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Vol. 98. Issue 7.
Pages 395-402 (August - September 2020)
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Vol. 98. Issue 7.
Pages 395-402 (August - September 2020)
Original article
DOI: 10.1016/j.cireng.2020.07.014
Identification of Occult Adenomas in Primary Hyperparathyroidism With 18F-Fluorocholine PET/CT
Identificación de adenomas ocultos en hiperparatiroidismo primario con PET-TC 18F-fluorocolina
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Eulàlia Ballester Vázqueza,
Corresponding author
ballester.eulalia@gmail.com

Corresponding author.
, José Ignacio Pérez Garcíaa, Diego Alfonso López Morab, Clara Galán Martíneza, Elena Pareja Nietoa, Montserrat Clos Enrríqueza, José Antonio González Lópeza, Antonio Moral Duartea
a 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, Spain
b Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
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Tables (2)
Table 1. Epidemiological and Clinical Characteristics of the Sample and Control Groups Pre- and Postoperative.
Table 2. Postoperative Results of the MIBI-Negative Patient Group (Sample Group) Treated Surgically.
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Abstract
Introduction

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.

Methods

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.

Results

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 2 groups.

Conclusion

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.

Keywords:
Primary hyperparathyroidism
Multiple endocrine neoplasm
Parathyroid adenoma
Parathyroid hyperplasia
Choline PET/CT
18F-fluorocholine
Resumen
Introducción

La principal causa de hiperparatiroidismo primario en nuestro medio es el adenoma paratiroideo único. La paratiroidectomía se considera el único tratamiento potencialmente curativo y requiere de estudios de imagen de localización preoperatorios para un abordaje quirúrgico dirigido. En pacientes con negatividad en pruebas convencionales, la PET-TC colina ha demostrado tasas de sensibilidad superiores respecto al gold-standard.

Métodos

Se diseñó un estudio de cohortes prospectivo que incluyó a 34 pacientes con diagnóstico de hiperparatiroidismo primario entre 2017 y 2019, candidatos a cirugía con pruebas de imagen con gammagrafía y SPECT-TC MIBI negativas. A todos se les realizó una PET-TC con 18F-fluorocolina. Los resultados se compararon con un grupo control de 30 pacientes con pruebas convencionales positivas intervenidos en el mismo período.

Resultados

La PET-TC colina detectó tejido paratiroideo hiperfuncionante en el 85% de los pacientes con gammagrafía previa negativa. Se realizó resección selectiva del adenoma identificado en estos pacientes, con criterio de curación en el 87% de los casos, sin precisar de exploración cervical bilateral. Los niveles de PTH, calcemia y el peso glandular fueron significativamente menores en este grupo con respecto al control. No se identificaron diferencias respecto al criterio de curación ni a la vía de abordaje en ambos grupos.

Conclusión

En nuestro estudio, la PET-TC colina demostró tasas superiores de detección que permitieron aumentar el número de pacientes candidatos a cirugía dirigida con disminución de la morbilidad quirúrgica, especialmente en grupos con adenomas de menor tamaño asociados a niveles más bajos de calcemia y PTH preoperatorias y en pacientes con cirugías cervicales previas.

Palabras clave:
Hiperparatiroidismo primario
Neoplasia endocrina múltiple
Adenoma paratiroideo
Hiperplasia paratiroidea
PET-TC colina
18F-fluorocolina

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