Intraoperative Detection of Hyperplastic Parathyroid Gland With Positron Emitter 18F-Fluorocholine and Handheld Probe

Area of Science:

• Nuclear medicine
• Surgical oncology
• Endocrinology

Background:

• Hyperplastic parathyroid glands can be challenging to locate during surgery, potentially leading to incomplete resection or damage to surrounding tissues.
• Accurate intraoperative localization is crucial for successful parathyroidectomy and normalization of calcium levels.
• Positron emission tomography (PET) tracers offer high sensitivity for detecting specific tissues.

Observation:

• The study details the first use of a positron emitter, F-fluorocholine (F-FCH), with a handheld probe for intraoperative detection of a hyperplastic parathyroid gland.
• The method was applied to a 69-year-old woman, enabling the precise resection of a small parathyroid gland.
• Radiation dose estimations for the surgical team were performed.

Findings:

• Intraoperative F-FCH detection successfully guided the resection of a small parathyroid gland.
• Postoperative parathyroid hormone (PTH) and serum calcium levels were normalized in the patient.
• Calculated radiation doses to the surgical staff and surgeons' fingers were significantly below annual occupational exposure limits.

Implications:

• Intraoperative F-FCH detection with a handheld probe is a safe and feasible technique for localizing small parathyroid glands.
• This approach can improve surgical outcomes for patients with hyperparathyroidism by ensuring complete gland removal.
• The method holds potential for broader application in endocrine surgery requiring precise tissue localization.