Erschienen in:
01.02.2012 | Endocrine Tumors
A Meta-analysis of Preoperative Localization Techniques for Patients with Primary Hyperparathyroidism
verfasst von:
Kevin Cheung, MSc, MD, Tracy S. Wang, MD, MPH, Forough Farrokhyar, MPhil, PhD, Sanziana A. Roman, MD, Julie A. Sosa, MD, MA
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 2/2012
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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.