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Impact of Fluoro-Choline PET/CT in Reduction in Failed Parathyroid Localization in Primary Hyperparathyroidism

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Abstract

Introduction

Accurate localization of the pathological parathyroid gland is a prerequisite for minimally invasive surgical management of hyperparathyroidism (HPT). Poor imaging or discordance in odd situations like ectopic adenomas, parathyroid hyperplasia, syndromic HPT results in localization dilemma thus causing failed parathyroidectomy. We studied the impact of Fluoro-Choline (FCH) PET/CT imaging in reduction in localization failure of parathyroid adenoma.

Materials and methods

We did a retrospective observational study (2018–2021) of HPT among which 97 patients underwent focused parathyroidectomy (FP). All patients had undergone ultrasound imaging and 99mTc-sestaMIBI scan with early SPECT/CT (MIBI). When this preliminary imaging was doubtful or negative or multiple lesions were expected, FCH PET/CT was performed. We compared the localization accuracy of MIBI scan and FCH PET/CT with surgical outcomes as reference standard.

Results

MIBI scan showed overall lesion detection rate (LDR) of 88.65% in localization of pathological parathyroid gland in 97 patients. The addition of FCH PET/CT improved the overall lesion detection to 97.9%. The overall possible localization failure was reduced from 11.34 to 2.06% with the addition of FCH PET/CT (p < 0.05).

Out of 97 patients of FP, 87 patients showed features of parathyroid adenoma. Single hyperplastic gland was seen in 7 patients, lipoadenoma was seen in 1 patient and 1 patient had features suggestive of parathyroiditis on histopathology. FCH PET/CT was a useful adjunct and showed significant reduction in localization failure of parathyroid adenoma.

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Acknowledgments

I express my sincere gratitude to Dr. Vuthaluru Seenu, Dr. Danny Joy, Dr. Anurag Srivastava, and Rajendra Aphale for their kind contribution in this study.

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Author notes

  1. Rijuta Aphale and Nishikant Damle have contributed equally to this study.

Authors and Affiliations

  1. Department of Surgical Disciplines, All India Institute of India New Delhi, New Delhi, India

    Rijuta Aphale & Sunil Chumber

  2. Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

    Rijuta Aphale

  3. Department of Nuclear Medicine, All India Institute of India, New Delhi, New Delhi, India

    Nishikant Damle, Yamini Dharmashaktu & Chandrashekhar Bal

  4. Department of Biostatistics, All India Institute of India, New Delhi, New Delhi, India

    Maroof Khan

  5. Department of Endocrinology and Metabolism, All India Institute of India, New Delhi, New Delhi, India

    Rajesh Khadgawat

  6. Department of Pathology, All India Institute of India, New Delhi, New Delhi, India

    Shipra Agarwal

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  1. Rijuta Aphale
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Correspondence to Sunil Chumber.

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Aphale, R., Damle, N., Chumber, S. et al. Impact of Fluoro-Choline PET/CT in Reduction in Failed Parathyroid Localization in Primary Hyperparathyroidism. World J Surg 47, 1231–1237 (2023). https://doi.org/10.1007/s00268-022-06866-6

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  • DOI: https://doi.org/10.1007/s00268-022-06866-6

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