Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism?
Détails
Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_418F4D04BCA3
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism?
Périodique
Frontiers in medicine
ISSN
2296-858X (Print)
ISSN-L
2296-858X
Statut éditorial
Publié
Date de publication
2023
Peer-reviewed
Oui
Volume
10
Pages
1148287
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Résumé
To investigate the value of presurgical <sup>18</sup> F-FCH PET/CT in detecting additional hyperfunctioning parathyroids despite a positive <sup>99m</sup> Tc-sestamibi parathyroid scintigraphy in patients with primary hyperparathyroidism (pHPT).
This is a retrospective study involving patients with pHPT, positive parathyroid scintigraphy performed before <sup>18</sup> F-FCH PET/CT, and parathyroid surgery achieved after PET/CT. Imaging procedures were performed according to the EANM practice guidelines. Images were qualitatively interpreted as positive or negative. The number of pathological findings, their topography, and ectopic location were recorded. Histopathology, Miami criterion, and biological follow-up were considered to ensure effective parathyroidectomy confirming the complete excision of all hyperfunctioning glands. The impact of <sup>18</sup> F-FCH PET/CT on therapeutic strategy was recorded.
64/632 scanned pHPT patients (10%) were included in the analysis. According to a per lesion-based analysis, sensitivity, specificity, positive predictive value, and negative predictive value of <sup>99m</sup> Tc-sestamibi scintigraphy were 82, 95, 87, and 93%, respectively. The same values for <sup>18</sup> F-FCH PET/CT were 93, 99, 99, and 97%, respectively. <sup>18</sup> F-FCH PET/CT showed a significantly higher global accuracy than <sup>99m</sup> Tc-sestamibi scintigraphy: 98% (CI: 95-99) vs. 91% (CI: 87-94%). Youden Index was 0.79 and 0.92 for <sup>99m</sup> Tc-sestamibi scintigraphy and <sup>18</sup> F-FCH PET/CT, respectively. Scintigraphy and PET/CT were discordant in 13/64 (20%) patients (49 glands). <sup>18</sup> F-FCH PET/CT identified nine pathologic parathyroids not detected by <sup>99m</sup> Tc-sestamibi scintigraphy in 8 patients (12.5%). Moreover, <sup>18</sup> F-FCH PET/CT allowed the reconsideration of false-positive scintigraphic diagnosis (scinti+/PET-) for 8 parathyroids in 7 patients (11%). The <sup>18</sup> F-FCH PET/CT influenced the surgical strategy in 7 cases (11% of the study population).
In a preoperative setting, <sup>18</sup> F-FCH PET/CT seems more accurate and useful than <sup>99m</sup> Tc-sestamibi scan in pHPT patients with positive scintigraphic results. Positive parathyroid scintigraphy could be not satisfactory before neck surgery particularly in patients with multiglandular disease, suggesting a need to evolve the practice and define new preoperative imaging algorithms including <sup>18</sup> F-FCH PET/CT at the fore-front in pHPT patients.
This is a retrospective study involving patients with pHPT, positive parathyroid scintigraphy performed before <sup>18</sup> F-FCH PET/CT, and parathyroid surgery achieved after PET/CT. Imaging procedures were performed according to the EANM practice guidelines. Images were qualitatively interpreted as positive or negative. The number of pathological findings, their topography, and ectopic location were recorded. Histopathology, Miami criterion, and biological follow-up were considered to ensure effective parathyroidectomy confirming the complete excision of all hyperfunctioning glands. The impact of <sup>18</sup> F-FCH PET/CT on therapeutic strategy was recorded.
64/632 scanned pHPT patients (10%) were included in the analysis. According to a per lesion-based analysis, sensitivity, specificity, positive predictive value, and negative predictive value of <sup>99m</sup> Tc-sestamibi scintigraphy were 82, 95, 87, and 93%, respectively. The same values for <sup>18</sup> F-FCH PET/CT were 93, 99, 99, and 97%, respectively. <sup>18</sup> F-FCH PET/CT showed a significantly higher global accuracy than <sup>99m</sup> Tc-sestamibi scintigraphy: 98% (CI: 95-99) vs. 91% (CI: 87-94%). Youden Index was 0.79 and 0.92 for <sup>99m</sup> Tc-sestamibi scintigraphy and <sup>18</sup> F-FCH PET/CT, respectively. Scintigraphy and PET/CT were discordant in 13/64 (20%) patients (49 glands). <sup>18</sup> F-FCH PET/CT identified nine pathologic parathyroids not detected by <sup>99m</sup> Tc-sestamibi scintigraphy in 8 patients (12.5%). Moreover, <sup>18</sup> F-FCH PET/CT allowed the reconsideration of false-positive scintigraphic diagnosis (scinti+/PET-) for 8 parathyroids in 7 patients (11%). The <sup>18</sup> F-FCH PET/CT influenced the surgical strategy in 7 cases (11% of the study population).
In a preoperative setting, <sup>18</sup> F-FCH PET/CT seems more accurate and useful than <sup>99m</sup> Tc-sestamibi scan in pHPT patients with positive scintigraphic results. Positive parathyroid scintigraphy could be not satisfactory before neck surgery particularly in patients with multiglandular disease, suggesting a need to evolve the practice and define new preoperative imaging algorithms including <sup>18</sup> F-FCH PET/CT at the fore-front in pHPT patients.
Mots-clé
PET, choline, hyperparathyroidism, parathyroid, parathyroid adenoma, scintigraphy, sestamibi
Pubmed
Web of science
Open Access
Oui
Création de la notice
23/05/2023 14:38
Dernière modification de la notice
23/01/2024 8:24