The utility of the radionuclide probe in parathyroidectomy for primary hyperparathyroidism

Lim, Ming Sheng; Jinih, Marcel; Ngai, C. H.; Foley, Niamh M.; Redmond, H. Paul

The utility of the radionuclide probe in parathyroidectomy for primary hyperparathyroidism

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Published Version

Date

2017

Authors

Lim, Ming Sheng

Jinih, Marcel

Ngai, C. H.

Foley, Niamh M.

Redmond, H. Paul

Publisher

Royal College of Surgeons of England

Published Version

10.1308/rcsann.2017.0016

Abstract

INTRODUCTION: Parathyroidectomy is the definitive treatment for primary hyperparathyroidism but the intraoperative identification of adenomas is challenging. The aim of this study was to evaluate the utility of a radionuclide probe (RNP) in addition to intraoperative parathyroid hormone (IOPTH) measurement as an intraoperative diagnostic adjunct in patients undergoing parathyroidectomy for primary hyperparathyroidism. METHODS: This was a retrospective cohort study of patients treated between 2004 and 2015 in a university affiliated teaching hospital. Patients were grouped into those with RNP use (RNP+) and those without (RNP-). The primary outcome measure was rate of operative failure, which included false positives. The diagnostic sensitivity and positive predictive value of both RNP and IOPTH were also evaluated. RESULTS A total of 298 patients were included in the study, 127 (42.6%) being in the RNP+ group and 171 (57.4%) in the RNP- group. The false positive rate for the RNP+ patients was 1.6% compared with 9.4% for RNP- patients (p= 0.006, hazard ratio [HR]: 6.45). The rates of operative failure were 6.3% and 11.7% respectively (p= 0.159, HR: 1.97). RNP use had a sensitivity of 92.0% and a positive predictive value of 98.3% compared with 78.6% and 95.2% respectively for IOPTH monitoring. CONCLUSIONS: RNP use is associated with fewer false positives and reduced operative failure than IOPTH measurement. It also has a higher sensitivity and positive predictive value. RNP use is recommended in centres that have the required facilities.

Keywords

Parathyroidectomy , Parathyroid neoplasm , Intraoperative care , Sensitivity

Citation

Lim, M. S., Jinih, M., Ngai, C. H., Foley, N. M. and Redmond, H. P. (2017) 'The utility of the radionuclide probe in parathyroidectomy for primary hyperparathyroidism', Annals of the Royal College of Surgeons of England, 99(5), pp. 369-372. doi: 10.1308/rcsann.2017.0016