Qu’attend le chirurgien de la scintigraphie au sestaMIBI ?

Abstract

Nowadays, the incidence of hyperparathyroidism is increasing (about 3%). Its revealing aspect and its surgical treatment have changed these past few years. They evolved into mini-invasive approaches which lead to a more accurate gland resection, respecting the healthy ones. The interest of methoxy-isobutyl-isonitrile (MIBI) scintigraphy is now well established and contributes to this evolution. Different categories of hyperparathyroidism (primary, secondary, tertiary, sporadic vs. familial, adenoma vs. carcinoma) have been separated to evoke the consensual surgical indications. SestaMIBI scintigraphy always follows a cervical sonogram and can be associated, in some cases, with a scannography. It only has to be performed in case of a surgery treatment and exclusively helps in topographic diagnosis. However, it remains a lot of false positive errors (nodular goitre, nodular or carcinomatous thyroids, lymphadenopathies) and some rare false negative errors (encountered in early hyperparathyroidism). The major interest of MIBI scintigraphy is its help in the topographic diagnosis of surgical hyperparathyroidism. It can detect parathyroid ectopias, multiglandular diseases, underlining the most pathological ones. It has become the most necessary examination in hyperparathyroidism pre-operative check-up and, in association with sonography and scannography, can lead to an accurate and mini-invasive surgical treatment.