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

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

  1. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Kevin Cheung MSc, MD & Forough Farrokhyar MPhil, PhD

  2. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Tracy S. Wang MD, MPH

  3. Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Sanziana A. Roman MD

  4. Divisions of Endocrine Surgery and Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Julie A. Sosa MD, MA

Authors
  1. Kevin Cheung MSc, MD
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  2. Tracy S. Wang MD, MPH
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  3. Forough Farrokhyar MPhil, PhD
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  4. Sanziana A. Roman MD
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  5. Julie A. Sosa MD, MA
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Correspondence to Julie A. Sosa MD, MA.

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Cheung, K., Wang, T.S., Farrokhyar, F. et al. A Meta-analysis of Preoperative Localization Techniques for Patients with Primary Hyperparathyroidism. Ann Surg Oncol 19, 577–583 (2012). https://doi.org/10.1245/s10434-011-1870-5

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  • DOI: https://doi.org/10.1245/s10434-011-1870-5

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