Papier Aleksandra, Kenig Jakub, Barczyński Marcin
Przegl Lek. 2014;71(1):14-8.
Intraoperative iPTH assay (IOPTH) is often used during minimally invasive parathyroidectomy (MIP) to predict operative success. The aim of this study was to evaluate diagnostic accuracy of IOPTH during MIP with respect to few prognostic criteria most commonly used.
A retrospective study of 455 patients with sporadic primary hyperparathyroidism undergoing MIP with IOPTH at our institution between 2003 and 2012 was undertaken. Diagnostic accuracy of few prognostic criteria most commonly used was done including Halle, Miami, Rome and Vienna criteria. Results of IOPTH were compared to outcomes of MIP in 6-months follow-up after surgery (serum calcium and iPTH levels). Both ROC (Receiver Operating Characteristics) curve and error matrix analysis were used for accuracy assessment of IOPTH prognostic criteria. Based on this method the following accuracy parameters were calculated for each IOPTH criterion separately: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy.
The following diagnostic accuracy parameters of IOPTH were found for each of the tested criteria (sensitivity, specificity, PPV, NPV, accuracy), respectively: for Halle criterion 63.2%, 100.0%, 100.0%, 12.6%, 65.1%; for Miami criterion 97.7%, 96.4%, 99.8%, 73.0%, 97.6%; for Rome criterion 84.4%, 100.0%, 100.0%, 27.2%, 85.3%; for Vienna criterion 93.7%, 92.3%, 99.5%, 47.1%, 93.6%.
Miami criterion of IOPTH is the most accurate in prognostication of postoperative serum calcium levels after MIP. Use of other criteria may involve a higher risk of false negative results and unnecessary conversion to more extensive neck dissection in search for non-existent hyperfunctioning parathyroid tissue.
术中甲状旁腺激素检测（IOPTH）常用于微创甲状旁腺切除术（MIP）中以预测手术成功率。本研究的目的是根据最常用的一些预后标准评估MIP期间IOPTH的诊断准确性。
对2003年至2012年间在我院接受MIP及IOPTH检测的455例散发性原发性甲状旁腺功能亢进患者进行回顾性研究。采用包括哈雷、迈阿密、罗马和维也纳标准在内的最常用的一些预后标准进行诊断准确性评估。将IOPTH检测结果与术后6个月随访时MIP的结果（血清钙和iPTH水平）进行比较。采用ROC（受试者工作特征）曲线和误差矩阵分析对IOPTH预后标准的准确性进行评估。基于该方法，分别为每个IOPTH标准计算以下准确性参数：敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和总体准确性。
对于每个测试标准（敏感性、特异性、PPV、NPV、准确性），分别发现IOPTH的以下诊断准确性参数：哈雷标准为63.2%、100.0%、100.0%、12.6%、65.1%；迈阿密标准为97.7%、96.4%、99.8%、73.0%、97.6%；罗马标准为84.4%、100.0%、100.0%、27.2%、85.3%；维也纳标准为93.7%、92.3%、99.5%、47.1%、93.6%。
IOPTH的迈阿密标准在预测MIP术后血清钙水平方面最为准确。使用其他标准可能会有更高的假阴性结果风险，并在寻找不存在的功能亢进甲状旁腺组织时不必要地转为更广泛的颈部清扫术。
