{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:31:59Z","timestamp":1786422719551,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Accurate preoperative localization of parathyroid adenomas is essential for the success of minimally invasive parathyroidectomy. This study evaluated the detection rate of parathyroid hormone assay on fine-needle aspiration washout and in conventional and advanced imaging modalities modeling a hypothetical stepwise diagnostic approach for primary hyperparathyroidism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective single-center study including 32 patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy and preoperative parathyroid hormone assay on fine-needle aspiration washout. We used the PTH-FNA washout to serum PTH ratio as the cutoff: a value greater than 1 was considered indicative of positive localization, while a value equal to or less than 1 was considered negative. Preoperative localization procedures included ultrasonography, MIBI-Scan, and\n                      <jats:sup>18<\/jats:sup>\n                      F-choline PET\/CT. Results were compared with postoperative histology and biochemical outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Parathyroid hormone assay on fine-needle aspiration washout was positive in 20 of 32 patients (62.5%, 95% CI 45.3\u201377.1%). Among washout-positive patients, 7 of 20 (35.0%) underwent surgery based on ultrasonography and washout findings alone, with histological confirmation of parathyroid adenoma in all cases. In the washout-positive subgroup in whom MIBI-Scan was also performed, scintigraphy was diagnostic in 7 of 13 cases (53.8%). In washout-negative patients, scintigraphy localized the lesion in 6 of 12 cases (50.0%). In patients with non-localizing washout and scintigraphy findings,\n                      <jats:sup>18<\/jats:sup>\n                      F-choline PET\/CT identified the lesion in all evaluated cases. In this retrospective series, a stepwise strategy based on ultrasonography combined with needle-aspiration washout as the first-line localization, followed by\n                      <jats:sup>18<\/jats:sup>\n                      F-choline PET\/CT in washout-negative cases, could have potentially avoided MIBI-scans in 25 out of 32 patients (78.1%; 95% CI 61.2\u201389.0%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This retrospective, single-center,\n                      <jats:italic>post-hoc<\/jats:italic>\n                      reconstructed cohort study might suggest a stepwise approach for preoperative localization of parathyroid adenoma based on parathyroid hormone assay on fine-needle aspiration washout combined with ultrasonography as a useful first-line diagnostic technique and reserving\n                      <jats:sup>18<\/jats:sup>\n                      F-choline PET\/CT for non-localizing cases. It may reduce the use of additional imaging and radiation exposure. Larger prospective studies are needed to confirm these findings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1926105","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:20:43Z","timestamp":1786422043000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative localization in primary hyperparathyroidism: a stepwise approach integrating PTH-FNA washout and second-line 18F-choline PET\/CT"],"prefix":"10.3389","volume":"17","author":[{"given":"Antonino","family":"Russo","sequence":"first","affiliation":[{"name":"Internal Medicine Division, \u201cSanta Chiara Hospital\u201d, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Erini","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences and Medical Imaging, Unit of Nuclear Medicine - Trento, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Donner","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences and Medical Imaging, Unit of Nuclear Medicine - Trento, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Magnani","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences and Medical Imaging, Unit of Nuclear Medicine - Trento, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Fasanella","sequence":"additional","affiliation":[{"name":"Department of Integrated Activities (DAI) of Pathology and Laboratory Medicine, Multizonal Unit of Clinical Pathology Laboratory, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Amadori","sequence":"additional","affiliation":[{"name":"Unit of Primary Care, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Cosimo","family":"Quattrocchi","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences and Medical Imaging, Unit of Radiology - Rovereto, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT)","place":["Trento, Italy"]},{"name":"Center for Medical Sciences, University of Trento","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Racanelli","sequence":"additional","affiliation":[{"name":"Internal Medicine Division, \u201cSanta Chiara Hospital\u201d, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT)","place":["Trento, Italy"]},{"name":"Center for Medical Sciences, University of Trento","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2008.03520.x","article-title":"Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK","volume":"71","author":"Yu","year":"2009","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230130","article-title":"Epidemiology and management of parathyroid gland disorders in Spain over 15 years: a retrospective multicentre analysis","volume":"15","author":"Darba","year":"2020","journal-title":"PloS One"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2020.101514","article-title":"Primary hyperparathyroidism","volume":"34","author":"Oberger Marques","year":"2020","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31430-7","article-title":"Hyperparathyroidism","volume":"391","author":"Bilezikian","year":"2018","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-012-2512-2","article-title":"Preoperative localization strategies for primary hyperparathyroidism: an economic analysis","volume":"19","author":"Lubitz","year":"2012","journal-title":"Ann Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.20131","article-title":"Minimally