Endocrine Abstracts

Background: Parathyroid imaging facilitates parathyroidectomy in patients with primary hyperparathyroidism. Preoperatively, concordance between ultrasonography (US) and Scintigraphy (RN) was sought in all patients, until the publication of NICE guidance in 2019, which recommended a sequential approach, with RN to be considered only if it “further guides surgical approach”. Since 2020 we initially request US and reserve RN scan for patients in whom US is negative/equivocal or in patients with chances of multiglandular disease.

Patients and Methods: We retrospectively reviewed records of 94 patients who underwent parathyroidectomy (unilateral neck exploration (UNE)) from 2021-2023. Clinical, biochemical, imaging and surgical findings were recorded. We compared the number of RN scan requests and cure rate during this period whilst following sequential imaging approach, to those obtained between 2014-2019 when US and RN were requested simultaneously in all patients.

Results: N= 94, mean age 68 years, 79% females, mean serum calcium 2.93mmol/l. The overall cure rate was 92%. US was unequivocally positive in 65(69%) patients. Following UNE, 62/65(95%) patients were cured and in all patients who were cured, surgical findings were concordant with US. 29(31%) patients had equivocal US findings and went on to have further imaging studies. In this cohort 24/29 (83%) patients were cured. As each RN scan cost is £400, between 2021-2023 we made a cost saving of £26000 (65 patients). The table shows that the cure rates, overall and in each sub-group, were almost identical between both time periods (P=ns for all).

Conclusion:Implementation of NICE guidance on imaging sequence in patients with primary hyperparathyroidism prior to UNE led to significant cost saving without adversely affecting the cure rate.