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The role of 18F-fluoromethylcholine-positron emission tomography-computed tomography for preoperative localization of hyperfunctioning parathyroid glands with special emphasis on multiglandular disease : a retrospective cohort study

Murad, Himam ; Ciacoi-Dutu, Camelia ; Lindblom, Gunnar and Almquist, Martin LU (2023) In Gland Surgery 12(11). p.1567-1578
Abstract

Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Definitive treatment is surgical. Preoperative localization of diseased glands increases the chance of successful treatment. The aim of this study is to investigate the diagnostic performance of 18F-fluoromethylcholine-positron emission tomography-computed tomography (18F-FCh-PET-CT) in preoperative localization of diseased parathyroid glands, when first-line examinations were inconclusive. Methods: This is a retrospective study. All patients with PHPT who underwent 18F-FCh-PET-CT, after inconclusive ultrasound examination and 99mTc-methoxyisobutylisonitrile/single-photon emission CT-CT, were included in cohort I.... (More)

Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Definitive treatment is surgical. Preoperative localization of diseased glands increases the chance of successful treatment. The aim of this study is to investigate the diagnostic performance of 18F-fluoromethylcholine-positron emission tomography-computed tomography (18F-FCh-PET-CT) in preoperative localization of diseased parathyroid glands, when first-line examinations were inconclusive. Methods: This is a retrospective study. All patients with PHPT who underwent 18F-FCh-PET-CT, after inconclusive ultrasound examination and 99mTc-methoxyisobutylisonitrile/single-photon emission CT-CT, were included in cohort I. Patients who were subsequently operated for their parathyroid disease, were included in cohort II. The performance of 18F-FCh-PET-CT was analyzed in two sets: per-lesion, and pergland analysis. Results: Out of 52 patients in cohort I, 18F-FCh-PET-CT identified single or multiple parathyroid lesions in 43 patients (83%). Nine patients had multiglandular disease. Thirty-four (65%) patients were subsequently operated and included in cohort II. Forty-four lesions were removed from these patients and 33 patients (97%) were cured. 18F-FCh-PET-CT localized 40 out of 44 lesions, with per-lesion and pergland sensitivities of 97% and 95%, and positive predictive values (PPVs) of 93% and 87%, respectively, in addition to a specificity of 97% and a negative predictive value (NPV) of 94% in the per-gland analysis. Comparable excellent results were detected in multiglandular disease with sensitivity of 94.1%, specificity of 89%, PPV of 84%, and NPV of 94%. Conclusions: Our study demonstrates the high diagnostic performance of 18F-FCh-PET-CT in the preoperative localization of diseased parathyroid gland in patients with PHPT, especially in multiglandular PHPT.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
F-fluoromethylcholine-positron emission tomography-computed tomography (F-FCh-PET-CT), minimally invasive parathyroidectomy (MIP), parathyroid surgery, Primary hyperparathyroidism (PHPT)
in
Gland Surgery
volume
12
issue
11
pages
12 pages
publisher
AME Publishing Company
external identifiers
  • pmid:38107488
  • scopus:85178444317
ISSN
2227-684X
DOI
10.21037/gs-23-232
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2023 Gland Surgery. All Rights Reserved.
id
789be0af-13de-4eb4-8f2d-fba913dabf04
date added to LUP
2024-01-05 09:36:40
date last changed
2024-04-20 05:58:38
@article{789be0af-13de-4eb4-8f2d-fba913dabf04,
  abstract     = {{<p>Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Definitive treatment is surgical. Preoperative localization of diseased glands increases the chance of successful treatment. The aim of this study is to investigate the diagnostic performance of <sup>18</sup>F-fluoromethylcholine-positron emission tomography-computed tomography (<sup>18</sup>F-FCh-PET-CT) in preoperative localization of diseased parathyroid glands, when first-line examinations were inconclusive. Methods: This is a retrospective study. All patients with PHPT who underwent <sup>18</sup>F-FCh-PET-CT, after inconclusive ultrasound examination and <sup>99m</sup>Tc-methoxyisobutylisonitrile/single-photon emission CT-CT, were included in cohort I. Patients who were subsequently operated for their parathyroid disease, were included in cohort II. The performance of <sup>18</sup>F-FCh-PET-CT was analyzed in two sets: per-lesion, and pergland analysis. Results: Out of 52 patients in cohort I, <sup>18</sup>F-FCh-PET-CT identified single or multiple parathyroid lesions in 43 patients (83%). Nine patients had multiglandular disease. Thirty-four (65%) patients were subsequently operated and included in cohort II. Forty-four lesions were removed from these patients and 33 patients (97%) were cured. <sup>18</sup>F-FCh-PET-CT localized 40 out of 44 lesions, with per-lesion and pergland sensitivities of 97% and 95%, and positive predictive values (PPVs) of 93% and 87%, respectively, in addition to a specificity of 97% and a negative predictive value (NPV) of 94% in the per-gland analysis. Comparable excellent results were detected in multiglandular disease with sensitivity of 94.1%, specificity of 89%, PPV of 84%, and NPV of 94%. Conclusions: Our study demonstrates the high diagnostic performance of <sup>18</sup>F-FCh-PET-CT in the preoperative localization of diseased parathyroid gland in patients with PHPT, especially in multiglandular PHPT.</p>}},
  author       = {{Murad, Himam and Ciacoi-Dutu, Camelia and Lindblom, Gunnar and Almquist, Martin}},
  issn         = {{2227-684X}},
  keywords     = {{F-fluoromethylcholine-positron emission tomography-computed tomography (F-FCh-PET-CT); minimally invasive parathyroidectomy (MIP); parathyroid surgery; Primary hyperparathyroidism (PHPT)}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{1567--1578}},
  publisher    = {{AME Publishing Company}},
  series       = {{Gland Surgery}},
  title        = {{The role of <sup>18</sup>F-fluoromethylcholine-positron emission tomography-computed tomography for preoperative localization of hyperfunctioning parathyroid glands with special emphasis on multiglandular disease : a retrospective cohort study}},
  url          = {{http://dx.doi.org/10.21037/gs-23-232}},
  doi          = {{10.21037/gs-23-232}},
  volume       = {{12}},
  year         = {{2023}},
}