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Evaluation of an optimal cutoff of parathyroid venous sampling gradient for localizing primary hyperparathyroidism

 Jooyeon Lee  ;  Namki Hong  ;  Byung Moon Kim  ;  Dong Joon Kim  ;  Mijin Yun  ;  Jong Ju Jeong  ;  Yumie Rhee 
 JOURNAL OF BONE AND MINERAL METABOLISM, Vol.38(4) : 570-580, 2020-07 
Journal Title
Issue Date
Female ; Humans ; Hyperparathyroidism, Primary / blood* ; Hyperparathyroidism, Primary / diagnosis ; Hyperparathyroidism, Primary / diagnostic imaging ; Hyperparathyroidism, Primary / surgery ; Male ; Middle Aged ; Parathyroid Glands / diagnostic imaging ; Parathyroid Glands / pathology ; Parathyroid Glands / surgery* ; Parathyroid Hormone / blood ; ROC Curve ; Retrospective Studies ; Ultrasonography
Optimal cutoff ; Parathyroid venous sampling ; Pre-operative localization ; Primary hyperparathyroidism ; Threshold
Introduction: Parathyroid venous sampling (PVS) has been reported to be a useful adjunctive test in localizing lesions in elusive cases of primary hyperparathyroidism (PHPT). Conventional cutoff (twofold) is now widely being used, but optimal cutoff threshold for PVS gradient based on discriminatory performance remains unclear.

Materials and methods: Among a total of 197 consecutive patients (mean age 58.2 years, female 74.6%) with PHPT who underwent parathyroidectomy at a tertiary center between 2012 and 2018, we retrospectively analyzed 59 subjects who underwent PVS for persistent or recurrent disease after previous parathyroidectomy, or for equivocal or negative results from conventional imaging modalities including ultrasonography (US) and Tc99m-Sestamibi SPECT-CT (MIBI). True parathyroid lesions were confirmed by combination of surgical, pathological findings, and intraoperative parathyroid hormone (PTH) changes. Optimal PVS cutoff were determined by receiver-operating characteristics (ROC) analysis with Youden and Liu method.

Results: Compared to subjects who did not require PVS, PVS group tends to have lower PTH (119.8 pg/mL vs 133.7 pg/mL, p = 0.075). A total of 79 culprit parathyroid lesions (left 40; right 39) from 59 patients (left 24; right 26; bilateral 9) were confirmed by surgery. The optimal cutoff for PVS gradient was estimated as 1.5-fold gradient (1.5 ×) with sensitivity of 61.8% and specificity of 84%. When 1.5 × cutoff was applied, PVS improved the discrimination for true parathyroid lesions substantially based on area under ROC (0.892 to 0.942, p < 0.001) when added to US and MIBI.

Conclusion: Our findings suggest that PVS with cutoff threshold 1.5 × can provide useful complementary information for pre-operative localization in selected cases.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Yun, Mijin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Rhee, Yumie(이유미) ORCID logo https://orcid.org/0000-0003-4227-5638
Jeong, Jong Ju(정종주) ORCID logo https://orcid.org/0000-0002-4155-6035
Hong, Nam Ki(홍남기) ORCID logo https://orcid.org/0000-0002-8246-1956
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