wetenschapsdag 2023 | 33 Sessie 1b: Ticks, Checks and Balances x1 Auteurs W.Y. van der Plas, M. Tulu, E.J.M. Nieveen van Dijkum, K. in ´t Hof, A.F. Engelsman Abstract titel Diagnostic accuracy of imaging for intraoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism Background Accurate preoperative adenoma localization facilitates minimal invasive parathyroidectomy (MIP) and is crucial for successful treatment of primary hyperparathyroidism (pHPT). However, no consensus has been reached on the type of imaging modality to be used as the gold standard. We aimed to determine and compare the diagnostic accuracy of frequently applied imaging modalities, including ultrasound (US) in combination with Technetium-99m (99mT) sestamibi SPECT/CT scan, 4D-CT scan, and PET-CT scan. Methods A retrospective analysis was conducted including patients who underwent MIP for pHPT from three hospitals in The Netherlands. The imaging accuracy was assessed by calculating sensitivity and positive predictive value (PVV) for different imaging techniques and used imaging modalities were correlated with patient characteristics. Results In total, 189 patient were included for analysis of which 169 patients (89.4%) with a pathologist confirmed parathyroid adenoma (positive pathology result) and in 20 patients (10.6%) preoperative localization did not match with the pathology findings. PET-CT scan had the highest PPV of 96.2%. The PPV of 4D-CT was 75.0%, and US in combination with 99mTc sestamibi SPECT/CT scan had a PPV of 84.0%. The percentage of patients requiring a second modality because of inconclusive results was 27% for 4D-CT, 29% for PET-CT, 46% for US/SPECT respectively (p=0.041). Patients who required secondary imaging were older, (p=0.018), had more frequently a genetic parathyroid disorder (p=0.04) and a lower adenoma weight (p=0.01) compared to those who required only the one imaging modality. Conclusion PET-CT scan has a high PPV and required the lowest rate of secondary imaging. and its use in preoperative planning of MIP may be considered more frequently.
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