Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Department of Surgery, University of California Davis, Sacramento, CA, USA. Electronic address: https://twitter.com/clairegravesmd.
Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. Electronic address: https://twitter.com/thomashopemd.
Surgery. 2022 Jan;171(1):47-54. doi: 10.1016/j.surg.2021.05.056. Epub 2021 Jul 21.
Preoperative parathyroid imaging guides surgeons during parathyroidectomy. This study evaluates the clinical impact of F-fluorocholine positron emission tomography for preoperative parathyroid localization on patients with primary hyperparathyroidism.
Patients with primary hyperparathyroidism and indications for parathyroidectomy had simultaneous F-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 F-fluorocholine positron emission tomography imaging was assessed using 3 anatomic locations (left neck, right neck, and mediastinum), with surgery as the gold standard.
In 101 patients, F-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. F-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 F-fluorocholine positron emission tomography (88.9%) outperformed both ultrasound (37.1%) and sestamibi (27.5%), as well as ultrasound and sestamibi combined (47.8%).
Long-term results in the first cohort in the United States to use F-fluorocholine positron emission tomography for parathyroid localization confirm its utility in a challenging cohort, with better sensitivity than ultrasound or sestamibi.
甲状旁腺术前影像学检查可指导甲状旁腺切除术。本研究评估了氟-18-胆碱正电子发射断层扫描（F-fluorocholine positron emission tomography，F-FCH PET）在原发性甲状旁腺功能亢进患者甲状旁腺术前定位中的临床影响。
原发性甲状旁腺功能亢进患者且有甲状旁腺切除术适应证者同时进行 F-FCH PET 成像/磁共振成像检查。在随后接受甲状旁腺切除术的患者中，术后至少 6 个月的实验室检查值为治愈依据。以手术为金标准，评估 F-FCH PET 成像在左颈、右颈和纵隔 3 个解剖部位的定位灵敏度和特异性。
在 101 例患者中，F-FCH PET 总体上定位了 93%患者至少 1 个候选病灶，在之前影像学检查为阴性的患者中定位了 91%患者的病灶，这导致 60%患者的术前策略发生改变。在 76 例行甲状旁腺切除术的患者中，58 例（77%）术后至少 6 个月有实验室数据，其中 55/58 例（95%）患者治愈。与基于超声的 20/57 例（35%）和基于 sestamibi 的 13/55 例（24%）相比，F-FCH PET 成功指导了 48/58 例（83%）患者的治愈性手术。在基于解剖部位的分析中，F-FCH PET 的灵敏度（88.9%）优于超声（37.1%）和 sestamibi（27.5%），以及超声和 sestamibi 的联合检查（47.8%）。
在美国首个使用 F-FCH PET 进行甲状旁腺定位的队列中，长期结果证实了其在具有挑战性的患者群体中的实用性，其灵敏度优于超声或 sestamibi。
