Focused parathyroidectomy without intraoperative parathormone testing is safe after pre-operative localization with 18 F-Fluorocholine PET/CT.

Autor: Hocevar M; Department of Surgical Oncology, Institute of Oncology Ljubljana, Slovenia. Electronic address: mhocevar@onko-i.si., Lezaic L; Department of Nuclear Medicine, University Medical Centre Ljubljana, Slovenia., Rep S; Department of Nuclear Medicine, University Medical Centre Ljubljana, Slovenia., Zaletel K; Department of Nuclear Medicine, University Medical Centre Ljubljana, Slovenia., Kocjan T; Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Slovenia., Sever MJ; Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Slovenia., Zgajnar J; Department of Surgical Oncology, Institute of Oncology Ljubljana, Slovenia., Peric B; Department of Surgical Oncology, Institute of Oncology Ljubljana, Slovenia.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2017 Jan; Vol. 43 (1), pp. 133-137. Date of Electronic Publication: 2016 Oct 21.
DOI: 10.1016/j.ejso.2016.09.016
Abstrakt: A focused surgical approach based on pre-operative localization replaced the classical four-gland exploration in patients with primary hyperparathyroidism (PHP). Sestamibi scanning and ultrasound are most often used localization modalities with reported sensitivity of 54-100% for identification of single gland disease. The aim of this study was to analyze the results of pre-operative localization with 18 F-Fluorocholine PET/CT (FCh-PET) in patients with PHP. A retrospective review of 151 patients with PHP who underwent surgery after pre-operative localization with FCh-PET was performed. Only a focused parathyroidectomy without ioPTH testing had been done in patients with single adenoma on FCh-PET. Primary outcome was operative failure, defined as persistent PHP. According to pre-operative FCh-PET 126 (83,4%) patients had single adenoma, 22 (14,5%) multiglandular disease and the test was negative in only two patients. Intraoperative failure experienced 4/126 patients (3,3%) with single adenoma. Removed parathyroid glands were normal in three and hyperplastic in one patient with intraoperative failure. A limited bilateral neck exploration with ioPTH testing was used in 14/22 patients with double adenoma and a classical four-gland exploration without ioPTH testing was used in 8/22 patients with more than two pathological glands according to pre-operative FCh-PET. Intraoperative failure experienced 2/22 patients (9,1%). In two patients with negative FCh-PET a classical four-gland exploration without ioPTH testing was used and one experienced intraoperative failure. A preoperative localization with FCh-PET is a reliable test in patients with PHP. Patients with a single adenoma on FCh-PET can safely undergo a focused parathyroidectomy without ioPTH testing.
(Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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