Analysis of visualization techniques such as Tc99m-MIBI SPECT/CT, 18F-fluorocholine PET/CT, ultrasound and laboratory measurements during surgery in patients operated with pre-diagnosed parathyroid adenoma

Parathyroid adenoma is one of the primary hyperthroidizm disease, whose only curative treatment is total surgical excision. In our study, the aim was to detect the localization of adenoma accurately by visualization methods in patients who were scheduled for surgery with a prediagnosis of parathyroid adenoma. In our study, the files of patients who were thought to have parathyroid adenoma with methods such as Tc99m-MIBI SPECT/CT, 18F-Fluorocholine PET/CT, ultrasound and biochemical examinations and were operated at the Department of General Surgery, Faculty of Medicine, Gaziantep University between 2012 and 2020 were retrospectively analyzed. Statistical analysis was carried out in terms of adenoma localization. Height and weight information about the patients were taken from the hospital records. Pathology results of the patients were also examined. Male and female over the age of 18, a total of 170 patients were included in our study. Of the patients, 31 were male (%18,2), and 139 were female (%81,8). The average age was 51,4. To detect localization, Tc99m-MIBI SPECT/CT and ultrasound were implemented to all patients, and besides on 15 patients, 18F-Fluorocholine PET/CT method was applied. In our study, the sensitivity of ultrasound was 82.6%, and the sensitivity of scintigraphy was 78.4%. Adenoma was correctly localized in 14 (93.3%) of 15 patients with the 18F-Fluorocholine PET / CT method. The weights of the pathological glands removed during surgery were measured in grams. In our statistical study, a significant relationship was found between gland weight and scintigraphy to determine localization (p:0,002). Preoperative serum PTH, calcium, phosphorus values, and 15 minutes after intraoperative excision, intact PTH values were measured in all our patients. In our statistical study, a significant relationship was found between phosphorus values and scintigraphy to determine localization (p:0,039). At the 15th minute after intraoperative excision, more than 50% decrease was observed in intact PTH values in 163 patients (95,8%). The percentage of intact PTH decline was calculated as the mean 82.06 ± 16.65 (Mean ± SD). In our study, the intact PTH value (p:0.001) studied 15 minutes after surgical extraction of adenoma; serum PTH value (p:0.001), serum phosphorus value (p:0.001), serum calcium value (p:0.001) within the first three months after surgery, significant improvement was observed. In our statistical study, no significant relationship was found between the visualization performed to determine localization and obesity. In patients with suspected parathyroid adenoma, accurate localization facilitates the surgeon's job for effective and reliable surgery. By this means the patient's surgery can be successfully performed in a shorter time with minimally invasive surgery. That at the same time allows fewer complications and a faster recovery in patients. It was concluded that the study of intraoperative intact PTH and the use of the 18F-Fluorocholine PET/CT method for localization yield more accurate results for localization and enable more successful surgical outcomes.