Primary Hyperparathyroidism: Outcomes of Repeated Imaging After Initial Negative Radiological Localization

Area of Science:

• Endocrinology
• Radiology
• Surgical Oncology

Background:

• Primary hyperparathyroidism (PHPT) diagnosis relies on radiological localization imaging.
• Initial imaging may fail, necessitating repeat scans for abnormal parathyroid gland identification.
• This study evaluates outcomes of repeated parathyroid localization imaging in the UK.

Purpose of the Study:

• To explore patient outcomes following repeated parathyroid localization imaging after initial negative results.
• To identify factors predicting successful radiological localization on repeat scans.
• To inform optimal imaging pathways for PHPT.

Main Methods:

• Retrospective analysis of PHPT patients undergoing repeated imaging (2015-2020).
• Recorded scan episodes, types, intervals, and localization success.
• Investigated reasons for repeat imaging and predictive factors.

Main Results:

• 45 patients had repeat imaging after initial negative localization.
• 39 patients did not undergo surgery; 28% had positive scans on repeat.
• No success in imaging or surgery for patients undergoing three or four imaging sets.

Conclusions:

• A streamlined parathyroid pathway is needed, prioritizing surgical suitability assessment before repeat imaging.
• A second scan is indicated for patients unsuitable for conservative management and fit for surgery.
• Repeating imaging more than twice offers no discernible benefit.