer. / Solórzano, C. C.; Carneiro-Pla, D. M.; Lew, John; Rodgers, Steven; Montano, R.; Irvin, G. L.

In: Annals of Surgical Oncology, Vol. 14, No. 11, 01.11.2007, p. 3216-3222.

Research output: Contribution to journalArticle

Solórzano, C. C. ; Carneiro-Pla, D. M. ; Lew, John ; Rodgers, Steven ; Montano, R. ; Irvin, G. L. / Intra-operative parathyroid hormone monitoring in patients with parathyroid cancer. In: Annals of Surgical Oncology. 2007 ; Vol. 14, No. 11. pp. 3216-3222.
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abstract = "Background: Intra-operative parathyroid hormone (PTH) monitoring (IPM) is 97{\%} accurate in predicting postoperative eucalcemia in sporadic primary hyperparathyroidism (SPHPT). However, its usefulness in parathyroid cancer has not been demonstrated. This study reports IPM accuracy during surgical resections for parathyroid cancer. Methods: Eight of 556 consecutive patients with SPHPT underwent parathyroidectomy using IPM and had parathyroid cancer. Operative success was defined as eucalcemia > six months and operative failure/persistent cancer as hypercalcemia within six months of parathyroidectomy. The IPM criterion for operative success was defined as a >50{\%} decrease of peripheral PTH levels from the highest either pre-incision or pre-excision values, 10 minutes after resection. Results: In eight patients, 11 operations were performed. Ten operations (91{\%}) resulted in >50{\%} intra-operative PTH decrease. However, in only seven (70{\%}) of these resections, eucalcemia was achieved for >6 months with five of these seven (71{\%}) procedures being initial en bloc resections. The remaining 3/10 (30{\%}) operations with >50{\%} intra-operative PTH decrease resulted in operative failures. In the last operation, intraoperative parathormone monitoring (IPM) correctly predicted operative failure. IPM sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in predicting outcome were 100, 40, 70, 100, and 75{\%}, respectively. Conclusions: IPM with the criterion of >50{\%} PTH drop from the highest level is less accurate in predicting operative success in parathyroid cancer when compared to SPHPT. A >50{\%} intra-operative PTH level decrease in patients with parathyroid cancer, particularly in reoperative cases, is less predictive of complete resection. The initial recognition of this disease followed by proper resection remains essential in the treatment of parathyroid cancer.",
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AU - Solórzano, C. C.

AU - Carneiro-Pla, D. M.

AU - Lew, John

AU - Rodgers, Steven

AU - Montano, R.

AU - Irvin, G. L.

PY - 2007/11/1

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N2 - Background: Intra-operative parathyroid hormone (PTH) monitoring (IPM) is 97% accurate in predicting postoperative eucalcemia in sporadic primary hyperparathyroidism (SPHPT). However, its usefulness in parathyroid cancer has not been demonstrated. This study reports IPM accuracy during surgical resections for parathyroid cancer. Methods: Eight of 556 consecutive patients with SPHPT underwent parathyroidectomy using IPM and had parathyroid cancer. Operative success was defined as eucalcemia > six months and operative failure/persistent cancer as hypercalcemia within six months of parathyroidectomy. The IPM criterion for operative success was defined as a >50% decrease of peripheral PTH levels from the highest either pre-incision or pre-excision values, 10 minutes after resection. Results: In eight patients, 11 operations were performed. Ten operations (91%) resulted in >50% intra-operative PTH decrease. However, in only seven (70%) of these resections, eucalcemia was achieved for >6 months with five of these seven (71%) procedures being initial en bloc resections. The remaining 3/10 (30%) operations with >50% intra-operative PTH decrease resulted in operative failures. In the last operation, intraoperative parathormone monitoring (IPM) correctly predicted operative failure. IPM sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in predicting outcome were 100, 40, 70, 100, and 75%, respectively. Conclusions: IPM with the criterion of >50% PTH drop from the highest level is less accurate in predicting operative success in parathyroid cancer when compared to SPHPT. A >50% intra-operative PTH level decrease in patients with parathyroid cancer, particularly in reoperative cases, is less predictive of complete resection. The initial recognition of this disease followed by proper resection remains essential in the treatment of parathyroid cancer.

AB - Background: Intra-operative parathyroid hormone (PTH) monitoring (IPM) is 97% accurate in predicting postoperative eucalcemia in sporadic primary hyperparathyroidism (SPHPT). However, its usefulness in parathyroid cancer has not been demonstrated. This study reports IPM accuracy during surgical resections for parathyroid cancer. Methods: Eight of 556 consecutive patients with SPHPT underwent parathyroidectomy using IPM and had parathyroid cancer. Operative success was defined as eucalcemia > six months and operative failure/persistent cancer as hypercalcemia within six months of parathyroidectomy. The IPM criterion for operative success was defined as a >50% decrease of peripheral PTH levels from the highest either pre-incision or pre-excision values, 10 minutes after resection. Results: In eight patients, 11 operations were performed. Ten operations (91%) resulted in >50% intra-operative PTH decrease. However, in only seven (70%) of these resections, eucalcemia was achieved for >6 months with five of these seven (71%) procedures being initial en bloc resections. The remaining 3/10 (30%) operations with >50% intra-operative PTH decrease resulted in operative failures. In the last operation, intraoperative parathormone monitoring (IPM) correctly predicted operative failure. IPM sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in predicting outcome were 100, 40, 70, 100, and 75%, respectively. Conclusions: IPM with the criterion of >50% PTH drop from the highest level is less accurate in predicting operative success in parathyroid cancer when compared to SPHPT. A >50% intra-operative PTH level decrease in patients with parathyroid cancer, particularly in reoperative cases, is less predictive of complete resection. The initial recognition of this disease followed by proper resection remains essential in the treatment of parathyroid cancer.

KW - Cancer

KW - Hormone

KW - Intra-operative

KW - Parathyroid

KW - PTH

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