Abstract | BACKGROUND: Parathyroid histopathology has been used to predict single or multiglandular disease (MGD). " Hyperplasia" implies MGD, whereas " adenoma" suggests single gland involvement. Intraoperative parathyroid hormone (PTH) monitoring (IPM) guides parathyroidectomy based on function. We sought to evaluate the accuracy of histopathology in the diagnosis of single or MGD and in predicting operative success. METHODS: RESULTS: Of 402 patients, 384 had 1 gland excised resulting in operative success; hyperplasia was diagnosed in 244 of the 384 (64%), with only 2 developing recurrence. Of the 384 patients, 140 (37%) had adenomas with 1 late recurrence. There were 18 patients with MGD (14 hyperplasias, 4 adenomas). There were 5 failures with hyperplasia predicting MGD. Histopathology was incorrect in predicting the number of glands involved in 249 of 402 (62%) patients, and IPM was incorrect in only 13 (3%). CONCLUSION: Histopathology of excised abnormal parathyroid glands does not predict the secretory function of the remaining parathyroid glands left in situ. IPM guided parathyroidectomy accurately based on function alone; however, histopathology was inaccurate in predicting MGD and should not be used to guide parathyroidectomy in patients with SPHPT.
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Authors | Denise M Carneiro-Pla, Rita Romaguera, Mehrdad Nadji, John I Lew, Carmen C Solorzano, George L Irvin 3rd |
Journal | Surgery
(Surgery)
Vol. 142
Issue 6
Pg. 930-5; discussion 930-5
(Dec 2007)
ISSN: 1532-7361 [Electronic] United States |
PMID | 18063078
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adenoma
(metabolism, pathology, surgery)
- Humans
- Hyperparathyroidism, Primary
(metabolism, pathology, surgery)
- Hyperplasia
- Parathyroid Glands
(metabolism, pathology)
- Parathyroid Hormone
(blood, metabolism)
- Parathyroid Neoplasms
(metabolism, pathology, surgery)
- Parathyroidectomy
- Predictive Value of Tests
- Recurrence
- Treatment Outcome
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