invasive procedure for resection of a parathyroid adenoma: the role of preoperative high-resolution ultrasonography","volume":"33","author":"Gilat","year":"2005","journal-title":"J Clin Ultrasound"},{"key":"B7","article-title":"Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies","volume":"33","author":"O'Doherty","year":"1992","journal-title":"J Nucl Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-018-4123-z","article-title":"Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis","volume":"46","author":"Treglia","year":"2019","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-022-06866-6","article-title":"Impact of fluorocholine PET\/CT in reduction in failed parathyroid localization in primary hyperparathyroidism","volume":"47","author":"Aphale","year":"2023","journal-title":"World J Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.23736\/S1824-4785.23.03514-8","article-title":"18F]F-Choline PET\/CT and 4D-CT in the evaluation of primary hyperparathyroidism: rivals or allies","volume":"67","author":"Fiz","year":"2023","journal-title":"Q J Nucl Med Mol Imaging"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2020190190","article-title":"Parathyroid 4D CT: What the surgeon wants to know","volume":"40","author":"Bunch","year":"2020","journal-title":"Radiographics"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines10010123","article-title":"The current role of parathyroid fine-needle biopsy (P-FNAB) with iPTH-washout concentration (iPTH-WC) in primary hyperparathyroidism: a single center experience and literature review","volume":"10","author":"Obo\u0142o\u0144czyk","year":"2022","journal-title":"Biomedicines"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2015.12.065","article-title":"Focused parathyroidectomy without intraoperative parathormone monitoring: the value of PTH assay in preoperative ultrasound-guided fine-needle aspiration washout","volume":"6","author":"Kuzu","year":"2016","journal-title":"Ann Med Surg (Lond)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2016-0543","article-title":"Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids","volume":"55","author":"Trimboli","year":"2017","journal-title":"Clin Chem Lab Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4677","article-title":"Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the Fifth International Workshop","volume":"37","author":"Bilezikian","year":"2022","journal-title":"J Bone Miner Res"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4689","article-title":"Surgical aspects of primary hyperparathyroidism","volume":"37","author":"Perrier","year":"2022","journal-title":"J Bone Miner Res"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-024-01796-5","article-title":"Management of surgical diseases of primary hyperparathyroidism: indications of the United Italian Society of Endocrine Surgery (SIUEC)","volume":"76","author":"Del Rio","year":"2024","journal-title":"Updates Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1186\/s12893-026-03768-5","article-title":"Preoperative imaging strategies to optimize surgical treatment in primary hyperparathyroidism (pHPT)","volume":"26","author":"Fries","year":"2026","journal-title":"BMC Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1177\/19160216241304366","article-title":"A positive parathyroid washout may obviate the need for nuclear scintigraphy in parathyroid adenoma localization: a retrospective study","volume":"53","author":"Moise","year":"2024","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-006-9180-z","article-title":"Sonographically guided fine-needle aspiration with rapid parathyroid hormone assay","volume":"13","author":"Maser","year":"2006","journal-title":"Ann Surg Oncol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/BF03350906","article-title":"Preoperative evaluation of parathyroid lesions in patients with concomitant thyroid disease: role of high-resolution ultrasonography and dual-phase technetium-99m sestamibi scintigraphy","volume":"27","author":"Kebapci","year":"2004","journal-title":"J Endocrinol Invest"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1595461","article-title":"Conventional imaging techniques plus 18F-fluorocholine PET\/CT: a comparative study of diagnostic accuracy in localizing parathyroid adenomas in primary hyperparathyroidism","volume":"16","author":"Chiu","year":"2025","journal-title":"Front Endocrinol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02487-y","article-title":"Will 18F-fluorocholine PET\/CT replace other methods of preoperative parathyroid imaging","volume":"71","author":"Giovanella","year":"2021","journal-title":"Endocrine"},{"key":"B24","article-title":"Primary hyperparathyroidism: update on presentation,\u00a0diagnosis, and management in primary care","volume":"57","author":"Pallan","year":"2011","journal-title":"Can Fam Physician"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6498\/aaa86f","article-title":"18F-choline PET\/CT for parathyroid scintigraphy: significantly lower radiation exposure of patients in comparison to conventional nuclear medicine imaging approaches","volume":"38","author":"Rep","year":"2018","journal-title":"J Radiol Prot"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.760419","article-title":"Parathyroid imaging: past, present, and future","volume":"12","author":"Morris","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-021-05334-y","article-title":"The EANM practice guidelines for parathyroid imaging","volume":"48","author":"Petranovi\u0107 Ov\u010dari\u010dek","year":"2021","journal-title":"Eur J Nucl Med Mol Imaging"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1926105\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:20:44Z","timestamp":1786422044000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1926105\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":27,"alternative-id":["10.3389\/fendo.2026.1926105"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1926105","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"article-number":"1926105"}}