CONCORDANCE OF IMAGING TESTS AND INTRAOPERATIVE FINDINGS IN PRIMARY HYPERPARATHYROIDISM

AUTHORS:
A. Camacho Aroca (MADRID, Spain) , E. Colmenarejo García (MADRID, Spain) , L. Luján Sardiña (MADRID, Spain) , C. Ferrero San Román (MADRID, Spain) , A. Valdazo Gómez (MADRID, Spain) , A. León Brestcher (MADRID, Spain) , M. Ramírez Bescós (MADRID, Spain) , P. Soto García (MADRID, Spain) , P. Gadea Uría (MADRID, Spain) , M. Zubillaga Gómez (madrid, Spain) , A.D. Castillo Zambrano (MADRID, Spain) , C. Sevillano Collantes (MADRID, Spain) , O. Meizoso Pita (MADRID, Spain) , V. Triviño Yannuzzi (MADRID, Spain) , I. Huguet Moreno (MADRID, Spain) , M. Llavero Valero (MADRID, Spain) , J. Modamio Molina (MADRID, Spain) , Á. Carretero García (MADRID, Spain) , T. Talaván Zanón (MADRID, Spain) , D. Roldán Cortés (MADRID, Spain) , S. Alonso García (MADRID, Spain) , I. Galán González (MADRID, Spain) , R. Pastorín Salís (MADRID, Spain) , C. Pardo Martínez (MADRID, Spain) , I. Sánchez Egido (MADRID, Spain) , A. Ruiz De La Hermosa García-Pardo (MADRID, Spain) , L.D.P. Latorre Marlasca (MADRID, Spain) , G. Paseiro Crespo (MADRID, Spain) , B. Fernández Escudero (Madrid, Spain) , L. Zeng Zhang (madrid, Spain) , M.d.M. García González (madrid, Spain) , L. Rambla Aguilar (madrid, Spain)
Background:
The importance of agreement between preoperative localization tests and intraoperative findings in hyperparathyroidism is crucial when designing the diagnostic and surgical strategy. If we find out the cause of the discordance or propose the most sensitive and specific imaging test for the location of the adenomas, the possibility of double adenoma or hyperplasia, hyperparathyroidism surgery will continue to evolve towards the least possible invasion. The new localization techniques, autofluorescence and indocyanine green, should demonstrate greater sensitivity and diagnostic profitability.
Methods:
Review of the series of 350 patients. Period of 10 years. "Infanta Leonor" University Hospital Madrid, Spain.
Results:
Average age: 62 years (25-88). Female 54%; male 46%; Asymptomatic: 71.2%; Average PTH: 277 pg/ml, Calcium: 10.76 mg/dl, Ionic calcium: 1.27, Alkaline phosphatase 105.87. In Ggraphy: most frequent: lower right (32%). 10% not located. Ultrasound sensitivity very variable (18% to 58%). Sensitivity of 90% for the TAC Choline, the most sensitive and specific. Non-localization was reduced by 9% with the addition of FCH PET/CT. Upper right the most complicated to locate. The greatest discordance between imaging tests: lower left. PTH value independent for localization, not so much calcium values. Pathology: 5% hyperplasias. 3% double adenomas.
Conclusions:
PTH levels and, to a lesser extent, calcium levels are related to discordance in imaging tests in PPH. Scintigraphy is the first option in our environment. Spect CT Choline was more sensitive, specific and reduced non-localized cases by 9%.