Annals of Surgical Oncology

, Volume 19, Issue 2, pp 577–583 | Cite as

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

  • Kevin Cheung
  • Tracy S. Wang
  • Forough Farrokhyar
  • Sanziana A. Roman
  • Julie A. Sosa
Endocrine Tumors



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.


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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Kevin Cheung
    • 1
  • Tracy S. Wang
    • 2
  • Forough Farrokhyar
    • 1
  • Sanziana A. Roman
    • 3
  • Julie A. Sosa
    • 4
  1. 1.Department of SurgeryMcMaster UniversityHamiltonCanada
  2. 2.Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  3. 3.Division of Endocrine Surgery, Department of SurgeryYale University School of MedicineNew HavenUSA
  4. 4.Divisions of Endocrine Surgery and Surgical Oncology, Department of SurgeryYale University School of MedicineNew HavenUSA

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