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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2020

01-10-2020 | Hyperparathyroidism | Endocrine Tumors

Utility of a Second 99mTc-MIBI Scintigraphy Before Reoperation for Patients With Persistent Sporadic Primary Hyperparathyroidism: Results of a Retrospective Multicenter Study

Authors: Samuel Frey, MD, Clément Couëtte, MD, Christophe Trésallet, MD, PhD, Antoine Hamy, MD, Cécile Caillard, MD, Claire Blanchard, MD, PhD, Fabrice Menegaux, MD, PhD, Nathalie Chereau, MD, Matthieu Wargny, MD, Charlotte Lussey-Lepoutre, MD, PhD, Delphine Drui, MD, Catherine Ansquer, MD, Eric Mirallié, MD

Published in: Annals of Surgical Oncology | Issue 10/2020

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Abstract

Background

Persistent primary hyperparathyroidism (PHPT) occurs in 2.5% to 15% of cases after parathyroidectomy. Few studies have evaluated the best pre-reoperative imaging approaches for persistent sporadic PHPT. This retrospective multicenter study aimed to evaluate the benefit of a second pre-reoperative 99mTc-methoxy-isobutyl-isonitrile (MIBI) scintigraphy for patients with persistent PHPT who had a 99mTc-MIBI before their initial surgery.

Methods

The study enrolled 50 patients with persistent sporadic PHPT who had reoperation between 2006 and 2016 in three French University Hospitals (Angers, Nantes, and La Pitié Salpêtrière-Paris). Preoperative 99mTc-MIBI scan was performed before each operation.

Results

After the reoperation, 42 patients (84%) were cured. By the second 99mTc-MIBI, 31 patients (62%) had a removed gland identified. A new pathologic gland was identified by a second 99mTc-MIBI in 25 patients (50%), and this imaging permitted correction of an initial surgical error in six patients (12%). A second 99mTc-MIBI showed a sensitivity of 63%, a specificity of 89%, a positive predictive value (PPV) of 78%, and a negative predictive value (NPV) of 80%. A concordant second 99mTc-MIBI and ultrasonography (17 patients) showed a sensitivity of 70%, a specificity of 81%, a PPV of 70%, and an NPV of 81%.

Conclusions

Performing a second 99mTc-MIBI scan permitted 62% of the persistent PHPT patients to be cured, allowing identification of new pathologic glands in 50% of the cases and correction of an initial surgical error in 12% of the cases, with high specificity and PPV. These results reinforce the fact that a second 99mTc-MIBI scan should be performed at first intention before reoperation of patients with persistent PHPT, regardless of the result from the initial 99mTc-MIBI scan.
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Metadata
Title
Utility of a Second 99mTc-MIBI Scintigraphy Before Reoperation for Patients With Persistent Sporadic Primary Hyperparathyroidism: Results of a Retrospective Multicenter Study
Authors
Samuel Frey, MD
Clément Couëtte, MD
Christophe Trésallet, MD, PhD
Antoine Hamy, MD
Cécile Caillard, MD
Claire Blanchard, MD, PhD
Fabrice Menegaux, MD, PhD
Nathalie Chereau, MD
Matthieu Wargny, MD
Charlotte Lussey-Lepoutre, MD, PhD
Delphine Drui, MD
Catherine Ansquer, MD
Eric Mirallié, MD
Publication date
01-10-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08428-3

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