Alternative(s) to 99mTc-sestamibi preoperative scintigraphy for the localization of hypersecreting parathyroid glands in the event of complete shortage of 99mTechnetium (99mTc) - INAHTA Brief

Due to several periods of shortage of 99m-Technetium (Tc-99m) supply- a radioactive element needed to perform preoperative Tc-99m-sestamibi scintigraphy in certain cases of hyperparathyroidism (HPT)- the Directorate General for Health (DGS) asked HAS to determine if, in the event of complete shortage of Tc-99m, one (or more) test(s) could replace it without risk to patients.

The objective of this assessment is therefore not to call the reference strategy into question. Following laboratory confirmation of HPT, the preoperative first-line strategy provides for the combination of cervical ultrasonography (US) and 99mTc scintigraphy…

Currently, 99mTc scintigraphy in addition to US is used to:

• confirm the nature of a suspicious lesion seen on US;
• detect a eutopic or ectopic abnormal parathyroid gland not seen on US.

The imaging test(s) for the preoperative assessment are requested by the surgeon or endocrinologist,  who always work together in collaboration, particularly with the nuclear medicine and radiology team