Abstract
Background
Preoperative parathyroid imaging guides surgeons during parathyroidectomy. This study
evaluates the clinical impact of 18F-fluorocholine positron emission tomography for preoperative parathyroid localization
on patients with primary hyperparathyroidism.
Methods
Patients with primary hyperparathyroidism and indications for parathyroidectomy had
simultaneous 18F-fluorocholine positron emission tomography imaging/magnetic resonance imaging. In
patients who underwent subsequent parathyroidectomy, cure was based on lab values
at least 6 months after surgery. Location-based sensitivity and specificity of 18F-fluorocholine positron emission tomography imaging was assessed using 3 anatomic
locations (left neck, right neck, and mediastinum), with surgery as the gold standard.
Results
In 101 patients, 18F-fluorocholine positron emission tomography localized at least 1 candidate lesion
in 93% of patients overall and in 91% of patients with previously negative imaging,
leading to a change in preoperative strategy in 60% of patients. Of 76 patients who
underwent parathyroidectomy, 58 (77%) had laboratory data at least 6 months postoperatively,
with 55/58 patients (95%) demonstrating cure. 18F-fluorocholine positron emission tomography successfully guided curative surgery
in 48/58 (83%) patients, compared with 20/57 (35%) based on ultrasound and 13/55 (24%)
based on sestamibi. In a location-based analysis, sensitivity of 18F-fluorocholine positron emission tomography (88.9%) outperformed both ultrasound
(37.1%) and sestamibi (27.5%), as well as ultrasound and sestamibi combined (47.8%).
Conclusion
Long-term results in the first cohort in the United States to use 18F-fluorocholine positron emission tomography for parathyroid localization confirm
its utility in a challenging cohort, with better sensitivity than ultrasound or sestamibi.
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References
- Parathyroidectomy for asymptomatic primary hyperparathyroidism: a revised cost-effectiveness analysis incorporating fracture risk reduction.Surgery. 2017; 161: 16-24
- The effect of parathyroidectomy on bone fracture risk in patients with primary hyperparathyroidism.Arch Surg. 2006; 141 (discussion 889–891): 885-889
- The long-term benefit of parathyroidectomy in primary hyperparathyroidism: a 10-year prospective surgical outcome study.Surgery. 2009; 146: 1006-1013
- Undertreatment of primary hyperparathyroidism in a privately insured US population: decreasing utilization of parathyroidectomy despite expanding surgical guidelines.Surgery. 2021; 169: 87-93
- Influence of a negative sestamibi scan on the decision for parathyroid operation by the endocrinologist and surgeon.Surgery. 2017; 161: 35-43
- Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial.Ann Surg. 2007; 246 (discussion 980–981): 976-980
- Localization of parathyroid disease in reoperative patients with primary hyperparathyroidism.Int J Endocrinol. 2020; 2020: 9649564
- The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism.JAMA Surg. 2016; 151: 959-968
- F18-choline, a novel PET tracer for parathyroid adenoma?.J Clin Endocrinol Metab. 2013; 98: 3111-3112
- Phospholipid/Ca2+-dependent protein kinase activity in human parathyroid adenoma.Endocrinol Jpn. 1987; 34: 965-968
- Usefulness of 18F-fluorocholine positron emission tomography-computed tomography in locating lesions in hyperparathyroidism: a systematic review.JAMA Otolaryngol Head Neck Surg. 2019; 145: 743-750
- 18F-fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with (99m)Tc-MIBI or (99m)Tc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients.Eur J Nucl Med Mol Imaging. 2018; 45: 1762-1771
- Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis.Eur J Nucl Med Mol Imaging. 2019; 46: 751-765
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- Accuracy of 18F-fluorocholine PET for the detection of parathyroid adenomas: prospective single center study [e-pub ahead of print].J Nucl Med. 2021; (Accessed July 16, 2021)https://doi.org/10.2967/jnumed.120.256735
- 18-F-fluorocholine PETMR: optimizing injection delay for parathyroid adenoma localization.J Nucl Med. 2018; 59: 236
- 18F-choline PET/CT and PET/MRI in primary and recurrent hyperparathyroidism: a systematic review of the literature.Ann Nucl Med. 2020; 34: 601-619
- Benefit of 18F-fluorocholine PET imaging in parathyroid surgery.Eur Radiol. 2018; 28: 2700-2707
- Is 18F-fluorocholine-positron emission tomography/computerized tomography a new imaging tool for detecting hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism?.J Clin Endocrinol Metab. 2014; 99: 4531-4536
- 18F fluorocholine PET/MR imaging in patients with primary hyperparathyroidism and inconclusive conventional imaging: a prospective pilot study.Radiology. 2017; 284: 460-467
- F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study.Eur J Nucl Med Mol Imaging. 2018; 45: 658-666
- Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of 18F-fluorocholine PET/CT.Eur J Nucl Med Mol Imaging. 2018; 45: 1772-1780
- Additional value of integrated 18F-choline PET/4D contrast-enhanced CT in the localization of hyperfunctioning parathyroid glands and correlation with molecular profile.Eur J Nucl Med Mol Imaging. 2019; 46: 766-775
- 18Fluorocholine PET/CT scanning with arterial phase-enhanced CT is useful for persistent/recurrent primary hyperparathyroidism: first UK case series results.Ann R Coll Surg Engl. 2019; 101: 501-507
- 18F-fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study.Eur J Nucl Med Mol Imaging. 2014; 41: 2083-2089
- 18F-fluorocholine PET/CT in primary hyperparathyroidism: superior diagnostic performance to conventional scintigraphic imaging for localization of hyperfunctioning parathyroid glands.J Nucl Med. 2020; 61: 577-583
- Minimally invasive parathyroidectomy guided by intraoperative parathyroid hormone monitoring (IOPTH) and preoperative imaging versus bilateral neck exploration for primary hyperparathyroidism in adults.Cochrane Database Syst Rev. 2020; 10: CD010787
- Can imaging studies be omitted in patients with sporadic primary hyperparathyroidism?.J Surg Res. 2018; 231: 257-262
- Increasing trend of bilateral neck exploration in primary hyperparathyroidism.Am J Surg. 2020; 219: 466-470
- Preoperative parathyroid localization does not improve surgical outcomes for patients with primary hyperparathyroidism.Am J Surg. 2020; 220: 533-535
- Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound.Langenbecks Arch Surg. 2011; 396: 83-90
- Approach to the patient with persistent or recurrent primary hyperparathyroidism.J Clin Endocrinol Metab. 2011; 96: 2950-2958
- Multimodal preoperative localization improves outcomes in reoperative parathyroidectomy: a 25-year surgical experience.Am Surg. 2019; 85: 939-943
Article info
Publication history
Published online: July 20, 2021
Accepted:
May 4,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
