[Do We Have to Wait for the Result of the Intraoperative Quick Parathormone Test in Preoperative Localised Sporadic Parathyroid Adenoma?]

Background In the recent years, targeted surgery, especially minimally invasive parathyroidectomy, has become the procedure of choice to treat sporadic primary hyperparathyroidism (pHPT) and is performed after preoperative standardised, accurate and reliable localisation. The intraoperative quick parathyroid hormone (qPTH) test is considered as a condition for successful resection of the parathyroid adenoma. The intraoperative qPTH test prolongs surgery and anaesthesia. The aim of this study was to evaluate whether there are disadvantages if patients do not wait for the qPTH result before terminating the procedure. Methods Between March 2009 and September 2017, 202 patients with solitary parathyroid adenoma - diagnosed on the basis of concordant positive results in Tc-99m-sestamibi scintigraphy and neck ultrasound - were scheduled for a focused procedure. In all patients, frozen section and qPTH test (baseline and 15 minutes after adenoma resection) were performed, but in patients with parathyroid adenoma that was evident to the responsible surgeon after macroscopic resection, surgery was not finished before the results of the qPTH test were available. The result of frozen section was awaited in all cases. Patients were informed that re-exploration has to be performed on the following day if there were persistently high levels of PTH after adenoma excision. Results Overall, 176 (87.1%) of the 202 targeted procedures were finished without waiting for the qPTH test result. The mean operation time was 60.4 min (SD 32.9). In all patients, the result of the qPTH test was received after extubation. Successful excision of the adenoma was confirmed by a PTH drop of at least 50% into the standard range. In 26 (12.9%) patients the qPTH result was waited for. The mean operation time in these cases was significantly longer with 112.0 min (SD 43.1). In 8 of these 26 patients, the operation was extended with unilateral or bilateral exploration, due to the inadequate decrease in qPTH. Overall, 2 of 202 (0.99%) patients suffered persistent disease after the focussed approach. Conclusion In patients with sporadic pHPT and preoperative and consistently solitary parathyroid adenoma - localised by neck ultrasound and Tc-99m-sestamibi scintigraphy -, the result of the qPTH test must not generally be awaited. The prerequisite is an adenoma that is convincing for the surgeon and which can be confirmed in frozen section analyses. This approach is safe and spares operative time and money.