IES2025 Research, Audit and Quality Improvement Projects E-Posters (60 abstracts)
A review of current approach to preoperative imaging and resultant operative findings in parathyroidectomy surgery for primary hyperparathyroidism
Rachel Byrne 1 , Wei Keong Kon 1 , Conall Fitzgerald 1,2 , John Kinsella 1,2 , Paul Lennon 1,2 , Brendan Conlon 1,2 , Con Timon 1,2 & Agnieszka Pazderska 1
1St. James Hospital, Dublin, Ireland; 2Royal Victoria Eye and Ear Hospital, Dublin
Approaches to preoperative imaging in primary hyperparathyroidism (PHPT) vary in clinical practice. British and European endocrine societies recommend ultrasound (US), Single Photon Emission Computed Tomography (SPECT) or Computed Tomography (CT) without specific guidance around which to use and when. Our institution’s usual approach is to arrange US and SPECT simultaneously. We assessed the degree of concordance between preoperative imaging and histological findings to determine a local recommended approach to preoperative imaging in PHPT. Charts of 60 patients with biochemical evidence of PHPT who underwent parathyroidectomy were analysed. 56/60 had an US, 57/60 had a SPECT and 12/60 had a CT. 51.8% of US and 64.9% of SPECT were concordant with histology. 51 patients had an adenoma. Of those with both US and SPECT, 66.6% had concordant imaging. 10 additional adenomas were detected on SPECT that were not found on US and 4 additional were detected on US but not on SPECT. The PPV of US in detecting an adenoma was 86.6% with sensitivity of 55%. The PPV of SPECT in detecting an adenoma was 86% with sensitivity of 75%. The overall sensitivity of combined US and SPECT was 86.2%. No cases of adenoma were picked up on CT that were not already found on US or SPECT. We recommend that those with positive US for adenoma should proceed to surgery. Those with negative US should proceed to SPECT. Those with negative 1st and 2nd line imaging may consider; 3rd line CT or proceed directly to exploratory surgery.
Volume 115
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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