Endocrine Tumors

Annals of Surgical Oncology

, Volume 19, Issue 2, pp 577-583

First online:

A Meta-analysis of Preoperative Localization Techniques for Patients with Primary Hyperparathyroidism

  • Kevin CheungAffiliated withDepartment of Surgery, McMaster University
  • , Tracy S. WangAffiliated withDepartment of Surgery, Medical College of Wisconsin
  • , Forough FarrokhyarAffiliated withDepartment of Surgery, McMaster University
  • , Sanziana A. RomanAffiliated withDivision of Endocrine Surgery, Department of Surgery, Yale University School of Medicine
  • , Julie A. SosaAffiliated withDivisions of Endocrine Surgery and Surgical Oncology, Department of Surgery, Yale University School of Medicine Email author 

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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.


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.


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.


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.