Endocrine Abstracts

Aim: To assess the appropriateness of parathyroid imaging performed in patients with primary hyperparathyroidism at the United Lincolnshire Hospital NHS Trust from 2018 to 2019.

Background: Primary hyperparathyroidism (PHPT) is a clinical and biochemical diagnosis. Reported sensitivity for imaging localisation of parathyroid adenomas for ultrasound and sestamibi scans are not high at 65 to 85% and 71 to 92%, respectively. Surgeons use combined ultrasound and sestamibi scan (sensitivity >90%) for preoperative localisation to facilitate minimally invasive surgeries. Bilateral neck exploration is considered if parathyroid imaging is negative. Thus, imaging in PHPT should be used as a localising tool preoperatively to determine surgical approaches.

Methods and Results: Imaging appropriateness was evaluated for patients (n=126) who had sestamibi scans from 2018 to 2019 from their clinic letters. An independent endocrinologist assessed the accuracy of the evaluation. If the patient had established PHPT, familial hypocalcaemia hypercalciuria ruled out and met the criteria for surgery based on NIH and NICE guidelines, the scans were deemed appropriate. The initial audit showed: Overall, 22% of the imaging was requested inappropriately. Amongst patients who had appropriate and inappropriate imaging, the proportion of patients who had or are awaiting surgery is 68% and 34%, respectively. 32% of appropriately imaged patients were managed conservatively or deemed unfit for surgery after the multidisciplinary team meeting (MDT) discussion. 74% of patients had clear surgery discussions, but the same was unclear for the remaining 26%.

Conclusion: PHPT patients should be offered imaging as localising tools only after they meet the criteria and are deemed fit for surgery. This audit showed that one-fourth of the patients had avoidable parathyroid imaging. When the diagnosis is ambiguous, imaging should be requested after MDT discussion to ensure the appropriate use of NHS resources and limit unnecessary radiation exposure.