Contemporary localization diagnostics in primary hyperparathyroidism. Review of visualization techniques including ultrasonography, PTH washout, 99mTc-MIBI scintigraphy, and 18F-choline PET.
Background: Primary hyperparathyroidism is a set of symptoms caused by overproduction of parathormone (PTH), leading to impaired calcium and phosphorus metabolism. Proper diagnosis and detection of a parathyroid adenoma, including ectopic ones, is crucial to confirm the diagnosis and to tailor further treatment. In clinical practice, preoperative localization of parathyroid adenomas is a difficult task. Conventional imaging studies such as ultrasonography (US) and 99mTc-MIBI scintigraphy often cause unequivocal results; therefore, additional examinations are needed. The following paper discusses currently available diagnostic methods that could help in doubtful cases, and which should be considered during localization of parathyroid lesions.
Methods: When writing the following paper, we researched medical databases, such as PubMed and Google Scholar, for papers published in 2000-2024 with special attention paid to the latest articles published in the past 5 years. The presented data are gathered from 66 selected publications on primary hyperparathyroidism and contemporary methods of localization diagnostics by keywords: "primary hyperparathyroidism", "parathyroids", "parathormone", "MIBI", "scintigraphy", "parathyroids ultrasonography", "parathyroid adenoma", "parathyroid localization diagnostics", "imaging studies in hyperparathyroidism", "minimally invasive surgery in hyperparathyroidism", "18F-choline", "PET", and "PTH washout."
Results: Use of positron emission tomography with 18F-choline (18F-FCH PET/CT) or parathormone washout from ultrasound-guided fine-needle aspiration (FNA) increases the effectiveness of localization diagnostics. Due to the high sensitivity of those tests, contemporary reports emphasize their value more often than ever. These examinations have a great impact on the accurate identification of parathyroid lesions, and in some cases they allow minimally invasive surgery to be performed.
Conclusions: The following paper underlines a need for determination of a perfect tool for primary hyperparathyroidism localization diagnostics based on its sensitivity and availability; however, contemporary available tests and exams when combined may bring great results and allow a patient to be qualified for a minimally invasive surgical treatment.