Endocrine Abstracts

Background: Primary hyperparathyroidism is an endocrine disorder characterized by autonomous production of parathyroid hormone (PTH) results in the derangement of calcium metabolism. Imaging modalities used to localize includes technetium-99m sestamibi, sestamibi-single photon emission computed tomography (SPECT), SPECT-CT fusion, ultrasound Neck and Four dimensional computed tomography (4D-CT). Sestamibi scintigraphy combined with sestamibi single photon emission computed tomography (SPECT) has the highest positive predictive value among available imaging techniques. In our trust we do ultrasound scan (USS) neck prior to sestamibi scintigraphy as it is highly sensitive in experienced hands, inexpensive, non-invasive and reproducible in operating room. In addition to two imaging modalities there is dedicated parathyroid MDT prior to intervention.

Aims: This study aims to determine the role of Ultrasound Neck, sestamibi scintigraphy and Multidisciplinary team discussion in localization of parathyroid lesion.

Methods: A retrospective, quantitative study of patients that had been diagnosed with primary hyperparathyroidism was performed. All patients who had been diagnosed from April 2014 - April 2017 were evaluated; these patients were identified using the institutes’ clinical coding. Data collected included patient demographics, diagnosis, types of imaging, histological diagnosis, post-operative calcium and parathyroid hormone levels, and whether recurrence occurred in any of these patients.

Results: A total of 71 patients met the inclusion criteria for the study. Analysis of results showed that 95.8% (68/71) patients received an ultrasound scan of the neck and 93% (66/71) received a SPECT-CT. Out of the 68 patients, 76% (54/71) were correctly diagnosed as having a parathyroid adenoma by USS and 80% (57/71) by SPECT-CT. All these patients were discussed in dedicated parathyroid multidisciplinary team meeting prior to intervention. Only 2 (3%) of the patients had a recurrence, although follow-up was still awaited for multiple patients.

Conclusion: US neck is non-invasive subjective dependent highly sensitive imaging modality with comparable results with Sestamibi Scintigraphy.