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

Himam Murad; Camelia Ciacoi-Dutu; Gunnar Lindblom; Martin Almquist

doi:10.21037/gs-23-232

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

Gland Surg. 2023 Nov 24;12(11):1567-1578. doi: 10.21037/gs-23-232. Epub 2023 Nov 15.

Authors

Himam Murad¹, Camelia Ciacoi-Dutu², Gunnar Lindblom², Martin Almquist³

Affiliations

¹ Department of Surgery, Highland Hospital, Eksjö, Sweden.
² Department of Nuclear Medicine, Ryhov Hospital, Jönköping, Sweden.
³ Department of Surgery and Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.

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. 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 per-gland 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 per-gland 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.

Keywords: 18F-fluoromethylcholine-positron emission tomography-computed tomography (18F-FCh-PET-CT); Primary hyperparathyroidism (PHPT); minimally invasive parathyroidectomy (MIP); parathyroid surgery.