Endocrine Abstracts

Background: Effective preoperative localization is crucial for successful surgical outcome in primary hyperparathyroidism. Ultrasonography (US) and radionuclide (RN) scan are requested, either concurrently or sequentially. At our centre, we also request a second US scan by an experienced radiologist to enhance localization accuracy in patients with negative first US scan irrespective of the outcome of RN scan.

Study Aim: To identify the diagnostic accuracy and impact on surgical outcome of a second US, performed by a specialist head and neck radiologist prior to surgery following the US and RN scans.

Patients and Methods: Records of patients undergoing parathyroidectomy for primary hyperparathyroidism from 2016-2023 were reviewed and demographic, biochemical, imaging, surgical and histological findings were recorded. Patients who had a second US scan after the initial US and RN scan were identified and their indications were studied along with cure rate following surgery. Cure was defined by postoperative normocalcaemia and histological confirmation.

Results: 157 patients had parathyroid surgery (78% female; mean age 68 years). 36 were operated after the initial US without further imaging while 121 patients had both US and RN scans. 87/121 patients had conclusive RN findings although in 28/87 with negative initial US, a second US was requested for better anatomical localisation (group A). 34/121 had inconclusive findings and in 16/34 a second US scan was requested (group B). Overall, 44 patients (groups A+B) had second US scan with a cure rate of 90% while in group B alone it was 98%. These figures were comparable to cure rate in the overall cohort (92%).

Conclusion: Repeat US performed by a specialist radiologist demonstrated a high success rate. It can be usefully considered especially in patients with inconclusive imaging. It has the added advantage of being cost-effective with no radiation exposure while improving diagnostic accuracy.