Background: Primary hyperparathyroidism (PHPT) is a biochemical diagnosis. Where clinically indicated, surgical removal of the culprit gland(s) offers potential cure. Parathyroid localisation imaging (PLI) is not used to diagnose PHPT, but can guide surgical planning, and so may be undertaken if (focused) parathyroidectomy is contemplated.
Objective: To determine if PLI is optimally utilised (surgical planning for established PHPT) in a tertiary hospital setting.
Methods: We audited retrospectively the reports of all imaging studies undertaken at Royal Perth Hospital over a one-year period containing the keyword “parathyroid”, limited to PLI modalities in patients without end-stage renal failure (pre-dialysis/dialysis). We obtained additional clinical and biochemical data using electronic data sources.
Results: There were 58 PLI studies performed in 45 patients, but only 38 (84%) patients had an established biochemical PHPT diagnosis. Of those with PHPT, only 28 (74%) proceeded to parathyroidectomy. There were 21 PLI studies (36% of total) performed in patients without established PHPT, or in those with PHPT but who did not proceed to surgery. PLI studies were requested most frequently by Endocrine Surgeons (31 [53%]) and Endocrinologists (22 [38%]). Patients investigated by Endocrine Surgeons (71%) and Endocrinologists (67%) were similarly likely to proceed to parathyroidectomy, whereas none of the patients investigated by other clinicians proceeded to surgery.
Conclusion: Most PLI studies (37 [64%]) were performed in patients with established PHPT who proceeded to surgery, but a significant proportion were undertaken without clear indication or utility. Confirming a biochemical diagnosis of PHPT and the patient’s suitability for surgery prior to requesting PLI could decrease the number of low-value investigations being performed.