ECEESPE2025 Poster Presentations Bone and Mineral Metabolism (112 abstracts)
Parathyroid washout’s role in accurate adenoma localisation and diagnostic cut-offs
Ekin Yiğit Köroğlu 1 , Berna Evranos Ogmen 2 , belma tural balsak 1 , Mustafa Ömer Yazıcıoğlu 3 , cevdet aydin 2 , Oya Topaloglu 2 , Reyhan Ersoy 2 & Bekir Cakir 2
1Ankara Bilkent City Hospital, Endocrinology and Metabolism Diseases, Ankara, Türkiye; 2Ankara Yıldırım Beyazıt University Faculty of Medicine, Endocrinology and Metabolism Diseases, Ankara, Türkiye; 3Ankara Bilkent City Hospital, General Surgery, Ankara, Türkiye
JOINT1090
Purpose: Accurate adenoma localisation is necessary for the application of minimally invasive surgery, which is preferred in the treatment of primary hyperparathyroidism. This study aimed to determine appropriate cut-off values for the parathormone-washout(PTH-WO) method.
Design: A total of 402 PTH-WO assays from 339 patients were included in the study. The diagnostic accuracy of the test was assessed by accepting as a positive result a PTH-WO result higher than the serum PTH level [PTH-WO/serum PTH(PTH ratio)>1]. In addition, a cut-off value for the test was established by evaluating the PTH washout results obtained in comparison with postoperative histopathology. Undiluted test results were not included to obtain a clear numerical value in this evaluation. The results of parathyroid scintigraphy and fine needle aspiration biopsy(FNAB) were compared with postoperative histopathology.
Results: While 309(76. 86%) of the PTH-WO procedures were considered positive, 93(23. 13%) were considered negative if the PTH ratio was >1. When these results were compared with the postoperative histopathology, the test’s sensitivity was 92. 51%, and the specificity was 100. 00%. In the analysis of the remaining 292 PTH-WO samples after excluding the undiluted ones, the sensitivity and specificity of the method were 92. 3% and 94. 1%, respectively, with a PTH ratio >0. 99. With a cut-off value of 99. 5 ng/l for PTH-WO value, 93. 1% sensitivity and 94. 3% specificity were obtained. The sensitivities of parathyroid scintigraphy and FNAB were 53. 4% and 15. 3%, respectively.
| Parameters | n | Value |
| Age (years) | 339 | 54. 00 (19. 00-81. 00) |
| Calcium (mg/dl) | 339 | 11. 00 (8. 90-14. 90) |
| Corrected Calcium (mg/dl) | 339 | 10. 60 (8. 30-14. 70) |
| Phosphorus (mg/dl) | 339 | 2. 70 (1. 40-4. 70) |
| Alkaline phosphatase (U/l) | 315 | 106. 09 ± 42. 09 |
| Creatinine (mg/dl) | 339 | 0. 74 ± 0. 14 |
| Glomerular filtration rate (ml/min) | 339 | 97. 00 (60. 00-134. 00) |
| Serum Parathormone (ng/l) | 339 | 154. 00 (81. 00-738. 00) |
| 24-hour urinary calcium (mg/day) | 339 | 298. 50 (80. 00-947. 00) |
| Right | Left | Level VII lymph node compartment | Overall | |
| Superior | 11 (3. 13%) | 18 (5. 12%) | N/A | 29 (8. 26%) |
| Inferior | 149 (51. 20%) | 142 (40. 45%) | N/A | 291 (82. 90%) |
| Intrathyroidal | 16 (4. 55%) | 12 (3. 41%) | N/A | 28 (7. 97%) |
| Level VII lymph node compartment | N/A | N/A | 3 (0. 85%) | 3 (0. 85%) |
| Overall | 176 (50. 14%) | 172 (49. 00%) | 3 (0. 85%) | 351 (100. 00 %) |
Conclusion: The PTH-WO method is safe and cheap, with high sensitivity and specificity in localising parathyroid adenoma. In cases where radiological methods cannot achieve localisation with specified cut-off values, it has high diagnostic accuracy.
Volume 110
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