Diagnostic Performance of 18F-Choline Positron Emission Tomography/Contrast-Enhanced Computed Tomography in Adenoma Detection in Primary Hyperparathyroidism after Inconclusive Imaging: A Retrospective Study of 215 Patients
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Population
2.2. Measurements
2.2.1. General Measurements
- Demographic data: sex, age, body mass index (BMI)
- Medical background: hypertension, diabetes, osteoporosis, nephrolithiasis, multiple endocrine neoplasia (MEN), HRPT2 mutation, and persistent or recurrent hyperparathyroidism
- Surgical background: thyroid surgery or parathyroid surgery
2.2.2. Preoperative Measurements
- Biological findings: calcium level (mmol/L) and PTH level (expressed as the PTH/normal PTH ratio due to differences in normal ranges among laboratories)
- Preoperative 18F-choline PET/ceCT data: lesion location, number of lesions, lesion size, and maximum standardised uptake value (SUVmax)
2.2.3. Perioperative Findings
2.2.4. Histological Findings
2.2.5. Follow-Up
2.3. Protocols
2.3.1. 18F-Choline PET/ceCT Protocol
2.3.2. Surgical Protocol
2.4. Data Interpretation and Statistics
2.4.1. Diagnostic Performances
- True positive (TP): a removed gland leading to cure with pathological findings on histological examination.
- False positive (FP): a removed gland not leading to cure but with normal findings on histological examination.
- False negative (FN): a removed gland not considered pathological on 18F-choline PET/ceCT but its removal leads to cure with pathological findings on histological examination.
- True negative (TN): glands not considered pathological on 18F-choline PET/ceCT or during surgical exploration.
2.4.2. Correlation between 18F-Choline PET/ceCT and Surgical Findings
- Removed glands with different locations on 18F-choline PET/ceCT and during a surgical examination
- Removed glands not described as pathological on 18F-choline PET/ceCT but showing pathological findings on histological examination
- Removed glands described as pathological on 18F-choline PET/ceCT but without pathological findings during surgical and/or histological examination
2.4.3. Statistics
3. Results
3.1. Population Characteristics
3.2. Surgical Results
3.3. 18F-Choline PET/ceCT Results and Performances
3.4. Correlation between 18F-Choline PET/ceCT and Surgical Findings
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Mean (Standard Deviation) or Number (Proportion) | Range |
---|---|---|
Age (years) (n = 215) | 62 (14.2) | (18–87) |
Sex (n = 215) | ||
Male | 52 (24%) | |
Female | 163 (76%) | |
BMI (kg/m2) (n = 215) | 26.2 (6.0) | (13.9–51.3) |
Hypertension (n = 215) | 81 (38%) | |
Osteoporosis (n = 215) | 84 (39%) | |
Fractures (n = 215) | 27 (13%) | |
Nephrolithiasis (n = 215) | 63 (29%) | |
Previous cervical surgery (n = 215) | ||
Thyroidectomy | ||
Partial | 7 (3.3%) | |
Total | 7 (3.3%) | |
Parathyroidectomy | ||
Minimally invasive | 7 (3.3%) | |
SBPE | 23 (11%) | |
Preoperative markers | ||
Calcium (mmol/L) (n = 215) | 2.77 (0.19) | (2.28–3.64) |
PTH (normal ratio) (n = 208) | 2.18 (1.00) | (0.61–19.80) |
Postoperative markers, day 1 | ||
Calcium (mmol/L) (n = 214) | 2.38 (0.196) | (1.930–3.120) |
PTH (ng/L) (n = 201) | 13.9 (10.8) | (4.0–65.0) |
PTH (normal ratio) (n = 200) | 0.35 (0.26) | (0.10–1.94) |
Postoperative markers, week 6 | ||
Calcium (mmol/L) (n = 209) | 2.370 (0.141) | (1.190–2.910) |
PTH (normal ratio) (n = 195) | 0.917 (0.472) | (0.280–4.630) |
Surgical approach (n = 215) | ||
Minimally invasive | 52 (24%) | |
SBPE | 163 (76%) | |
Surgical complications (n = 215) | ||
Hypocalcaemia | 7 (3.4%) | |
Recurrent laryngeal nerve palsy | 6 (2.9%) | |
Superficial hematoma | 1 (0.4%) | |
Cure rate at 6 weeks (n = 210) | 202 (95%) |
