A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol 2012 Feb;19(2):577-83
Date
06/29/2011Pubmed ID
21710322DOI
10.1245/s10434-011-1870-5Scopus ID
2-s2.0-84856642720 (requires institutional sign-in at Scopus site) 282 CitationsAbstract
BACKGROUND: Reported accuracy of preoperative localization imaging for primary hyperparathyroidism (pHPT) varies. The purpose of this study is to determine the accuracy of ultrasound, sestamibi-single photon emission computed tomography (SPECT), and four-dimensional computed tomography (4D-CT) as preoperative localization strategies.
METHODS: A meta-analysis was performed of studies investigating the accuracy of ultrasound, sestamibi-SPECT, and 4D-CT for preoperative localization in pHPT. Electronic databases were systematically searched, and two independent reviewers reviewed results using specific criteria. Study quality was assessed using a validated measure for diagnostic imaging studies. Study heterogeneity and pooled results were calculated.
RESULTS: 43 studies met criteria for inclusion, and data were available for extraction in 19 ultrasound, 9 sestamibi-SPECT, and 4 4D-CT studies. Ultrasound had pooled sensitivity and positive predictive value (PPV) of 76.1% (95% CI 70.4-81.4%) and 93.2% (90.7-95.3%), respectively. Sestamibi-SPECT had pooled sensitivity and PPV of 78.9% (64-90.6%) and 90.7% (83.5-96.0%), respectively. Only two 4D-CT studies investigated patients undergoing initial parathyroidectomy. Results suggested sensitivity and PPV of 89.4% and 93.5%, respectively.
CONCLUSIONS: Ultrasound and sestamibi-SPECT are similar in ability to preoperatively localize abnormal parathyroid glands in pHPT. Accuracy may be improved with 4D-CT; however, further investigation is required. Choice of preoperative imaging strategy depends on numerous patient, institutional, and economic factors of which the surgeon must be aware.
Author List
Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JAAuthor
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Four-Dimensional Computed TomographyHumans
Hyperparathyroidism, Primary
Predictive Value of Tests
Preoperative Care
Radiopharmaceuticals
Technetium Tc 99m Sestamibi
Tomography, Emission-Computed, Single-Photon
