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Evaluation of Halle, Miami, Rome, and Vienna intraoperative iPTH assay criteria in guiding minimally invasive parathyroidectomy

  • Endocrine Surgery
  • Published:
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Abstract

Background and aims

Intraoperative parathyroid hormone assay (IOPTH) has been used during minimally invasive parathyroidectomy (MIP) to predict operative success. However, the applied criteria are not equivalent in detection of multiglandular disease (MGD) and predicting cure. The purpose of this study was to evaluate the most commonly applied criteria of IOPTH in patients undergoing MIP in a tertiary referral center.

Materials and methods

A retrospective review of 260 patients with sporadic primary hyperparathyroidism and concordant results of sestamibi scanning and ultrasound of the neck undergoing MIP (135 video-assisted and 125 open) between Dec 2002 and May 2008, with a 6-month postoperative follow-up of intact parathyroid hormone and serum calcium levels, was performed. The main outcome measures included evaluation of predictive values of Halle, Miami, Rome, and Vienna IOPTH interpretation criteria.

Results

The following overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive values were found, respectively: 65%, 62.9%, 100%, 100%, and 14.2% for Halle criterion; 97.3%, 97.6%, 93.3%, 99.6%, and 70% for Miami criterion; 83.8%, 82,9%, 100%, 100%, and 26.3% for Rome criterion; and 92.3%, 92.2%, 93.3%, 99.6%, and 60.9% for Vienna criterion.

Conclusions

Miami criterion followed by Vienna criterion was found to be the best balanced among other criteria, with the highest accuracy in intraoperative prediction of cure. However, Rome criterion followed by Halle criterion was found to be the most useful in intraoperative detection of MGD. Nevertheless, their application in patients qualified for MIP with concordant results of sestamibi scanning and ultrasound of the neck would result in a significantly higher number of negative conversions to bilateral neck explorations and only a marginal improvement in the success rate of primary operations.

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Authors and Affiliations

  1. Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Prądnicka Street, 31-202, Krakow, Poland

    Marcin Barczynski, Aleksander Konturek, Stanislaw Cichon & Wojciech Nowak

  2. Department of Endocrinology, Jagiellonian University College of Medicine, 17 Kopernika Street, 31-501, Krakow, Poland

    Alicja Hubalewska-Dydejczyk

Authors
  1. Marcin Barczynski
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  2. Aleksander Konturek
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  3. Alicja Hubalewska-Dydejczyk
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  4. Stanislaw Cichon
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  5. Wojciech Nowak
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Correspondence to Marcin Barczynski.

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Barczynski, M., Konturek, A., Hubalewska-Dydejczyk, A. et al. Evaluation of Halle, Miami, Rome, and Vienna intraoperative iPTH assay criteria in guiding minimally invasive parathyroidectomy. Langenbecks Arch Surg 394, 843–849 (2009). https://doi.org/10.1007/s00423-009-0510-z

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  • DOI: https://doi.org/10.1007/s00423-009-0510-z

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