Original Scientific ArticlesCost-Effectiveness of Preoperative Sestamibi Scan for Primary Hyperparathyroidism Is Dependent Solely upon the Surgeon’s Choice of Operative Procedure
Section snippets
Methods
Before addressing the issue of cost, one must evaluate the sensitivity and specificity of sestamibi scanning for detecting single adenomatous disease to determine whether in fact it is accurate enough to encourage its use to guide a limited exploration. Another issue that must be established is the true incidence of single-gland disease in patients with non-multiple endocrine neoplasia (MEN), nonfamilial primary hyperparathyroidism. Although this has been reviewed in the past (1981), at that
Sensitivity and Specificity of Sestamibi Scanning
The average sensitivity in all qualifying reports of sestamibi scans in 784 patients ranged between 80% and 100%, with an average of 90.74% (Table 1). It has been demonstrated recently that regardless of the acquisition method, localization of adenomas (with sestamibi) should be > 90%; otherwise, the technique is suboptimal.[13]After omitting all “suboptimal” scans, the average sensitivity became 94.54%, but to remain conservative, we used 90% for all further calculations.
In determining the
Discussion
The use of preoperative scanning for patients with sporadic primary hyperparathyroidism has been a controversial topic for many years. The potential benefits for the majority of patients afflicted with this disease are often discounted because of the lack of a single test that is sensitive enough to be applied to the entire population in question, and specific enough to allow an acceptably low failure rate. Although few would argue that a smaller operation would be preferable provided success
Authors’ Note
Because of the extent of the metaanalysis, all articles reviewed could not be cited in the references. The complete reference list may be obtained by contacting the authors or via the Internet at www. endocrine-surgery.com/authors.html.
Acknowledgements
The authors thank Kathy Sheehan, PhD, for her assistance with the statistical analysis.
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