Whole-blood versus laboratory intraoperative parathyroid hormone assays and optimisation of intraoperative monitoring during parathyroidectomy: A retrospective cohort study
In brief
A 10-minute whole-blood test rules in successful excision 97% of the time
In 103 patients undergoing parathyroidectomy, a whole-blood test showing a greater than 50% hormone drop at 10 minutes had a 97% chance of correctly indicating early biochemical success. But it missed many patients who did not achieve success: its negative predictive value was only 51%, and the laboratory assay performed better overall. A negative point-of-care result should not be relied on alone.
- Journal
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Q1)
- Published
- 3 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- O O'Connor, M Senbeto, S Balasubramanian
- PMID
- 42827161
- DOI
- 10.1007/s00405-026-10642-w
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 7 October 2026): Whole‑blood POC PTH assay vs lab assay comparison
Abstract
PURPOSE: Intraoperative parathyroid hormone (IOPTH) monitoring supports focused parathyroidectomy by confirming biochemical response after gland excision, but standard assays may be logistically burdensome. Whole-blood point-of-care (POC) assays offer faster turnaround but may have reduced sensitivity. We compared a whole-blood POC IOPTH assay (NBCL CONNECT) with a standard laboratory assay and evaluated candidate IOPTH criteria and sampling timepoints. METHODS: We performed a single-centre retrospective cohort study of consecutive patients undergoing parathyroidectomy for primary hyperparathyroidism with IOPTH monitoring over an 18-month period. Paired samples were collected pre-incision, pre-excision, and approximately 5 and 10 min post-excision and analysed using NBCL CONNECT assay performed in theatre, and the laboratory PTH assay performed in the hospital laboratory. The reference outcome was early biochemical success defined by postoperative calcium normalisation and appropriate postoperative PTH profile during the postoperative period. Diagnostic accuracy (sensitivity, specificity, PPV, NPV) was assessed for prespecified IOPTH criteria at 5 and 10 min. RESULTS: Among 103 patients, early biochemical success was achieved in 98 (95.1%). Across evaluated criteria, the laboratory assay demonstrated higher overall diagnostic performance than NBCL CONNECT at both 5 and 10 min (Online Resource 1). For NBCL CONNECT, the prespecified 10-minute criterion (> 50% PTH decline from the lower pre-excision value) yielded a PPV of 96.9% (95% CI 89.3-99.6) and NPV of 51.4% (95% CI 34.0-68.6). ROC analyses showed consistently higher AUCs for the laboratory assay; differences were less marked at 10 min. CONCLUSION: Whole-blood POC IOPTH using NBCL CONNECT provides a practical intraoperative adjunct but has limited negative predictive value. A 10-minute sample interpreted as a > 50% decline from the lower pre-excision value maximised diagnostic performance within this cohort, supporting a rule-in role for confirming adequacy of excision while cautioning against reliance on a negative POC result alone.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.