Abstract
ObjectiveA novel immunochromatographic test strip method was developed to detect tissue parathyroid hormone (PTH) using the immune colloidal gold technique (ICGT). The accuracy and application value of this method for intraoperative parathyroid identification were evaluated.MethodsSerum samples were collected to measure PTH by both ICGT and electrochemiluminescence immunoassay (ECLIA). Patients who underwent unilateral and total thyroidectomy were enrolled to evaluate the feasibility and clinical efficacy of rapid intraoperative identification of parathyroid glands via PTH determination using ICGT. Two sample preparation methods, fine needle aspiration (FNA) and tissue block homogenate (TBH), were used for PTH-ICGT analysis.ResultsBablok analysis showed a linear relationship between the serum PTH measurements obtained by ICGT and ECLIA. Non-parathyroid tissues had much lower PTH concentrations (14.8 ± 2.1 pg/ml, n = 97) detected by ICGT, compared to the parathyroid gland tissues (955.3 ± 16.1 pg/ml, n = 79; P < 0.0001), With biopsy results as the standard, ICGT showed higher diagnosis rates as compared with direct visual inspection, for identifying both parathyroid glands (97.4 vs. 78.2%) and non-parathyroid tissues (100 vs. 68.9%). The cut-off values for parathyroid identification by FNA and TBH methods were 63.99 and 136.30 pg/ml, respectively. The detection time was 2 min by TBH method for in vitro tissue detection and 6 min by FNA method for in situ tissue detection, both of which were faster than traditional intraoperative cryopathological examination (usually >30 min). Intraoperative application of ICGT method was associated with higher postoperative serum calcium and blood PTH levels at 1 and 3 months as well as a lower incidence of postoperative transient hypocalcemia, as compared with direct visual inspection.ConclusionPTH-ICGT assay shows high potential as a rapid, novel alternative for intraoperative parathyroid identification.
Highlights
Hypoparathyroidism is an abnormal condition characterized by low levels of parathyroid hormone (PTH) [1]
Several auxiliary techniques are used during thyroid surgery to minimize the probability of parathyroid removal and the subsequent development of postoperative hypoparathyroidism and hypocalcemia, such as carbon nanoparticle suspension negative imaging, visible staining by methylene blue or antiparathyroid antibody BB5 G1 conjugated to Cibacron blue, and gamma probe identification [5,6,7,8,9]
Consistency Between Parathyroid Hormone-Immune Colloidal Gold Technique and Electrochemiluminescence Immunoassay Methods A total of 151 serum samples were collected at the time of thyroid surgery to verify the consistency between PTH-ICGT and Electrochemiluminescence immunoassay (ECLIA) methods
Summary
Hypoparathyroidism is an abnormal condition characterized by low levels of parathyroid hormone (PTH) [1]. Several auxiliary techniques are used during thyroid surgery to minimize the probability of parathyroid removal and the subsequent development of postoperative hypoparathyroidism and hypocalcemia, such as carbon nanoparticle suspension negative imaging, visible staining by methylene blue or antiparathyroid antibody BB5 G1 conjugated to Cibacron blue, and gamma probe identification [5,6,7,8,9]. Intraoperative frozen sectioning for histological examination is useful in differentiating parathyroid tissue from other tissues and is selectively used to identify the presence of parathyroid tissue and to provide histological confirmation for potential parathyroid autotransplantation This method has many disadvantages in the identification of parathyroid glands. This technique is timeconsuming, usually exceeding 30 min, which may delay the operation time and affect the vitality of the remaining parathyroid glands to be autotransplanted, even resulting in transplantation failure
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