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Schritte International 5 Answer Key.Diagnostic performance of triple-time positron emission tomography and chromogranin A measurement in malignant solitary parathyroid adenoma and hyperplasia.
In patients with primary hyperparathyroidism, the diagnosis of malignancy at the time of initial surgery is considered a contraindication to reoperation. In this study, we evaluated the role of combined measurement of chromogranin A (CgA) and triple-time positron emission tomography (PET) in patients with a parathyroid adenoma/hyperplasia diagnosed by preoperative imaging or intraoperative exploration. After institutional review board approval, 34 consecutive patients referred for parathyroid surgery were included. Preoperative PET/CT with technetium-99m methoxyisobutylisonitrile (MIBI) and triple-time scintigraphy were performed. A definitive malignant diagnosis was based on histopathological findings. Sixty-seven percent of patients (22/33) had CgA > 10 ng/mL. The sensitivity, specificity, and accuracy of CgA > 10 ng/mL and MIBI-PET(+) findings were 81, 63, and 70%, and 84, 67, and 75% with triple-time scintigraphy, respectively. The area under the receiver operating characteristics (ROC) curves of CgA > 10 ng/mL, MIBI-PET(+), and triple-time scintigraphy were 0.795, 0.89, and 0.89, respectively (P = 0.06, P < 0.0001, P = 0.09, respectively). Among patients with pathologically proven solitary parathyroid adenoma/hyperplasia, triple-time scintigraphy is the most sensitive and specific imaging modality. Combined PET/CT with MIBI allows a possible 0b46394aab