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Diagnostic Rechallenge with 18F-FCH PET/CT Often Allows Minimally Invasive Parathyroidectomy While Maintaining Exceptional Cure Rates

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Abstract

Background

Minimally invasive parathyroidectomy (MIP) has gained acceptance as the preferred surgical procedure for management of primary hyperparathyroidism (pHPT). Appropriate selection of patients for a MIP is a crucial step in its utilization. The aim of the study was to evaluate the role of 18F-FCH PET/CT as second-line imaging for accurately directing MIP.

Methods

This is a retrospective single-center study. Seventy-two patients with biochemical evidence of pHPT and a non-conclusive or negative first-line imaging (ultrasound and dual isotope subtraction scintigraphy) received 18F-FCH PET/CT between January 2018 and February 2020. All imaging studies were performed at our institution. Assessment of therapeutic changes and outcomes was performed.

Results

of the 72 patients imaged with 18F-FCH PET/CT, 54 subsequently underwent parathyroidectomy. When considering the ability of 18F-FCH PET/CT alone to predict a uniglandular disease, the sensitivity, specificity, PPV and NPV were 92.7% (95%CI: 80.1—98.5), 46.2% (19.2–74.9), PPV 87.3% (80.5—92) and NPV 61.2% (31.4—84.5), respectively. When we combined the data provided by 18F-FCH PET/CT with the data already collected from 1st line imaging we were able to complete a minimally invasive surgery in 38 of the 41 (92%) patients with a uniglandular disease. Thirteen patients (24%) had a multiglandular disease, all of them except one underwent bilateral neck exploration based on the data collected by all imaging modalities combined. Overall, cure was achieved in 53 (98%) patients.

Conclusion

18F-FCH PET/CT, interpreted along with first-line imaging results in selected patients, can better facilitate utilization of MIS while maintaining exceptional cure rates.

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Funding

The authors have no funding or financial support for this manuscript.

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Author notes

  1. David Taïeb and Fréderic Sebag have authors contributed equally.

Authors and Affiliations

  1. Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille, France

    Shani Goren, Nunzia Cinzia Paladino, Carole Guerin & Fréderic Sebag

  2. Department of General and Oncological Surgery–Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel

    Shani Goren, Shachar Laks & Dan Assaf

  3. Department of Endocrinology, Conception University Hospital, APHM, Aix Marseille University, Marseille, France

    Thomas Cuny

  4. Department of Radiology, La Timone University Hospital, Aix-Marseille University, Marseille, France

    Josiane Vaillant-Lombard

  5. Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264, rue Saint-Pierre, 13385, Marseille, France

    Clément Mennetrey, Christelle Fargette & David Taïeb

  6. Department of Nuclear Medicine, University Hospital of Bordeaux, Bordeaux, France

    Elif Hindié

Authors
  1. Shani Goren
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  2. Nunzia Cinzia Paladino
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Corresponding author

Correspondence to David Taïeb.

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Conflict of interest

The authors have nothing to disclose.

Ethical approval

The study was approved by the Assistance Publique-Hôpitaux de Marseille ethics advisory committee. Waiver of patient consent was granted by the ethics committee, given the retrospective nature of the study

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Informed consent was obtained from all individual participants included in the study.

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Goren, S., Paladino, N.C., Laks, S. et al. Diagnostic Rechallenge with 18F-FCH PET/CT Often Allows Minimally Invasive Parathyroidectomy While Maintaining Exceptional Cure Rates. World J Surg 46, 2409–2415 (2022). https://doi.org/10.1007/s00268-022-06629-3

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  • DOI: https://doi.org/10.1007/s00268-022-06629-3

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