| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Articles |
Washington University School of Medicine,
1
Department of Pathology and Immunology and
2
Department of Surgery; and
3
Department of Laboratories, Barnes-Jewish Hospital, St. Louis, MO 63110.
aAddress correspondence to this author at: Department of Pathology and Immunology, Campus Box 8118, Washington University School of Medicine, Washington University Medical Center, 660 S. Euclid Ave., St. Louis, MO 63110-1093. Fax 314-362-1461; e-mail mscott{at}labmed.wustl.edu.
Background: 99mTc-sestamibi scans and rapid, intraoperative intact parathyroid hormone (PTH) assays allow preoperative identification of diseased glands and intraoperative confirmation of diseased gland removal, respectively. Use of these two new technologies may facilitate simpler, more concise surgery, shorter hospital stays, and decreased costs for frozen-section analysis. One major drawback to this new strategy has been the high cost of rapid point-of-care PTH assays.
Methods: We performed rapid PTH assays with the DPC Turbo PTH assay on the DPC IMMULITE automated analyzer. The number of intraoperative frozen sections, type of anesthesia, surgical approach, length of hospital stay, and pre- and postoperative calcium values were compared between a group of 49 patients undergoing parathyroidectomy where the intraoperative PTH assay was used in conjunction with preoperative imaging, and a historical control group of 55 patients before the use of these two technologies in our institution.
Results: Comparison of the Turbo PTH assay to the standard IMMULITE PTH assay gave the following: y = 1.08x - 4.36 (r = 0.97; n = 48). For the 49 patients, the median turnaround time for each intraoperative PTH determination was 19 min (range, 14–40 min). The median decrease in PTH values from baseline was 88% (range, 33–99%). Thirty-seven patients required two PTH determinations, 7 required three, 4 had four, and 1 required five determinations. The average laboratory cost for the rapid intraoperative PTH assays was <$100 per patient (range, $55 to $113). Compared with the control group, the experimental group had significantly fewer frozen sections (1.4 vs 2.5; P <0.0001), shorter hospital stays (17 discharged on the day of surgery vs none discharged on the day of surgery; P <0.0001), greater use of local anesthesia (33% vs 0%; P <0.001), and more unilateral, rather than bilateral neck explorations (65% vs 0%; P <0.001).
Conclusions: The combination of intraoperative Turbo PTH assay and preoperative 99mTc-sestamibi scans can lead to significant decreases in laboratory and surgical pathology costs, hospital stays, and exposure to general anesthesia by facilitating concise parathyroidectomy surgery.
The following articles in journals at HighWire Press have cited this article:
|
|
 |
|
  S.-K. Meyer, M. Zorn, K. Frank-Raue, M. W Buchler, P. Nawroth, and T. Weber Clinical impact of two different intraoperative parathyroid hormone assays in primary and renal hyperparathyroidism Eur. J. Endocrinol., February 1, 2009; 160(2): 275 - 281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. J. Sokoll, F. H. Wians Jr, and A. T. Remaley Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing Clin. Chem., July 1, 2004; 50(7): 1126 - 1135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Bieglmayer, G. Prager, and B. Niederle Kinetic Analyses of Parathyroid Hormone Clearance as Measured by Three Rapid Immunoassays during Parathyroidectomy Clin. Chem., October 1, 2002; 48(10): 1731 - 1738. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. C. Lee and J. A. Norton Multiple-Gland Disease in Primary Hyperparathyroidism: A Function of Operative Approach? Arch Surg, August 1, 2002; 137(8): 896 - 900. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Kao, J. A. van Heerden, D. R. Farley, G. B. Thompson, and R. L. Taylor Intraoperative Monitoring of Parathyroid Hormone with a Rapid Automated Assay that is Commercially Available Ann. Clin. Lab. Sci., July 1, 2002; 32(3): 244 - 251. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
