Background/Objectives: Parathyroidectomy is a curative procedure for primary hyperparathyroidism, and multi-phase CT is an integral part of surgical planning. While patients may be referred to centers specializing in endocrine surgery, their imaging may be performed at other facilities without the same high-volume expertise. Methods: A retrospective review was performed of radiologist second reads of outside neck CT imaging in patients with hyperparathyroidism referred for surgical management. Results: The initial outside report was 59% sensitive for localization of parathyroid adenoma in the 74 patients with surgical pathologic confirmation. Second reads of the same CT scans correctly identified the parathyroid adenoma in an additional 24% of patients, for a total sensitivity of 83%. For the 23% of patients with pathologically confirmed multi-gland involvement, the initial outside report was 21% sensitive for lesion detection, and the second read of the same scans was 68% sensitive. Conclusions: Endocrine surgeons should be aware that community-based radiology interpretation of neck CT may be less sensitive than reported series from academic and high-volume practices. In the present study, interpretation via second read of outside CT scans by a neuroradiologist engaged with the endocrine surgery service line increased the sensitivity of detecting candidate lesions, both for single-gland and multi-gland involvement. While it is preferred to have preoperative imaging and interpretation within the same high-volume center as the surgeon for consistency of imaging quality, experience and communication, radiologist second reads deserve financial and service line support when that is not possible given the impact on surgical planning and patient care.

Background: There exists an unmet clinical need to define definitive management strategies for patients with locally advanced non-melanoma skin cancers (NMSC), particularly if not amenable to surgical resection. Methods: We retrospectively reviewed a case series of locally advanced unresectable NMSC treated with induction systemic treatment followed by response-adapted consolidative radiation. Results: We identified 15 patients who met study criteria, including seven with basal cell carcinoma (BCC), six with cutaneous squamous cell carcinoma (CSCC), and two with Merkel cell carcinoma (MCC). Clinical complete response (CR) by physical examination was observed in all 15 patients. No locoregional or distant recurrences were observed in any histologic subtype after completion of radiation (median follow-up from completion of radiation: 18.1 months BCC, 22.5 months CSCC, 22.7 months MCC). The median duration of observed response (DOOR), measured from first clinical response was 26.9 months (26.2 BCC, 29.4 CSCC, 27.1 MCC). Radiation treatment volumes were response-adapted with median gross tumor volume reduction of 55.3% (15.3%–100%). Median treatment-free response was 20.5 months. No unexpected systemic therapy related toxicities were identified. Conclusions: In this single-institution retrospective case series, induction systemic therapy followed by response-adapted consolidative radiation was feasible and associated with durable disease control in selected patients with locally advanced unresectable NMSC.