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World Journal of Surgery
Published in: World Journal of Surgery 5/2019

01-05-2019 | Ultrasound | Original Scientific Report

18F-Fluorocholine PET/CT and Parathyroid 4D Computed Tomography for Primary Hyperparathyroidism: The Challenge of Reoperative Patients

Authors: Coralie Amadou, Géraldine Bera, Malek Ezziane, Linda Chami, Thierry Delbot, Agnès Rouxel, Monique Leban, Genevieve Herve, Fabrice Menegaux, Laurence Leenhardt, Aurélie Kas, Christophe Trésallet, Cécile Ghander, Charlotte Lussey-Lepoutre

Published in: World Journal of Surgery | Issue 5/2019

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Abstract

Background

To evaluate FCH-PET/CT and parathyroid 4D-CT so as to guide surgery in patients with primary hyperparathyroidism (pHPT) and prior neck surgery.

Methods

Medical records of all patients referred for a FCH-PET/CT in our institution were systematically reviewed. Only patients with pHPT, a history of neck surgery (for pHPT or another reason) and an indication of reoperation were included. All patients had parathyroid ultrasound (US) and Tc-99m-sestaMIBI scintigraphy, and furthermore, some patients had 4D-CT. Gold standard was defined by pathological findings and/or US-guided fine-needle aspiration with PTH level measurement in the washing liquid.

Results

Twenty-nine patients were included in this retrospective study. FCH-PET/CT identified 34 abnormal foci including 19 ectopic localizations. 4D-CT, performed in 20 patients, detected 11 abnormal glands at first reading and 6 more under FCH-PET/CT guidance. US and Tc-99m-sestaMIBI found concordant foci in 8/29 patients. Gold standard was obtained for 32 abnormal FCH-PET/CT foci in 27 patients. On a per-lesion analysis, sensitivity, specificity, positive and negative predictive values were, respectively, 96%, 13%, 77% and 50% for FCH-PET/CT, 75%, 40%, 80% and 33% for 4D-CT. On a per-patient analysis, sensitivity was 85% for FCH-PET/CT and 63% for 4D-CT. FCH-PET/CT results made it possible to successfully remove an abnormal gland in 21 patients, including 12 with a negative or discordant US/Tc-99m-sestaMIBI scintigraphy result, with a global cure rate of 73%.

Conclusion

FCH-PET/CT is a promising tool in the challenging population of reoperative patients with pHPT. Parathyroid 4D-CT appears as a confirmatory imaging modality.
Appendix
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Metadata
Title
18F-Fluorocholine PET/CT and Parathyroid 4D Computed Tomography for Primary Hyperparathyroidism: The Challenge of Reoperative Patients
Authors
Coralie Amadou
Géraldine Bera
Malek Ezziane
Linda Chami
Thierry Delbot
Agnès Rouxel
Monique Leban
Genevieve Herve
Fabrice Menegaux
Laurence Leenhardt
Aurélie Kas
Christophe Trésallet
Cécile Ghander
Charlotte Lussey-Lepoutre
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 5/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-04910-6

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