J Korean Med Sci.  2012 Aug;27(8):890-895. 10.3346/jkms.2012.27.8.890.

Preoperative Predictive Factors for Parathyroid Carcinoma in Patients with Primary Hyperparathyroidism

• Bae JH
• Choi HJ
• Lee Y
• Moon MK
• Park YJ
• Shin CS
• Park DJ
• Jang HC
• Kim SY
• Kim SW

• KMID: 1714200
• DOI: http://doi.org/10.3346/jkms.2012.27.8.890

Abstract

This study was conducted to review the clinical characteristics of parathyroid carcinoma (PC) and to evaluate potential preoperative predictive factors for PC in patients with primary hyperparathyroidism (PHPT). We performed a retrospective review of electronic medical records of 194 patients with pathologically confirmed PHPT in affiliated teaching hospitals of Seoul National University from January 2000 to March 2011. Adenoma was diagnosed in 171 patients, hyperplasia in 12, and carcinoma in 11. Several biochemical measurements were higher in patients with PC than in patients with benign disease, including serum total calcium (P < 0.001), intact parathyroid hormone (P = 0.003), and alkaline phosphatase (ALP) (P < 0.001). Tumors were larger in PC than in benign disease (P < 0.001). Multivariate analysis revealed that serum ALP level (P < 0.001) and tumor size were associated with PC (P = 0.03). Tumor size and serum ALP level were evaluated as preoperative predictive factors for PC using ROC analyses: a tumor size of 3.0 cm (sensitivity 90.9%, specificity 92.1%) and serum ALP level of 285 IU/L (83.3%, 97.0%) had predictive value for the diagnosis of PC in patients with PHPT. In conclusion, elevated serum ALP and a large parathyroid mass at the time of diagnosis can be helpful to predict PC in patients with PHPT.

Keyword

Hyperparathyroidism; Parathyroid Neoplasms; Alkaline Phosphatase

MeSH Terms

Adenoma/complications/diagnosis/surgery
Adult
Aged
Alkaline Phosphatase/blood
Calcium/blood
Carcinoma/complications/diagnosis/surgery
Female
Follow-Up Studies
Humans
Hyperparathyroidism, Primary/complications/*diagnosis
Hyperplasia/complications/diagnosis
Male
Middle Aged
Neoplasm Staging
Parathyroid Hormone/blood
Parathyroid Neoplasms/complications/*diagnosis/surgery
Predictive Value of Tests
*Preoperative Care
ROC Curve
Retrospective Studies
Parathyroid Hormone
Calcium
Alkaline Phosphatase

Figure

• 

  Fig. 1 Receiver operating curve analyses of tumor size and serum ALP level. Tumor size and serum ALP level were evaluated for preoperative predictive factors for PC. Tumor size (A) 3.0 cm had 90.9% of sensitivity, 92.1% of specificity and 43.4% of positive predictive values (PPV), 99.9% of negative predictive value (NPV). Serum ALP level (B) 285 IU/L had 83.3% of sensitivity, 97.0% of specificity and 33.3% of PPV, 99.9% of NPV.

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