PET-TC [18F]F-choline and intraoperative PTH in the surgical treatment of the primary hyperparathyroidism without preoperative location.

Background and objectives: To assess the feasibility of performing selective parathyroidectomy without intraoperative parathyroid hormone (PTHio) determination when first-line preoperative localization tests (ultrasonography and [^99mTc]Tc-MIBI) are negative and/or discordant, and second-line [¹⁸F]F-Colina PET-CT, is positive.

Materials and methods: Retrospective cohort study, including patients with negative or discordant ultrasound and MIBI scans and positive [¹⁸F]F-Colina PET-CT, who underwent selective parathyroidectomy between 2019 and 2022. Groups were compared based on PTHio determination. Study variables were: gender, mean age, biochemical cure assessed by PTH value (pg/mL) and corrected calcium by albumin (mg/dL) at 6 months post-surgery follow-up, and histopathological analysis.

Results: The final sample included 42 patients. At 6 months post-surgery, in the PTHio group (20 patients), PTH values were 64.50 pg/mL and calcium 9.30 pg/mL, with 19 adenomas and 1 hyperplasia found. In the non-PTHio group (22 patients), PTH values were 61 pg/mL and calcium 9.37 pg/mL, with 22 adenomas found. No statistically significant differences were found between both groups.

Conclusions: Based on the results obtained in our patient cohort, selective parathyroidectomy could be considered with negative or discordant first-line tests and positive [¹⁸F]F-Colina PET-CT, without intraoperative PTH determination.