Superior sensitivity of 18F-fluorocholine: PET localization in primary hyperparathyroidism.

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.

• Authors: Claire E Graves, Thomas A Hope, Jina Kim, Miguel H Pampaloni, Wouter Kluijfhout, Carolyn D Seib, Jessica E Gosnell, Wen T Shen, Sanziana A Roman, Julie A Sosa, Quan-Yang Duh, Insoo Suh
• Journal: Surgery (Surgery) Vol. 171 Issue 1 Pg. 47-54 (01 2022) ISSN: 1532-7361 [Electronic] United States
• PMID: 34301418 (Publication Type: Clinical Trial, Phase II, Clinical Trial, Phase III, Comparative Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Chemical References

• Fluorine Radioisotopes
• fluorocholine
• Technetium Tc 99m Sestamibi
• Choline

Topics

• Aged
• Choline (administration & dosage, analogs & derivatives)
• Female
• Fluorine Radioisotopes (administration & dosage)
• Humans
• Hyperparathyroidism, Primary (diagnosis, etiology, pathology, surgery)
• Magnetic Resonance Imaging (statistics & numerical data)
• Male
• Middle Aged
• Parathyroid Glands (diagnostic imaging, pathology, surgery)
• Parathyroid Neoplasms (complications, diagnosis, pathology, surgery)
• Parathyroidectomy (statistics & numerical data)
• Positron-Emission Tomography (methods, statistics & numerical data)
• Preoperative Care (methods, statistics & numerical data)
• Technetium Tc 99m Sestamibi (administration & dosage)
• Treatment Outcome