Unidad de Cirugía Endocrina, Mama y Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
Unidad de Cirugía Endocrina, Mama y Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
Cir Esp (Engl Ed). 2020 Aug-Sep;98(7):395-402. doi: 10.1016/j.ciresp.2020.01.003. Epub 2020 Feb 28.
Single parathyroid adenomas are the most common cause of primary hyperparathyroidism (PHP) in our population. Parathyroidectomy is still the only potentially curative treatment and requires preoperative localization imaging studies to perform selective surgery. In patients with negative results on conventional tests, PET/CT has demonstrated higher sensitivity rates.
A prospective cohort study was designed, including 34 patients diagnosed with PHP between 2017 and 2019, candidates for surgery with negative preoperative localization tests with scintigraphy and MIBI SPECT/CT. All patients underwent PET/CT with 18F-Fluorocholine. The clinical, biochemical and postoperative outcome results were compared with a control group of 30 patients with positive standard tests.
Hyperfunctional parathyroid tissue was detected in 85% of the patients that had undergone choline PET/CT. The selective resection of the adenoma identified in these patients achieved curative criteria in 87% of the cases without undergoing bilateral cervical surgical exploration. The preoperative levels of PTH, calcemia and gland weight were significantly lower in this group compared to the control group. No differences were identified in cure criteria or approach between the 2groups.
In our study, choline PET/CT showed higher detection rates compared to the gold standard. The increase provides the opportunity to perform unilateral selected adenoma resection, especially in patients with smaller adenomas associated with lower calcemia and PTH levels and patients with previous cervical surgery.
甲状旁腺腺瘤是我国人群原发性甲状旁腺功能亢进（PHP）的最常见原因。甲状旁腺切除术仍然是唯一有潜在治愈作用的治疗方法，需要术前定位成像研究来进行选择性手术。在常规检查结果为阴性的患者中，PET/CT 显示出更高的敏感性。
设计了一项前瞻性队列研究，纳入了 2017 年至 2019 年间诊断为 PHP 的 34 例患者，这些患者为手术候选者，术前定位检查（闪烁扫描和 MIBI SPECT/CT）均为阴性。所有患者均接受 18F-氟胆碱 PET/CT 检查。比较了临床、生化和术后结果与 30 例标准检查阳性的对照组。
在接受胆碱 PET/CT 检查的患者中，85%的患者检测到功能性甲状旁腺组织。在这些患者中，选择性切除在 87%的病例中达到了治愈标准，而无需进行双侧颈探查手术。与对照组相比，该组患者的术前甲状旁腺激素（PTH）、血钙和腺体重量水平明显更低。两组间治愈标准或手术方式无差异。
在我们的研究中，与金标准相比，胆碱 PET/CT 显示出更高的检测率。这种增加提供了进行单侧选择性腺瘤切除术的机会，特别是在与较低血钙和 PTH 水平相关的较小腺瘤患者以及先前有颈部手术的患者中。
