Cost utility of routine imaging with Tc-99m-sestamibi in primary hyperparathyroidism before initial surgery

Area of Science:

• Endocrinology
• Nuclear Medicine
• Surgical Oncology

Background:

• Primary hyperparathyroidism management involves surgical intervention.
• Technetium-99m-sestamibi (Tc-99m-sestamibi) scans are used for parathyroid adenoma localization.
• The utility of Tc-99m-sestamibi scans before initial parathyroid surgery remains debated.

Purpose of the Study:

• To analyze the cost-effectiveness of Tc-99m-sestamibi scans before initial surgery for primary hyperparathyroidism.
• To correlate preoperative scan findings with surgical outcomes.
• To evaluate the diagnostic accuracy and impact of Tc-99m-sestamibi scans on surgical planning.

Main Methods:

• A prospective study of 22 patients with primary hyperparathyroidism undergoing dual-phase Tc-99m-sestamibi scans before bilateral neck exploration.
• Surgical findings were compared with preoperative scan results.
• Cost-utility analysis was performed based on scan costs and diagnostic yield.

Main Results:

• Tc-99m-sestamibi scans correctly localized 84% of adenomas, but 18 of 19 adenomas were in the neck and easily found during surgery.
• Four scans (18%) had false-positive localizations, and two scans (9%) were false negatives.
• The scan did not alter surgical strategy or outcomes in any of the 22 patients.
• An ectopic adenoma was not detected by scanning or initial surgery.

Conclusions:

• Preoperative Tc-99m-sestamibi scanning offers no significant advantage when a complete bilateral neck exploration is performed for primary hyperparathyroidism.
• The scan's accuracy limitations and cost ($550 per scan) render it not cost-effective for routine preoperative use.
• Alternative diagnostic strategies or experienced surgical exploration may be more efficient.