How has the diagnostic approach to parathyroid localization techniques evolved in the past decade? Insights from a single-center experience

作者：Giuseppe Cacciatore, Manuela Mastronardi, Lucia Paiano, Hussein Abdallah, Carmelo Crisafulli, Franca Dore, Stella Bernardi, Nicolò de Manzini, Margherita Sandano, Chiara Dobrinja · 发表于：Updates in Surgery · 年份：2025 · DOI：10.1007/s13304-025-02090-8 · 被引用次数：7 · 研究领域：Parathyroid Disorders and Treatments、Genetic Syndromes and Imprinting、Thyroid and Parathyroid Surgery

The standardization of preoperative imaging in primary hyperparathyroidism is one of the current challenges of endocrine surgery. A correct localization of the hypersecretory gland by neck ultrasound and 99mTc-sestamibi (MIBI) scintigraphy are not sufficiently sensitive in some cases. In recent years, CT-4D, 18F-Fluorocholine PET/CT, and radio-guided parathyroidectomy have come into common use. The aim of this study is to evaluate the performance of 18F-Fluorocholine PET/CT after prior negative or discordant first-line imaging in patients with primary hyperparathyroidism undergoing parathyroid surgery. Monocentric observational study on patients affected by pHPT undergoing surgery from July 2009 to April 2024 at the Division of General Surgery, Cattinara Teaching Hospital of Trieste. Preoperative, intra-operative, and follow-up data were collected. The imaging methods used were neck ultrasound, 99mTc-sestamibi (MIBI) scintigraphy, and 18F-Fluorocholine PET/CT (since 2018). 172 patients were included. As first radiologic examination, neck ultrasound (US) was performed in 140 cases and 99mTc-sestamibi (MIBI) scintigraphy in 162. Ultrasound and/or scintigraphy imaging were sufficient for the identification of the gland in 127 patients (73.8%), while in 45 patients (26.2%), the localization was defined with other techniques. Particularly, three patients with negative or discordant first-line imaging underwent neck 4D-CT scan who was useful for parathyroid localization all cases (...