OPTIMIZING PARATHYROID SURGERY PRECISION: ASSESSING 18-FLUOROCHOLINE-PET/CT ACCURACY IN PREOPERATIVE LOCALIZATION AND SURGICAL CORRELATIONS

AUTHORS:
C. Dobrinja (Trieste, Italy) , R. Laforgia (Bari, Ita) , C. Menghini (Trieste, Italy) , C. Crisafulli (Trieste, Italy) , F. Dore (Trieste, Italy) , N. de Manzini (Trieste, Italy) , M. Mastronardi (Trieste, Italy) , A. Pezzolla (Bari, Ita)
Background:
18-Fluorocholine-positron emission tomography/computed tomography (FCH-PET/CT) is highly sensitive imaging technique in pinpointing hyperfunctioning parathyroid glands, allowing a more targeted surgery. Our study aimed to analyze the accuracy of FCH-PET/CT in preoperative parathyroids localization, evaluating a possible correlation between localization at FCH-PET/CT and during surgery, and between Maximum Standardized-Uptake-Value (SUVmax) and parathyroid diameter, pre-operative parathyroid hormone (PTH) levels and histological findings.
Methods:
This is a retrospective cohort study on patients underwent surgery for primay hyperparathyroidism in two high-volume centers with a positive pre-operative FCH-PET/CT. Inter-rater agreement between FCH-PET/CT and intraoperative findings was analyzed with Cohen's Kappa. Pearson Correlation was used to evaluate a possible correlation between SUVmax and parathyroid dimension; Spearman Correlation between SUVmax and preoperative PTH. ANOVA was used to assess the relationship between SUVmax and histological findings.
Results:
Forty-height patients were enrolled, for a total of 49 parathyroids. Mean SUVmax was 6.25+-2.39; mean parathyroid dimension was 15.54+-6.16mm; median preoperative PTH was 118.50pg/ml (range 62.0-398.0pg/ml). A substantial agreement was found between PET/CT and intraoperative findings (Cohen's Kappa 0.649; p<0.001). No statistically significant correlation was found between SUVmax and parathyroid dimension (p=0.176), and between SUVmax and histological findings (p=0.898). A statistically significant positive correlation was found between SUVmax and pre-operative PTH (Spearman coefficient=1.0; p=0.010).
Conclusions:
SUVmax should be considered a valuable adjunct in the FCH-PET/CT interpretation. Since the agreement observed between PET/CT and intraoperative findings is substantial but not optimal, it is advisable to acquire intraoperative PTH measurements or perform parathyroid frozen section to confirm the accurate identification of the removed gland.