First Results After Implementation of Fluor Choline PET/CT as Standard First-Line Imaging: High Cure Rates but More Bilateral Neck Explorations

Abstract Background Since July 2023, Fluor Choline PET/CT has been approved in Switzerland as a first-line imaging modality for parathyroid adenoma localization in primary hyperparathyroidism (pHPT). This change represents a shift from previous reimbursement policies, which required inconclusive results from ultrasound and MIBI scintigraphy. Methods We retrospectively analysed 281 parathyroidectomies performed between January 2017 and June 2025. Thirty-three patients were excluded due to hereditary HPT, redo surgeries, lithium treatment, or pregnancy. Preoperative biochemical characteristics, imaging techniques, surgical approaches, and outcomes were compared between patients treated before (preCholin, N=161) and after (postCholin, N=87) the implementation of Fluor Choline PET/CT as standard first-line imaging. Results The overall cure rate was 96.7% (235/243) after the first operation and 98.8% after redo surgery in 5 cases (240/243). Sensitivity for MIBI scintigraphy/SPECT CT was 64.1%, whereas Fluor Choline PET/CT demonstrated a sensitivity of 90.5%, enabling precise localization of parathyroid lesions. Interestingly, the rate of bilateral neck explorations increased from 22.3% in the preCholin group to 31.0% in the postCholin group. Conclusion The implementation of Fluor Choline PET/CT as a standard first-line imaging modality for pHPT localization resulted in high cure rates. However, the increased rate of bilateral neck explorations warrants further investigation to understand its impact on surgical outcomes and patient management.