Utility of a Second 99m Tc-MIBI Scintigraphy Before Reoperation for Patients With Persistent Sporadic Primary Hyperparat
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ORIGINAL ARTICLE – ENDOCRINE TUMORS
Utility of a Second 99mTc-MIBI Scintigraphy Before Reoperation for Patients With Persistent Sporadic Primary Hyperparathyroidism: Results of a Retrospective Multicenter Study Samuel Frey, MD1, Cle´ment Coue¨tte, MD1, Christophe Tre´sallet, MD, PhD2, Antoine Hamy, MD3, Ce´cile Caillard, MD1, Claire Blanchard, MD, PhD1,4,5, Fabrice Menegaux, MD, PhD2, Nathalie Chereau, MD2, Matthieu Wargny, MD6, Charlotte Lussey-Lepoutre, MD, PhD7, Delphine Drui, MD8, Catherine Ansquer, MD9, and Eric Mirallie´, MD1,5 1
Chirurgie Cance´rologique, Digestive et Endocrinienne, Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France; 2Service de Chirurgie Visce´rale et Endocrinienne, La Pitie´-Salpeˆtrie`re, Paris, France; 3Service de Chirurgie Visce´rale et Endocrinienne, Centre Hospitalier Universitaire d’Angers, Angers, France; 4 Institut du Thorax, INSERM, CNRS, UNIV Nantes, Nantes, France; 5Universite´ de Nantes, quai de Tourville, Nantes, France; 6La Clinique des Donne´es, INSERM U1413, CHU de Nantes, Nantes, France; 7De´partement de Me´decine Nucle´aire, Pitie´-Salpeˆtrie`re Hospital, Sorbonne University, Paris, France; 8Clinique d’Endocrinologie–Maladies Me´taboliques et Nutrition, Centre Hospitalier Universitaire de Nantes, Nantes, France; 9Service de Me´decine Nucle´aire, CHU de Nantes, Nantes, France
ABSTRACT Background. Persistent primary hyperparathyroidism (PHPT) occurs in 2.5% to 15% of cases after parathyroidectomy. Few studies have evaluated the best prereoperative imaging approaches for persistent sporadic PHPT. This retrospective multicenter study aimed to evaluate the benefit of a second pre-reoperative 99mTcmethoxy-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 Pitie´ Salpeˆtrie`re-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-MIB
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