Scientific Reports (May 2023)

Preoperative imaging for hyperparathyroidism often takes upper parathyroid adenomas for lower adenomas

  • Annick Van den Bruel,
  • Jacqueline Bijnens,
  • Helena Van Haecke,
  • Vincent Vander Poorten,
  • Catherine Dick,
  • Tom Vauterin,
  • Frank De Geeter

DOI
https://doi.org/10.1038/s41598-023-32707-0
Journal volume & issue
Vol. 13, no. 1
pp. 1 – 7

Abstract

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Abstract We retrospectively evaluated how accurately preoperative imaging localizes parathyroid adenoma in superior versus inferior parathyroids. Over 6 years, 104 patients with primary hyperparathyroidism underwent parathyroid surgery in a single centre. Of these, 103 underwent ultrasound, 97 [99mTc]pertechnetate/MIBI SPECT/CT and 30 [18F]fluorocholine (FCH) PET/CT. One patient with a unilateral double adenoma was excluded from the analysis. Surgical findings with histopathologic confirmation of adenoma were used as the standard. Ultrasound misjudged 5 of 48 detected lower adenomas as upper, but 14 of 29 upper adenomas as lower (error rate 10 vs 48%, p = 0.0002). The corresponding error rates for [99mTc]pertechnetate/MIBI SPECT/CT were 3 versus 55% (p = 0.000014), and for [18F]FCH PET/CT 17 versus 36% (p = 0.26). Our results suggest that about half of the superior parathyroid adenomas which are detected, are erroneously assigned to the inferior position by both ultrasound and SPECT/CT imaging whereas the opposite mistake is significantly less frequent with ultrasound and SPECT/CT.