Routine preoperative (123)I-MIBG scintigraphy for patients with phaeochromocytoma is not necessary.
BACKGROUND
Functional imaging using (123)I-meta-iodo-benzyl-guanetidine (MIBG) scintigraphy has alleged 100% specificity for phaeochromocytoma (PHAEO). Its benefit in patients with biochemical diagnosis of PHAEO is arguable when cross-sectional radiology can demonstrate the side-size of the adrenal tumours.


METHODS
This is a retrospective review of clinical notes of patients undergoing adrenalectomy for PHAEO in a University centre.


RESULTS
Between January 2000 and December 2007, adrenalectomy for PHAEO was performed on 66 patients (28 M and 38 F, aged 24-82 years). Diagnosis was demonstrated by raised 24-h urine catecholamines (n = 14) or metanephrines (n = 52). The side and size of adrenal tumours were demonstrated on computed tomography (n = 58) and/or magnetic resonance imaging (n = 20) scans. MIBG scans were performed in 38 patients. Four of these patients were found to have non-adrenal pathology (haemangioblastomas, haemangioma, a bronchogenic cyst and an angiomyolipoma); hence, the positive predictive value of MIBG scan was 90%. In a further five patients, MIBG raised the suspicion of local metastatic disease but this was not confirmed on operative findings and no recurrence was detected in these patients during 6-92-month follow-up. This led to an overall rate of false-positive rate of 23%.


CONCLUSIONS
MIBG scintigraphy adds little to the routine preoperative management of patients with suspected PHAEO. Its use should be limited to the small minority of patients with negative cross-sectional imaging and those with recurrent or metastatic disease.
Mihai
Radu
R
Department of Endocrine Surgery, John Radcliffe Hospital, Oxford, UK. radumihai@doctors.org.uk
Gleeson
Fergus
F
Roskell
Derek
D
Parker
Andrew
A
Sadler
Greg
G
D019797:3-Iodobenzylguanidine; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D011300:Preoperative Care; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D019564:Unnecessary Procedures; D055815:Young Adult
D007457:Iodine Radioisotopes; D019797:3-Iodobenzylguanidine