Abstract
PurposeMinimally invasive parathyroidectomy (MIP) is the recommended treatment in primary hyperparathyroidism (pHPT) for which accurate preoperative localization is essential. The current imaging standard consists of cervical ultrasonography (cUS) and MIBI-SPECT/CT. 11C-MET PET/CT has a higher resolution than MIBI-SPECT/CT. The aim of this study was to determine the diagnostic performance of 11C-MET PET/CT after initial inconclusive or negative localization.MethodsWe performed a retrospective single center cohort study of patients with pHPT undergoing parathyroid surgery after prior negative imaging and later localization by means of 11C-MET PET/CT between 2006 and 2014. Preoperative localization by 11C-MET PET/CT was compared with later surgical localization, intraoperative quick PTH (IOPTH), duration of surgery, histopathology, and follow-up data. Also, differences in duration of surgery between the groups with and without correct preoperative localization were analyzed.ResultsIn 18/28 included patients a positive 11C-MET-PET/CT result corresponded to the surgical localized adenoma (64%). In 3/28 patients imaging was false positive and no adenoma was found. In 7/28 patients imaging was false negative at the side of the surgically identified adenoma. Sensitivity of 11C-MET PET/CT was 72% (18/25). Duration of surgery of correctly localized patients was significantly shorter compared to falsely negative localized patients (p = 0.045).ConclusionIn an intention to treat 11C-MET-PET/CT correctly localized the parathyroid adenoma in 18/28 (64%) patients, after previous negative imaging. A preoperatively correct localized adenoma leads to a more focused surgical approach (MIP) potentially reducing duration of surgery and potentially healthcare costs.
Highlights
IntroductionPrimary hyperparathyroidism (pHPT) is a common endocrine disorder, with the highest incidence in elderly women [1]
Adrienne H Brouwers and Schelto Kruijff contributed Primary hyperparathyroidism is a common endocrine disorder, with the highest incidence in elderly women [1]
But is associated with hereditary syndromes such as multiple endocrine neoplasia (MEN) type 1 and 2. primary hyperparathyroidism (pHPT) is characterized by hypercalcemia in the presence of high concentrations of PTH, which can lead to abdominal complaints, osteoporosis, kidney stones, muscle weakness, pain, depression and behavioral changes
Summary
Primary hyperparathyroidism (pHPT) is a common endocrine disorder, with the highest incidence in elderly women [1]. It occurs sporadically, but is associated with hereditary syndromes such as multiple endocrine neoplasia (MEN) type 1 and 2. Surgery is the only curative and recommended treatment in patients with pHPT usually by means of a minimally invasive parathyroidectomy (MIP). In MIP, surgeons remove the adenoma via a unilateral approach with a minimal invasive incision of 1–2 cm. In 80 to 90% of the pHPT cases, only a single parathyroid adenoma is present, making this surgical strategy. To be able to perform a unilateral MIP, accurate preoperative imaging is essential
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