Accuracy and cost-effectiveness of preoperative isotope and ultrasound imaging in primary hyperparathyroidism

A total of 54 patients underwent surgical exploration for primary hyperparathyroidism from 1980 to 1988. Beginning in November 1984 nearly all patients were evaluated with preoperative radionuclide and ultrasound imaging studies. Ultrasound correctly localized 76% of the adenomas removed at surgery, whereas the success rate with radionuclide imaging was 74%. Localization of hyperplastic glands was less successful with the use of either technique. Correct preoperative localization studies in cases of single adenoma reduced the operative time an average of 32 minutes when compared with those cases with no localization studies. Cost-effectiveness was studied based on current charges for operating room time, anesthesia, and the preoperative localization studies. An average cost savings of $124 per case was achieved when results of both localization studies were correct. These localization studies are quick, noninvasive, relatively inexpensive, and associated with no morbidity. Because it is possible to reduce operative time and overall costs, we recommend that radionuclide and ultrasound studies be routinely used in patients with primary hyperparathyroidism.