title: Focused parathyroidectomy without intraoperative parathormone testing is safe after pre-operative localization with18F-Fluorocholine PET/CT.
abstract: A focused surgical approach based on pre-operative localization replaced the classical four-gland exploration in patients with primary hyperparathyroidism (PHP). Sestamibi scanning and ultrasound are most often used localization modalities with reported sensitivity of 54-100% for identification of single gland disease. The aim of this study was to analyze the results of pre-operative localization with18F-Fluorocholine PET/CT (FCh-PET) in patients with PHP. A retrospective review of 151 patients with PHP who underwent surgery after pre-operative localization with FCh-PET was performed. Only a focused parathyroidectomy without ioPTH testing had been done in patients with single adenoma on FCh-PET. Primary outcome was operative failure, defined as persistent PHP. According to pre-operative FCh-PET 126 (83,4%) patients had single adenoma, 22 (14,5%) multiglandular disease and the test was negative in only two patients. Intraoperative failure experienced 4/126 patients (3,3%) with single adenoma. Removed parathyroid glands were normal in three and hyperplastic in one patient with intraoperative failure. A limited bilateral neck exploration with ioPTH testing was used in 14/22 patients with double adenoma and a classical four-gland exploration without ioPTH testing was used in 8/22 patients with more than two pathological glands according to pre-operative FCh-PET. Intraoperative failure experienced 2/22 patients (9,1%). In two patients with negative FCh-PET a classical four-gland exploration without ioPTH testing was used and one experienced intraoperative failure. A preoperative localization with FCh-PET is a reliable test in patients with PHP. Patients with a single adenoma on FCh-PET can safely undergo a focused parathyroidectomy without ioPTH testing.
authors: Department of Surgical Oncology, Institute of Oncology Ljubljana, Slovenia. Electronic address: mhocevar@onko-i.si.
authors: M
authors: M
authors: Hocevar
authors: Department of Nuclear Medicine, University Medical Centre Ljubljana, Slovenia.
authors: L
authors: L
authors: Lezaic
authors: Department of Nuclear Medicine, University Medical Centre Ljubljana, Slovenia.
authors: S
authors: S
authors: Rep
authors: Department of Nuclear Medicine, University Medical Centre Ljubljana, Slovenia.
authors: K
authors: K
authors: Zaletel
authors: Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Slovenia.
authors: T
authors: T
authors: Kocjan
authors: Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Slovenia.
authors: M J
authors: MJ
authors: Sever
authors: Department of Surgical Oncology, Institute of Oncology Ljubljana, Slovenia.
authors: J
authors: J
authors: Zgajnar
authors: Department of Surgical Oncology, Institute of Oncology Ljubljana, Slovenia.
authors: B
authors: B
authors: Peric
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002794:Choline / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; C514960:fluorocholine; D002794:Choline
keywords: (18)F-fluorocholine PET/CT; Adenoma; Focused surgical approach; Intaoperative parathyroid hormone testing; Multiglandular disease; Primary hyperparathyroidism