Johnson L R, Doherty G, Lairmore T, Moley J F, Brunt L M, Koenig J, Scott M G
Washington University School of Medicine, Department of Pathology and Immunology, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
Clin Chem. 2001 May;47(5):919-25.
(99m)Tc-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.
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.
Comparison of the Turbo PTH assay to the standard IMMULITE PTH assay gave the following: y = 1.08 x - 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).
The combination of intraoperative Turbo PTH assay and preoperative (99m)Tc-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.
（99m）锝-司他比显像扫描和快速术中完整甲状旁腺激素（PTH）测定，分别可以实现术前对病变腺体的识别以及术中对病变腺体切除的确认。使用这两项新技术可能有助于简化手术、缩短住院时间并降低冰冻切片分析的成本。这种新策略的一个主要缺点是即时快速PTH测定成本高昂。
我们使用DPC IMMULITE自动分析仪上的DPC Turbo PTH测定法进行快速PTH测定。比较了49例行甲状旁腺切除术的患者（术中使用PTH测定并结合术前影像学检查）与我院在使用这两项技术之前的55例患者的历史对照组之间的术中冰冻切片数量、麻醉类型、手术方式、住院时间以及术前和术后的钙值。
将Turbo PTH测定法与标准IMMULITE PTH测定法进行比较，结果如下：y = 1.08x - 4.36（r = 0.97；n = 48）。对于49例患者，每次术中PTH测定的中位周转时间为19分钟（范围为14 - 40分钟）。PTH值相对于基线的中位下降幅度为88%（范围为33% - 99%）。37例患者需要进行两次PTH测定，7例需要三次，4例需要四次，1例需要五次测定。快速术中PTH测定的平均实验室成本为每位患者低于100美元（范围为55美元至113美元）。与对照组相比，实验组的冰冻切片明显更少（1.4比2.5；P < 0.0001），住院时间更短（17例在手术当天出院，而对照组无患者在手术当天出院；P < 0.0001），局部麻醉的使用更多（33%比0%；P < 0.001），并且更多采用单侧而非双侧颈部探查（65%比0%；P < 0.001）。
术中Turbo PTH测定与术前（99m）锝-司他比显像扫描相结合，通过简化甲状旁腺切除术，可显著降低实验室和手术病理成本、缩短住院时间并减少全身麻醉暴露。
