In patients with primary hyperparathyroidism, first-line F18-choline PET/CT is a suitable and safe replacement for MIBI SPECT/CT, finds randomized clinical trial. https://ja.ma/4cljYgG
It will delay operations because of the very long waiting time for that procedure and especially for the health insurance companies to overtake the costs. It should be only recommended for persistent or recurrent pHPT.
Just 1 concern: the overall rate of success of surgery for pHPT is usually reported > 95%, even without preoperative localization studies. Here we have a rate of normocalcemia 85% after PetCholine and 56% after MIBI Scan! Just to be provocative: Should we argue that no localizing studies should be the first line strategy?
I think the problem is the skill of the surgical teams and not the method of glandular localization
important to set up such trial; but Normocalcemia at 1 month after positive first-line imaging-guided MIP was observed in 23 of 27 patients (85%) in the FCH1 group and 14 of 25 patients (56%) in the MIBI1 group. Sorry for beeing so blunt - but this is an unacceptable cure rate
The results are frightening. Also, 57 patients in four centres over almost 3 years! How many patients were screened for participation? How many patients were operated at the centres during the study period?
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Surgeon and writer
2moTerrible surgery! Unbelievable persistence rates!. Why JAMA-Oto did publish such a paper? Just because it was, supposedly, a RCT. This is a sheer example of RCT mesmerizing editors, the dark side of evidence based medicine. 😪 😫 😱