Receiver operating characteristic analysis of intraoperative parathyroid hormone monitoring to determine optimum sensitivity and specificity: Analysis of 896 cases

Christina S. Foley, Edwina C. Moore, Mira Milas, Eren Berber, Joyce Shin, Allan E. Siperstein

    Research output: Contribution to journalArticle

    Abstract

    Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

    Original languageEnglish (US)
    Pages (from-to)1117-1126
    Number of pages10
    JournalEndocrine Practice
    Volume25
    Issue number11
    DOIs
    StatePublished - Jan 1 2019

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    Parathyroid Hormone
    ROC Curve
    Sensitivity and Specificity
    Primary Hyperparathyroidism
    Area Under Curve
    Pathology
    Calcium

    ASJC Scopus subject areas

    • Endocrinology, Diabetes and Metabolism
    • Endocrinology

    Cite this

    Receiver operating characteristic analysis of intraoperative parathyroid hormone monitoring to determine optimum sensitivity and specificity : Analysis of 896 cases. / Foley, Christina S.; Moore, Edwina C.; Milas, Mira; Berber, Eren; Shin, Joyce; Siperstein, Allan E.

    In: Endocrine Practice, Vol. 25, No. 11, 01.01.2019, p. 1117-1126.

    Research output: Contribution to journalArticle

    Foley, Christina S. ; Moore, Edwina C. ; Milas, Mira ; Berber, Eren ; Shin, Joyce ; Siperstein, Allan E. / Receiver operating characteristic analysis of intraoperative parathyroid hormone monitoring to determine optimum sensitivity and specificity : Analysis of 896 cases. In: Endocrine Practice. 2019 ; Vol. 25, No. 11. pp. 1117-1126.
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    abstract = "Objective: 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. Methods: 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. Results: 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. Conclusion: 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.",
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    AU - Moore, Edwina C.

    AU - Milas, Mira

    AU - Berber, Eren

    AU - Shin, Joyce

    AU - Siperstein, Allan E.

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    N2 - Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

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