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Master Thesis

La scintigraphie parathyroïdienne au 99mTc/SestaMIBI a-t-elle encore sa place dans la recherche d'un adénome parathyroïdien à l'ère de la TEP-TDM au 18F-CHOLINE en routine clinique ?

Abstract : To investigate the place of parathyroid scintigraphy (99mTC/SestaMibi) and 18FCholine PET/CT in clinical routine settings as well as the possibility of better orienting patients with hyperparathyroidism between the two investigations to allow better diagnostic efficiency. Methods: between 2017-2020, 121 patients with biological hyperparathyroidism underwent surgical exploration with histological results on the basis of either 1 - a positive dual phase/dual tracer parathyroid scintigraphy or 2 - a positive 18F-Choline PET/CT following a negative (33 patients) or doubtful (23 patients) dual phase/dual tracer parathyroid scintigraphy or 3 - a high enough clinical and echographic suspicion of abnormal parathyroid lesion (12 patients). PTH and calcium were collected in all patients, together with vitamin D and phosphorus when available. Univariate analysis and logistic regression were used to predict the outcome of scintigraphy according to biological variables and in particular PTH. We also looked for biological parameters causing false negative scintigraphy, allowing to perform a 18F-Choline PET/CT in first intention. Result: all patients had biological hyperparathyroidism (mean PTH and calcemia was 276 pg/ml (± 432) and 2.63 mmol/L (± 0.23) respectively).The histological study found 112 parathyroid lesions (53/53, 28/35 and 31/33 in the positive, negative and inconclusive scintigraphy group respectively). The remaining 9 histological studies were negative (2 in the inconclusive scintigraphy group and 7 in the negative scintigraphy group). Mostly all doubtful dual phase/dual isotope scintigraphies (31/33, 94%) were finally associated with positive histological results. PTH, vitamin D, Calcium and phosphorus levels did not predict scintigraphic results. Conclusion: dual phase/dual tracer scintigraphy still has its place in clinical routine, allowing to identify most of patients with abnormal parathyroid tissue at the histological examination, after surgery, providing that questionable scintigraphies are classified as positive. 18F-Choline PET/CT is useful in second intention when dual phase/dual tracer scintigraphy is obviously negative in patients with biological hyperparathyroidism to improve the detection rate of the disease.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03344741
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Submitted on : Wednesday, September 15, 2021 - 11:12:10 AM
Last modification on : Monday, October 11, 2021 - 1:25:02 PM

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Kévin Hebert. La scintigraphie parathyroïdienne au 99mTc/SestaMIBI a-t-elle encore sa place dans la recherche d'un adénome parathyroïdien à l'ère de la TEP-TDM au 18F-CHOLINE en routine clinique ?. Médecine humaine et pathologie. 2021. ⟨dumas-03344741⟩

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