Parathyroid adenoma localization: our findings support a new first-line imaging strategy.
- Carlos E Costa Almeida
- há 17 horas
- 2 min de leitura
During the 11th Biennial Congress of the European Society of Endocrine Surgeons (ESES) in Geneva (Switzerland), we presented a retrospective review of the primary hyperparathyroidism (pHPT) cases treated in the Department of Head & Neck Surgery of the IPO Coimbra (Head: Dr. Paula Messias), with non-concordant preoperative localization imaging. This is a common issue when using conventional ultrasonography (US) combined with MIBI for preoperative localization of the diseased gland. This work was presented as a poster, with Dr. Ana Luis Martins as the first author (Dr. Carlos E. Costa Almeida as presenter), entitled: "From second-line to first-line: The emerging role of 11C-Choline PET/CT in parathyroid surgery".
Why is accurate preoperative localization so important today? Although bilateral neck exploration achieves good outcomes in terms of gland removal, it is associated with a higher complication rate compared with targeted parathyroidectomy. This minimally invasive approach allows direct access to the accurately localized adenoma, enabling its removal while avoiding unnecessary dissection. As a result, operations are faster, complication rates are lower, and surgical outcomes remain excellent. Today, targeted parathyroidectomy (minimally invasive parathyroidectomy) represents the preferred surgical approach, making near-perfect preoperative localization crucial.
Our results showed that, among 47 patients with pHPT, 53% had non-concordant US and MIBI findings. All these patients subsequently underwent additional evaluation with 11C-Choline PET/CT. US correctly localized the diseased gland in 29% of cases, MIBI in 70%, and 11C-Choline PET/CT in 100% of cases, confirming the PET/CT sensitivity of 100% in our series.
Ultimately, 11C-Choline PET/CT enabled the use of targeted parathyroidectomy (minimally invasive surgery), avoiding unilateral or bilateral neck exploration and potentially reducing complication rates. In our clinical practice, PET/CT has frequently altered the surgical strategy, including changing the side initially thought to harbor the diseased gland. Imagine exploring the right side based on US and MIBI findings when the diseased gland is actually located on the left. Surgical difficulty increases, stress and uncertainty escalate, and the risk of complications rises significantly.
I firmly believe—and our results support this—that we should reconsider our current approach to preoperative localization in pHPT. Why not replace MIBI with choline PET/CT as the first-line image? Are financial considerations outweighing clinical outcomes?
Dr. Carlos Eduardo Costa Almeida
General Surgery
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