Endocr Pract. 2019 Nov;25(11):1117-1126. doi: 10.4158/EP-2019-0191. Epub 2019 Aug 15.
While intraoperative parathyroid hormone (IOPTH) monitoring with a ≥50% drop commonly guides the extent of exploration for primary hyperparathyroidism (pHPT), receiver operating characteristic (ROC) analysis has not been performed to determine whether other criteria yield better sensitivity and specificity. The aim of this study was to identify the optimum percent change of IOPTH following removal of the abnormal parathyroid pathology, in order to predict biochemical cure. Secondary aims were to identify patient subgroups with increased area under the ROC curve (AUC) and the need for moderated criteria. A retrospective review was performed on patients undergoing primary parathyroid surgery for sporadic pHPT between 1999 and 2010 at a tertiary center for endocrine surgery. Eight hundred and ninety-six patients with primary hyperparathyroidism were included. Multigland disease (MGD) was defined as the intraoperative detection of more than 1 enlarged hypercellular gland or persistent disease after single gland excision. ROC analysis was used to determine the value with the best performance at predicting MGD, following bilateral exploration. MGD was diagnosed in 174 patients (19.4%). ROC analysis demonstrated an AUC of 0.69. An IOPTH drop of 72% was the point of optimal discrimination with a sensitivity of 55% and specificity of 76% for predicting MGD. Subgroup analysis by preoperative calcium, preoperative PTH, localization studies, or pre- and post-excision IOPTH, did not identify any factors associated with an improved AUC. To our knowledge, this is the first study to use ROC analysis in a large patient cohort. An IOPTH drop of 72% was found to have optimal discriminating ability. We failed to identify a subset of patients for whom there was substantial improvement in the AUC, sensitivity, or specificity. = area under the ROC curve; = bilateral neck exploration; = focal parathyroid exploration; = intraoperative parathyroid hormone; = multigland disease; = Tc99m-sestamibi I-123 subtraction single-photon emission computed tomography/computed tomography; = primary hyperparathyroidism; = receiver operating characteristic; = single gland disease; = surgeon-performed neck ultrasound.
虽然术中甲状旁腺激素 (IOPTH) 监测的下降幅度≥50%通常指导原发性甲状旁腺功能亢进症 (pHPT) 的探查范围，但尚未进行接收者操作特征 (ROC) 分析以确定其他标准是否能提供更好的敏感性和特异性。本研究的目的是确定异常甲状旁腺病变切除后 IOPTH 最佳百分比变化，以预测生化治愈。次要目的是确定具有增加 ROC 曲线下面积 (AUC) 和需要适度标准的患者亚组。回顾性分析了 1999 年至 2010 年在一家内分泌外科三级中心接受原发性甲状旁腺手术治疗散发性 pHPT 的 896 例患者。包括 174 例多腺体疾病 (MGD) 患者（19.4%）。MGD 的定义为术中发现 1 个以上肿大的高细胞腺体或单腺切除后持续存在疾病。ROC 分析用于确定双侧探查后预测 MGD 的最佳表现值。174 例患者诊断为 MGD（19.4%）。ROC 分析显示 AUC 为 0.69。IOPTH 下降 72%是最佳区分点，预测 MGD 的敏感性为 55%，特异性为 76%。术前钙、术前 PTH、定位研究或术前和术后 IOPTH 的亚组分析未发现任何与 AUC 改善相关的因素。据我们所知，这是第一项在大样本患者队列中使用 ROC 分析的研究。发现 IOPTH 下降 72%具有最佳的区分能力。我们未能确定 AUC、敏感性或特异性有实质性提高的亚组患者。AUC = ROC 曲线下面积；Bilateral Neck Exploration = 双侧颈部探查；Focal Parathyroid Exploration = 局部甲状旁腺探查；Intraoperative Parathyroid Hormone = 术中甲状旁腺激素；Multigland Disease = 多腺体疾病；Tc99m-sestamibi I-123 Subtraction Single-Photon Emission Computed Tomography/Computed Tomography = Tc99m- sestamibi I-123 减影单光子发射计算机断层扫描/计算机断层扫描；Primary Hyperparathyroidism = 原发性甲状旁腺功能亢进症；Receiver Operating Characteristic = 接收者操作特征；Single Gland Disease = 单腺体疾病；Surgeon-performed Neck Ultrasound = 外科医生执行的颈部超声。
