ECE2019 Guided Posters Calcium and Bone 1 (11 abstracts)
Utility of a second technecium99mMIBI-SPECT imaging before re-operating in patients with persistent sporadic primary hyperparathyroidism: results of a retrospective multicentric study
Samuel Frey 1 , Clément Couette 1 , Christophe Tresallet 2 , Antoine Hamy 3 , Cécile Caillard 1 , Claire Blanchard 1 , Emilie Lhermite 3 , Fabrice Menegaux 2 , Delphine Drui 4 , Catherine Ansquer 5 & Eric Mirallie 1
1Clinique de Chirurgie Digestive et Endocrinienne, Institut des maladies de l’Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes CEDEX 1, Nantes, France; 2Chirurgie Générale, Viscérale et Endocrinienne, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Universités Pierre et Marie Curie (Paris 6), 47-83, Boulevard de l’Hôpital, 75013, Paris, France; 3CHU Angers, Chirurgie digestive et endocrinienne, 49933 Angers cedex 09, Angers, France; 4Endocrinologie, Maladies Métaboliques et Nutrition, CHU de Nantes (Hôpital Laennec), Boulevard Jacques Monod, 44800 Saint-Herblain, Nantes, France; 5Médecine nucléaireHôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes CEDEX 1, Nantes, France.
Introduction: Persistent primary hyperparathyroidism (pHPT) occurs in 2.5 to 15% of cases after parathyroidectomy. Pre-operative localization studies (usually 99mTc-MIBI and cervical ultrasonography (US)) allow focused surgical approach (unilateral neck exploration or minimally invasive parathyroidectomy). Few studies have evaluated the best pre-reoperative approaches in case of persistent sporadic pHPT. The aim of our study is to evaluate the value of a second pre-operative 99mTc-MIBI in persistent sporadic pHPT and the interest of the adjunction of US.
Patients and Methods: Fifty patients operated on between 2006 and 2016 in three French University Hospitals (Nantes, La Pitié Salpêtrière, Paris and Angers) were included in this study. All patients had a persistent sporadic pHPT after a first surgery and have been re-operated on.A 99mTc-MIBI was performed in each case before the first and the second operation. US was always performed before the first operation and in 43 patients before re-operation. The cure rate (following second 99mTc-MIBI and second surgery), the number of new pathologic localized glands, and the intrinsic properties of second 99mTc-MIBI to localize the side of an abnormal parathyroid gland were evaluated. Intrinsic properties of 99mTc-MIBI and US were also evaluated.
Results: Forty-two patients (84%) were cured after the second surgery. Among these, 31 (62% of the patients) had a gland removed on the area identified by second-MIBI. Twenty-six new pathologic glands (52%) were identified by second-MIBI, including 18 patients (36%) with a multiglandular disease and 8 patients (16%) with a negative first-MIBI. Overall intrinsic properties of the second-MIBI are 67% sensitivity (se), 91% specificity (sp), 82% positive predictive value (PPV) and 81% negative predictive value (NPV). Performing the second-MIBI one year or more after the first -MIBI provided important sp: 97% vs 86% when second-MIBI was performed in the first year, and PPV: 93% vs 77%, but with a decreased sensitivity (59% vs 71%) and NPV (79% vs 82%). Concordant second-MIBI and US (17 patients) had the better se (77%), 85% sp, 77% PPV and 85% NPV.
Conclusion: Performing a second 99mTc-MIBI leads to find new pathologic glands in more than 50% of the cases in sporadic pHPT, especially in multiglandular disease. The concordant couple 99mTc-MIBI and US is the most accurate examination to localize the side of an abnormal parathyroid gland before re-operation. When discordant, the 99mTc-MIBI performed more than one year after the first-MIBI has the best specificity and NPV.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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