TP | TN | FP | FN | Se | Sp | PPV | NPV | |
---|---|---|---|---|---|---|---|---|
Per lesion | 219 | 592 | 21 | 28 | 88.6% | 96.6% | 91.4% | 95.4% |
Per patient | 164 | 21 | 25 | 86.8% | 88.6% |
Well Correlated (n = 220) | Uncorrelated (n = 49) | p | Test | |
---|---|---|---|---|
Age (years) | 62.0 ± 14.3 | 61.5 ± 13.6 | 0.83 | Welch |
BMI (kg/m²) | 26.2 ± 6.2 | 26.5 ± 6.0 | 0.77 | Welch |
Sex | ||||
Male | 51 (23%) | 12 (24%) | 0.84 | χ2 |
Female | 169 (77%) | 37 (76%) | ||
Hypertension | 86 (39%) | 17 (35%) | 0.57 | χ2 |
Diabetes | 14 (6.4%) | 2 (4.1%) | 0.74 | Fisher |
Osteoporosis | 87 (40%) | 18 (37%) | 0.72 | χ2 |
Fractures | 28 (13.0%) | 3 (6.1%) | 0.19 | |
Nephrolithiasis | 63 (29%) | 15 (31%) | 0.78 | χ2 |
Previous cervical surgery | ||||
Thyroidectomy | 0.81 | Fisher | ||
Partial | 7 (3.3%) | 2 (4.0%) | ||
Total | 8 (3.6%) | 1 (2.0%) | ||
Parathyroidectomy | ||||
Minimally invasive | 4 (1.8%) | 3 (6.1%) | 0.093 | Fisher |
SBPE | 20 (9.1%) | 7 (14.0%) | ||
Recurring disease | 16 (7.3%) | 7 (14.0%) | 0.16 | Fisher |
Persisting disease | 8 (3.6%) | 3 (6.1%) | ||
Preoperative markers | ||||
Calcium (mmol/L) | 2.76 ± 0.21 | 2.77 ± 0.18 | 0.67 | Welch |
PTH (normal ratio) | 2.27 ± 2.18 | 1.95 ± 0.95 | 0.12 | Welch |
Surgeon | ||||
JCL | 147 (67%) | 36 (75%) | 0.27 | χ2 |
LM | 73 (33%) | 12 (25%) | ||
Surgical approach | ||||
Minimally invasive | 52 (24%) | 0 (0%) | <0.001 | χ2 |
SBPE | 168 (76%) | 49 (100%) | ||
PET data | ||||
Size (mm) | 12.20 ± 7.61 | 3.90 ± 6.02 | <0.001 | Welch |
SUVmax | 4.25 ± 2.25 | 1.55 ± 2.00 | <0.001 | Welch |
Number of lesions | ||||
0 | 0 (0%) | 13 (27%) | <0.001 | Fisher |
1 | 162 (74%) | 22 (45%) | ||
>1 | 58 (26%) | 14 (29%) | ||
Cure rate | 212 (97%) | 43 (91%) | 0.081 | Fisher |
Variables | OR (95% CI) | p | Variables | OR (95% CI) | p | Variables | OR (95% CI) | p |
---|---|---|---|---|---|---|---|---|
SUVmax of lesion | 0.379 (0.281, 0.510) | <0.001 | Size of lesion | 0.703 (0.631, 0.785) | <0.001 | Number of lesions | 0.151 (0.039, 0.497) | <0.01 |
Osteoporosis | 0.854 (0.347, 2.10) | 0.73 | - | 1.430 (0.578, 3.56) | 0.44 | - | 0.851 (0.312, 2.210) | 0.74 |
Calcium level | 1.140 (0.187, 6.96) | 0.89 | - | 1.390 (0.158, 12.2) | 0.77 | - | 0.885 (0.665, 1.150) | 0.38 |
PTH ratio | 1.060 (0.741, 1.53) | 0.74 | - | 0.986 (0.593, 1.64) | 0.96 | - | 0.784 (0.436, 1.150) | 0.35 |
Age | 0.989 (0.958, 1.02) | 0.47 | - | 0.985 (0.953, 1.02) | 0.37 | - | 0.991 (0.960, 1.020) | 0.56 |
BMI | 0.984 (0.928, 1.04) | 0.60 | - | 1.050 (0.983, 1.12) | 0.15 | - | 0.999 (0.921, 1.080) | 0.99 |
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Benjamin, J.; Maillard, L.; Morelec, I.; Got, P.; Borson-Chazot, F.; Lifante, J.-C. Diagnostic Performance of 18F-Choline Positron Emission Tomography/Contrast-Enhanced Computed Tomography in Adenoma Detection in Primary Hyperparathyroidism after Inconclusive Imaging: A Retrospective Study of 215 Patients. Cancers 2022, 14, 2029. https://doi.org/10.3390/cancers14082029
Benjamin J, Maillard L, Morelec I, Got P, Borson-Chazot F, Lifante J-C. Diagnostic Performance of 18F-Choline Positron Emission Tomography/Contrast-Enhanced Computed Tomography in Adenoma Detection in Primary Hyperparathyroidism after Inconclusive Imaging: A Retrospective Study of 215 Patients. Cancers. 2022; 14(8):2029. https://doi.org/10.3390/cancers14082029
Chicago/Turabian StyleBenjamin, Johan, Laure Maillard, Isabelle Morelec, Philippe Got, Françoise Borson-Chazot, and Jean-Christophe Lifante. 2022. "Diagnostic Performance of 18F-Choline Positron Emission Tomography/Contrast-Enhanced Computed Tomography in Adenoma Detection in Primary Hyperparathyroidism after Inconclusive Imaging: A Retrospective Study of 215 Patients" Cancers 14, no. 8: 2029. https://doi.org/10.3390/cancers14082029