Intra-operative testing for parathyroid hormone: the Central Laboratory option

Area of Science:

• Endocrinology
• Surgical Oncology
• Clinical Pathology

Background:

• Intra-operative parathyroid hormone (PTH) testing verifies parathyroid tissue removal during surgery for primary hyperparathyroidism.
• Current intra-operative PTH testing methods are accurate but costly.
• A cost-effective alternative involves intra-operative PTH testing at a central laboratory.

Purpose of the Study:

• To evaluate the efficacy and cost-effectiveness of intra-operative PTH testing at a central laboratory for parathyroidectomy.
• To determine if central laboratory PTH testing can accurately confirm the removal of pathological parathyroid tissue.

Main Methods:

• A study involving 54 patients undergoing parathyroidectomy.
• Three blood samples collected: pre-anesthesia, and 5 and 10 minutes post-parathyroidectomy.
• Samples analyzed simultaneously at the Central Laboratory, with results phoned to the operating theatre.

Main Results:

• The procedure demonstrated high effectiveness, with 98.1% of patients successfully treated.
• Sensitivity was 94.0%, specificity 75.0%, and accuracy 92.6%.
• The method had 3 false negatives and 1 false positive.

Conclusions:

• Intra-operative PTH testing at a central laboratory is a viable, low-cost alternative to operating theatre testing.
• The primary drawback is the waiting time for results, comparable to histological examination.
• This method offers a practical solution where portable intra-operative PTH testing equipment is unavailable.