[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-56419-en":3,"doc-seo-56419-105":30,"detail-sidebar-cat-0-en-105":94},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":21,"is_downloadable":21,"audit_status":21,"page_count":22,"language":23,"language_code":24,"site_id":25,"html_lang":24,"table_of_contents":26,"faqs":27,"seo_title":13,"seo_description":14,"update_tm":28,"read_time":29},56419,1649267921044,"Ava Thompson","https://us-avatar.wpscdn.com/avatar/1800007509477c92dfb?_k=1782875107921204101",7,"Healthcare","Diagnostic localization techniques in Primary hyperparathyroidism","Preoperative imaging plays a central role in primary hyperparathyroidism surgical planning, balancing localization accuracy, functional information, accessibility, and patient safety. Cervical ultrasound is widely available but operator dependent; 99mTc-sestamibi SPECT adds resolution yet suffers from variable sensitivity due to tracer wash-out. Four-dimensional CT shows strong single-gland adenoma detection and specificity but adds radiation and offers limited value in multigland disease. Fluorocholine (FCH) PET/CT delivers consistently higher accuracy, especially for ectopic and deep glands and re-operative cases, enabling more targeted surgery, though cost and regulatory constraints remain key barriers.","The American Journal of Surgery 254 (2026) 116754  \nContents lists available at ScienceDirect  \nThe American Journal of Surgery  \njournal [homepage: www.americanjournalofsurgery.com](homepage: www.americanjournalofsurgery.com)  \nMy Thoughts / My Surgical Practice  \nDiagnostic localization techniques in Primary hyperparathyroidism: Is PET Choline the new gold standard?  \nPreoperative imaging is often utilized in primary hyperparathyroidism to assist with surgical planning and intraoperative decisionmaking. Cervical ultrasound remains the most accessible and widely used imaging modality, offering a simple and cost-effective approach.1 Sestamibi-SPECT, another readily available modality, provides higher-resolution images and functional insight based on radiotracer uptake intensity.2,3 Four-dimensional computed tomography (4D-CT) is particularly valued for its high single-gland adenoma detection rates and its reported near-perfect specificity in excluding multi-gland disease.4 More recently, Fluorocholine (FCH) PET/CT has emerged as a highly sensitive and specific technique, with the potential to surpass all three predecessors in localization accuracy. Yet, the question remains, does superior performance alone justify its adoption as the new gold standard?  \nAmong established localization modalities, 99mTc-sestamibi SPECThas long been the preoperative mainstay, with sensitivity often reported slightly higher than cervical ultrasound.1 This advantage disappears when surgeons perform the ultrasound themselves, Untch et al. reported 87 % accuracy for surgeon-performed ultrasound versus 76 % for SPECT.2 Ultrasound's accessibility is tempered by its operator dependence, while SPECT's performance is limited by variable sensitivity from rapid tracer wash-out.3 Increasing use of 4D-CT offers improved sensitivity and specificity for adenoma detection but provides limited benefit in multiglandular disease and involves higher radiation exposure.4 These limitations are magnified in re-operative cases such as persistent disease or ectopic parathyroid glands where precise localization is essential. In these patients, prior surgery often distorts anatomy, obscures tissue planes, and increases the risk of complications.8 While the utility of FCH PET/CT in such complex scenarios is rarely disputed, its broader application in patients with straightforward disease presentations remains the focus of ongoing debate.  \nFCH PET/CT consistently outperforms conventional modalities. In one study, it achieved an accuracy of 93.2 %, compared with 65.8 % for ^99mTc-sestamibi SPECT and 38.8 % for ultrasound.6 In another series, FCH PET/CT had an accuracy of 81.1 %, compared with 66.7 % for SPECT and 33.3 % for ultrasound.7  \nWhile most published evidence centers on FCH PET/CT, other PETcoupled modalities such as PET/MRI and 11C-choline PET/CT have also demonstrated promise in localizing hyperfunctioning parathyroid tissue.10 PET/MRI offers superior soft-tissue delineation with lower radiation exposure, though access remains limited. Similarly, 11C-choline PET/CT has shown comparable diagnostic accuracy but is constrained by the short half-life of 11C, restricting its clinical availability. Together, these findings suggest that the emerging role of choline-based PET  \nimaging in parathyroid disease may extend beyond a single radiotracer or modality.5  \nIts advantage is most pronounced in single-gland disease, where multiple studies have demonstrated localization accuracies exceeding 90 %.6,7 However, this benefit is less marked in multiglandular disease even with FCH PET/CT, partial or limited localization has been reported in a substantial proportion of such cases, with sensitivities dropping to the 60–70 % range.6 This limitation underscores the inherent difficulty of detecting smaller, less metabolically active hyperplastic glands, a challenge that no current imaging modality fully overcomes.  \nDespite these constraints, the clinical appeal ofFCH PET/CT rema","cbCailWAQ5xVd7uS","https://ap.wps.com/l/cbCailWAQ5xVd7uS","pdf",486991,3,1,2,"English","en",105,"# Preoperative imaging role in primary hyperparathyroidism\n## Performance of established modalities (ultrasound, Sestamibi-SPECT, 4D-CT)\n## Evidence for FCH PET/CT and comparisons\n## Considerations in multigland and re-operative cases\n## Clinical impact, alternatives, and implementation","[{\"question\":\"Why is preoperative imaging important in primary hyperparathyroidism surgery?\",\"answer\":\"It supports surgical planning and intraoperative decision-making by identifying abnormal parathyroid locations, which is especially critical when re-operative anatomy is distorted or when ectopic glands are suspected.\"},{\"question\":\"What are the main limitations of cervical ultrasound and 99mTc-sestamibi SPECT?\",\"answer\":\"Ultrasound accuracy is tempered by operator dependence, while SPECT performance is limited by variable sensitivity influenced by rapid radiotracer wash-out.\"},{\"question\":\"How does FCH PET/CT compare with other localization modalities?\",\"answer\":\"FCH PET/CT shows higher accuracy than conventional approaches, including ultrasound and 99mTc-sestamibi SPECT, with reported advantages that are most evident in single-gland disease and for ectopic or deep-seated glands.\"},{\"question\":\"Why might FCH PET/CT not be universally adopted as the new gold standard?\",\"answer\":\"Beyond performance, adoption is constrained by cost considerations and regulatory status, and some objectives can be achieved with established intraoperative adjuncts in high-volume endocrine centers.\"}]",1783890526,5,{"code":4,"msg":31,"data":32},"ok",{"site_id":25,"language":24,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":89,"head_meta":91,"extra_data":93,"updated_unix":28},"diagnostic-localization-techniques-in-primary-hyperparathyroidism","",{"@graph":36,"@context":88},[37,52,67],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,47,49],{"item":41,"name":42,"@type":43,"position":21},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":22},"https://docshare.wps.com/document/","Document",{"item":48,"name":12,"@type":43,"position":20},"https://docshare.wps.com/document/healthcare/",{"item":50,"name":13,"@type":43,"position":51},"https://docshare.wps.com/document/diagnostic-localization-techniques-in-primary-hyperparathyroidism/56419/",4,{"url":50,"name":13,"@type":53,"author":54,"headline":13,"publisher":56,"fileFormat":59,"inLanguage":24,"description":14,"dateModified":60,"datePublished":61,"encodingFormat":59,"isAccessibleForFree":62,"interactionStatistic":63},"DigitalDocument",{"name":9,"@type":55},"Person",{"url":41,"name":57,"@type":58},"DocShare","Organization","application/pdf","2026-07-20","2026-07-12",true,{"@type":64,"interactionType":65,"userInteractionCount":20},"InteractionCounter",{"@type":66},"ViewAction",{"@type":68,"mainEntity":69},"FAQPage",[70,76,80,84],{"name":71,"@type":72,"acceptedAnswer":73},"Why is preoperative imaging important in primary hyperparathyroidism surgery?","Question",{"text":74,"@type":75},"It supports surgical planning and intraoperative decision-making by identifying abnormal parathyroid locations, which is especially critical when re-operative anatomy is distorted or when ectopic glands are suspected.","Answer",{"name":77,"@type":72,"acceptedAnswer":78},"What are the main limitations of cervical ultrasound and 99mTc-sestamibi SPECT?",{"text":79,"@type":75},"Ultrasound accuracy is tempered by operator dependence, while SPECT performance is limited by variable sensitivity influenced by rapid radiotracer wash-out.",{"name":81,"@type":72,"acceptedAnswer":82},"How does FCH PET/CT compare with other localization modalities?",{"text":83,"@type":75},"FCH PET/CT shows higher accuracy than conventional approaches, including ultrasound and 99mTc-sestamibi SPECT, with reported advantages that are most evident in single-gland disease and for ectopic or deep-seated glands.",{"name":85,"@type":72,"acceptedAnswer":86},"Why might FCH PET/CT not be universally adopted as the new gold standard?",{"text":87,"@type":75},"Beyond performance, adoption is constrained by cost considerations and regulatory status, and some objectives can be achieved with established intraoperative adjuncts in high-volume endocrine centers.","https://schema.org",{"og:url":50,"og:type":90,"og:title":13,"og:site_name":57,"og:description":14},"article",{"robots":92,"canonical":50},"index,follow",{"doc_id":7,"site_id":25},{"code":4,"msg":5,"data":95},[96,100,104,108,112,117,120,125,130,133,137],{"id":21,"doc_module":4,"doc_module_name":46,"category_name":97,"show_sort_weight":98,"slug":99},"Story & 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