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Superior sensitivity of 18 F-fluorocholine: PET localization in primary hyperparathyroidism.
- Source :
-
Surgery [Surgery] 2022 Jan; Vol. 171 (1), pp. 47-54. Date of Electronic Publication: 2021 Jul 21. - Publication Year :
- 2022
-
Abstract
- Background: Preoperative parathyroid imaging guides surgeons during parathyroidectomy. This study evaluates the clinical impact of <superscript>18</superscript> F-fluorocholine positron emission tomography for preoperative parathyroid localization on patients with primary hyperparathyroidism.<br />Methods: Patients with primary hyperparathyroidism and indications for parathyroidectomy had simultaneous <superscript>18</superscript> F-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 <superscript>18</superscript> F-fluorocholine positron emission tomography imaging was assessed using 3 anatomic locations (left neck, right neck, and mediastinum), with surgery as the gold standard.<br />Results: In 101 patients, <superscript>18</superscript> F-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. <superscript>18</superscript> F-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 <superscript>18</superscript> F-fluorocholine positron emission tomography (88.9%) outperformed both ultrasound (37.1%) and sestamibi (27.5%), as well as ultrasound and sestamibi combined (47.8%).<br />Conclusion: Long-term results in the first cohort in the United States to use <superscript>18</superscript> F-fluorocholine positron emission tomography for parathyroid localization confirm its utility in a challenging cohort, with better sensitivity than ultrasound or sestamibi.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Choline administration & dosage
Female
Fluorine Radioisotopes administration & dosage
Humans
Hyperparathyroidism, Primary etiology
Hyperparathyroidism, Primary pathology
Hyperparathyroidism, Primary surgery
Magnetic Resonance Imaging statistics & numerical data
Male
Middle Aged
Parathyroid Glands pathology
Parathyroid Glands surgery
Parathyroid Neoplasms complications
Parathyroid Neoplasms pathology
Parathyroid Neoplasms surgery
Parathyroidectomy statistics & numerical data
Positron-Emission Tomography statistics & numerical data
Preoperative Care methods
Preoperative Care statistics & numerical data
Technetium Tc 99m Sestamibi administration & dosage
Treatment Outcome
Choline analogs & derivatives
Hyperparathyroidism, Primary diagnosis
Parathyroid Glands diagnostic imaging
Parathyroid Neoplasms diagnosis
Positron-Emission Tomography methods
Subjects
Details
- Language :
- English
- ISSN :
- 1532-7361
- Volume :
- 171
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34301418
- Full Text :
- https://doi.org/10.1016/j.surg.2021.05.056