MON-845 - The Utility of C-11 Choline PET Scanning in the Management of Complex Re-Operative Parathyroid Surgery

Title:

The Utility of C-11 Choline PET Scanning In The Management of Complex Re-Operative Parathyroid Surgery

Introduction:

Re-operative parathyroid surgery is technically challenging due to the complexity and variability in parathyroid anatomy compounded by the scarring and distortion of the tissues occurring after any previous operation. Many surgeons are unwilling to proceed with re-operative parathyroid surgery in the absence of clear imaging localization, leaving some patients without curative options. Traditional parathyroid localization studies (TLS) include technetium sestamibi scanning, cervical ultrasonography, and 4DCT scanning. C-11 Choline PET (CP) scanning is a relatively new and underutilized imaging modality for parathyroid localization. Here, we review our experience with the utility of CP in complex re-operative parathyroid patients with non-localizing traditional imaging results.

Methods:

All re-operative parathyroid surgeries performed by a single high-volume endocrine surgeon between January 2024 and January 2026 were reviewed. Cases felt to require clear imaging localization to proceed with additional curative surgery where CP was obtained after TL failed to localize the patient’s disease were analyzed.

Results:

During the study period 1,125 parathyroidectomies were performed, with 369 being re-explorations (33%). Of these, CP was obtained in 31 cases (8.4%) requiring clear localization in order to proceed with additional surgery where TLS were non-localizing. CP localized disease in 21 (68%) of these cases leading to curative parathyroidectomy. Of the 10 cases where CP was unhelpful, 7 were non-localizing and 3 had false positive findings leading to unsuccessful re-operations (9.6%). The mean time between unsuccessful and curative surgery was 36 months, with a range of 5 months to 15 years.

Conclusion:

This is the largest reported series analyzing the utility of C-11 Choline PET in in the management of complex re-operative parathyroid surgery. In the majority of such cases requiring clear localization to proceed with additional surgery where traditional imaging studies have been unhelpful, C-11 Choline PET was found to provide clear localization of disease leading to curative surgery that would otherwise have not been possible. While not without its limitations such as false positive results, this imaging modality should be utilized in the management of these complex patients.