18F-fluorocholine PET for Parathyroid Localization

The use of 18F-fluorocholine positron emission tomography for parathyroid localization within the first cohort in the United States is better in terms of sensitivity than ultrasound or sestamibi, suggests a study published in the Surgery.

Preoperative parathyroid imaging helps the surgeons during parathyroidectomy. A study conducted by Graves C et al. assesses the clinical influence of 18F-fluorocholine positron emission tomography for preoperative parathyroid localization on patients suffering from primary hyperparathyroidism.

The researchers selected patients with primary hyperparathyroidism and indications for parathyroidectomy had simultaneous 18F-fluorocholine positron emission tomography imaging/magnetic resonance imaging. In patients who underwent subsequent parathyroidectomy, treatment was based on lab values at least 6 months after surgery. Location-based sensitivity and specificity of 18F-fluorocholine positron emission tomography imaging was assessed using 3 anatomic locations (left neck, right neck, and mediastinum), with surgery as the gold standard.

Study Results

• Among the total 101 patients, 18F-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.
• 18F-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, the sensitivity of 18F-fluorocholine positron emission tomography (88.9%) outperformed both ultrasound (37.1%) and sestamibi (27.5%), as well as ultrasound and sestamibi combined (47.8%).

The researchers concluded that among the first cohort in the United States, the use of 18F-fluorocholine positron emission tomography for parathyroid localization confirms its utility in a challenging cohort, with better sensitivity than ultrasound or sestamibi.

Reference

Superior sensitivity of 18F-fluorocholine: PET localization in primary hyperparathyroidism by Graves C et al. published in the Surgery.

DOI: https://doi.org/10.1016/j.surg.2021.05.056