Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience
Background. The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80–85% of the cases) or by a multiglandular disease (15–20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the...
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Wiley
2021-01-01
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| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2021/2040284 |
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| author | Loredana De Pasquale Eleonora Lori Antonio Mario Bulfamante Giovanni Felisati Luca Castellani Alberto Maria Saibene |
| author_facet | Loredana De Pasquale Eleonora Lori Antonio Mario Bulfamante Giovanni Felisati Luca Castellani Alberto Maria Saibene |
| author_sort | Loredana De Pasquale |
| collection | DOAJ |
| description | Background. The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80–85% of the cases) or by a multiglandular disease (15–20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the literature, to perform focused parathyroidectomy, avoiding intraoperative parathormone assay (ioPTH). The most known are the CaPTHUS test and the Wisconsin index. We applied them to our experience. Methods. A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. Only patients affected with benign PHPT and neck ultrasound performed at our institution were included. Both patients for whom preoperative imaging agreed with the localization of a single diseased parathyroid and those with only ultrasound or scintigraphy positive for parathyroid localization underwent Mini-Invasive Video-assisted parathyroidectomy. In all cases, ioPTH assay was performed. The conversion to bilateral neck exploration was decided based on the drop in ioPTH. CaPTHUS score and the Wisconsin index (Win) were applied to the series. CaPTHUS score ≥3 and Win index >1600, according to the original studies of the literature, were considered at high probability of monoglandular disease. Outcomes in these two groups were examined. Results. 236 patients were eligible for the study. The pathology resulted in multiglandular disease in 24 patients (10.2%). Among these, 18 (75.0%) obtained a CaPTHUS score ≥3, and 20 (83.3%) had a Win index>1600. Intraoperative PTH allowed to identify multiglandular disease in 16 of 18 cases with CaPTHUS ≥3 and in 18 of 20 cases with win >1600, who could have been lost, based only on the results of these 2 tests. Conclusion. Based on our experience, CaPTHUS test and Wisconsin index were not so useful in predicting multiglandular disease as ioPTH. |
| format | Article |
| id | doaj-art-3f08aaec5ec54c38a747a676c8b1f53f |
| institution | Kabale University |
| issn | 1687-8337 1687-8345 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
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| series | International Journal of Endocrinology |
| spelling | doaj-art-3f08aaec5ec54c38a747a676c8b1f53f2025-02-03T06:47:55ZengWileyInternational Journal of Endocrinology1687-83371687-83452021-01-01202110.1155/2021/20402842040284Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center ExperienceLoredana De Pasquale0Eleonora Lori1Antonio Mario Bulfamante2Giovanni Felisati3Luca Castellani4Alberto Maria Saibene5Thyroid and Parathyroid Surgery Service (Head Dott. Loredana De Pasquale)-Otolaryngology Unit (Head: Professor Giovanni Felisati), ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via A. di Rudinì, 8, Milan 20142, ItalyDepartment of Surgical Science, “Sapienza” University of Rome, Rome 00161, ItalyOtolaryngology Unit (Head: Professor Giovanni Felisati), ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via A. di Rudinì, 8, Milan 20142, ItalyOtolaryngology Unit (Head: Professor Giovanni Felisati), ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via A. di Rudinì, 8, Milan 20142, ItalyOtolaryngology Unit (Head: Professor Giovanni Felisati), ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via A. di Rudinì, 8, Milan 20142, ItalyDepartment of Surgical Science, “Sapienza” University of Rome, Rome 00161, ItalyBackground. The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80–85% of the cases) or by a multiglandular disease (15–20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the literature, to perform focused parathyroidectomy, avoiding intraoperative parathormone assay (ioPTH). The most known are the CaPTHUS test and the Wisconsin index. We applied them to our experience. Methods. A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. Only patients affected with benign PHPT and neck ultrasound performed at our institution were included. Both patients for whom preoperative imaging agreed with the localization of a single diseased parathyroid and those with only ultrasound or scintigraphy positive for parathyroid localization underwent Mini-Invasive Video-assisted parathyroidectomy. In all cases, ioPTH assay was performed. The conversion to bilateral neck exploration was decided based on the drop in ioPTH. CaPTHUS score and the Wisconsin index (Win) were applied to the series. CaPTHUS score ≥3 and Win index >1600, according to the original studies of the literature, were considered at high probability of monoglandular disease. Outcomes in these two groups were examined. Results. 236 patients were eligible for the study. The pathology resulted in multiglandular disease in 24 patients (10.2%). Among these, 18 (75.0%) obtained a CaPTHUS score ≥3, and 20 (83.3%) had a Win index>1600. Intraoperative PTH allowed to identify multiglandular disease in 16 of 18 cases with CaPTHUS ≥3 and in 18 of 20 cases with win >1600, who could have been lost, based only on the results of these 2 tests. Conclusion. Based on our experience, CaPTHUS test and Wisconsin index were not so useful in predicting multiglandular disease as ioPTH.http://dx.doi.org/10.1155/2021/2040284 |
| spellingShingle | Loredana De Pasquale Eleonora Lori Antonio Mario Bulfamante Giovanni Felisati Luca Castellani Alberto Maria Saibene Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience International Journal of Endocrinology |
| title | Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience |
| title_full | Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience |
| title_fullStr | Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience |
| title_full_unstemmed | Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience |
| title_short | Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience |
| title_sort | evaluation of wisconsin and capthus indices usefulness for predicting monoglandular and multiglandular disease in patients with primary hyperparathyroidism through the analysis of a single center experience |
| url | http://dx.doi.org/10.1155/2021/2040284 |
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