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

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l’Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France

    Samuel Frey MD, Clément Couëtte MD, Cécile Caillard MD, Claire Blanchard MD, PhD & Eric Mirallié MD

  2. Service de Chirurgie Viscérale et Endocrinienne, La Pitié-Salpêtrière, Paris, France

    Christophe Trésallet MD, PhD, Fabrice Menegaux MD, PhD & Nathalie Chereau MD

  3. Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Universitaire d’Angers, Angers, France

    Antoine Hamy MD

  4. Institut du Thorax, INSERM, CNRS, UNIV Nantes, Nantes, France

    Claire Blanchard MD, PhD

  5. Université de Nantes, quai de Tourville, Nantes, France

    Claire Blanchard MD, PhD & Eric Mirallié MD

  6. La Clinique des Données, INSERM U1413, CHU de Nantes, Nantes, France

    Matthieu Wargny MD

  7. Département de Médecine Nucléaire, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France

    Charlotte Lussey-Lepoutre MD, PhD

  8. Clinique d’Endocrinologie–Maladies Métaboliques et Nutrition, Centre Hospitalier Universitaire de Nantes, Nantes, France

    Delphine Drui MD

  9. Service de Médecine Nucléaire, CHU de Nantes, Nantes, France

    Catherine Ansquer MD

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  1. Samuel Frey MD
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Correspondence to Eric Mirallié MD.

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Frey, S., Couëtte, C., Trésallet, C. et al. Utility of a Second 99mTc-MIBI Scintigraphy Before Reoperation for Patients With Persistent Sporadic Primary Hyperparathyroidism: Results of a Retrospective Multicenter Study. Ann Surg Oncol 27, 3831–3839 (2020). https://doi.org/10.1245/s10434-020-08428-3

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