A Meta-analysis of Preoperative Localization Techniques for Patients with Primary Hyperparathyroidism
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
- Greene, AB, Butler, RS, Mcintyre, S (2009) national trends in parathyroid surgery from 1998 to 2008: a decade of change. J Am Coll Surg 209: pp. 332-343 CrossRef
- Russell, CFJ, Dolan, SJ, Laird, JD (2006) Randomized clinical trial comparing scan-directed unilateral versus bilateral cervical exploration for primary hyperparathyroidism due to solitary adenoma. Br J Surg 93: pp. 418-421 CrossRef
- Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1,650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2010 (in press).
- Westerdahl, J, Bergenfelz, A (2007) Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg 246: pp. 976-980 CrossRef
- Bergenfelz, AOJ, Jansson, SKG, Wallin, GK, Mårtensson, HG, Rasmussen, L, Eriksson, HLO (2009) Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2, 708 patients. Langenbecks Arch Surg 394: pp. 851-860 CrossRef
- Udelsman, R, Pasieka, JL, Sturgeon, C, Young, JEM, Clark, OH (2009) Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94: pp. 366-372 CrossRef
- Rodgers, SE, Hunter, GJ, Hamberg, LM (2006) Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery 140: pp. 932-940 CrossRef
- Starker LF, Mahajan A, Björklund P, Sze G, Udelsman R, Carling T. 4D Parathyroid CT as the initial localization study for patients with De Novo primary hyperparathyroidism. Ann Surg. Oncol 2010;1–6.
- Moher, D, Liberati, A, Tetzlaff, J, Altman, DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6: pp. e1000097 CrossRef
- Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3(25).
- Whiting PF, Weswood ME, Rutjes AWS, Reitsma JB, Bossuyt PNM, Kleijnen J. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol. 2006;6(9).
- Reitsma J, Rutjes A, Whiting P, Vlassov V, Leeflang M, Deeks J. Assessing methodological quality. Cochrane Syst Rev Diagnostic Test Accuracy. 2009;1–28.
- Ruda, JM, Hollenbeak, CS, Stack, BC (2005) A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngology–head and neck surgery. J Am Acad Otolaryngology Head Neck Surg 132: pp. 359-372 CrossRef
- Gotthardt, M, Lohmann, B, Behr, TM (2004) Clinical value of parathyroid scintigraphy with technetium-99m methoxyisobutylisonitrile: discrepancies in clinical data and a systematic metaanalysis of the literature. World J Surg 28: pp. 100-107 CrossRef
- Arora, S, Balash, PR, Yoo, J, Smith, GS, Prinz, RA (2009) Benefits of surgeon-performed ultrasound for primary hyperparathyroidism. Langenbecks Arch Surg 394: pp. 861-867 CrossRef
- Solorzano, CC, Carneiro-Pla, DM, Irvin, GL (2006) Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg 202: pp. 18-24 CrossRef
- Solorzano, CC, Lee, TM, Ramirez, MC, Carneiro, DM, Irvin, GL (2005) Surgeon-performed ultrasound improves localization of abnormal parathyroid glands. Am Surg 71: pp. 557-562
- Soon, PSH, Delbridge, LW, Sywak, MS, Barraclough, BM, Edhouse, P, Sidhu, SB (2008) Surgeon performed ultrasound facilitates minimally invasive parathyroidectomy by the focused lateral mini-incision approach. World J Surg 32: pp. 766-771 CrossRef
- Gilat, H, Cohen, M, Feinmesser, R (2005) Minimally invasive procedure for resection of a parathyroid adenoma: the role of preoperative high-resolution ultrasonography. J Clin Ultrasound 33: pp. 283-287 CrossRef
- Grosso, I, Sargiotto, A, D’Amelio, P (2007) Preoperative localization of parathyroid adenoma with sonography and 99mTc-sestamibi scintigraphy in primary hyperparathyroidism. J Clin Ultrasound 35: pp. 186-190 CrossRef
- Lo, C-Y, Lang, BH, Chan, WF, Kung, AWC, Lam, KSL (2007) A prospective evaluation of preoperative localization by technetium-99m sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism. Am J Surg 193: pp. 155-159 CrossRef
- Erbil Y, x015F, im, et al. Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas. Laryngoscope. 2006;116(4):580–5.
- Lumachi, F, Zucchetta, P, Marzola, MC (2000) Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 143: pp. 755-760 CrossRef
- Mazzeo, S, Caramella, D, Lencioni, R (1996) Comparison among sonography, double-tracer subtraction scintigraphy, and double-phase scintigraphy in the detection of parathyroid lesions. AJR Am J Roentgenol 166: pp. 1465-1470
- Mihai, R, Simon, D, Hellman, P (2009) Imaging for primary hyperparathyroidism–an evidence-based analysis. Langenbecks Arch Surg 394: pp. 765-784 CrossRef
- Lavely, WC, Goetze, S, Friedman, KP (2007) Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med 48: pp. 1084-1089 CrossRef
- Nichols, KJ, Tomas, MB, Tronco, GG (2008) Preoperative parathyroid scintigraphic lesion localization: accuracy of various types of readings. Radiology 248: pp. 221-232 CrossRef
- A Meta-analysis of Preoperative Localization Techniques for Patients with Primary Hyperparathyroidism
Annals of Surgical Oncology
Volume 19, Issue 2 , pp 577-583
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, McMaster University, Hamilton, ON, Canada
- 2. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- 3. Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
- 4. Divisions of Endocrine Surgery and Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA