Diagnostic Role of Four-Dimensional Computed Tomography for Preoperative Parathyroid Localization in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis.

Lixin Sun,Ruchen Peng,Yuanyuan Yang,Zhimou Liu,Jian Yao,Pan Hao

doi:10.3390/diagnostics11040664

Lixin Sun, Ruchen Peng + Show 4 more

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https://doi.org/10.3390/diagnostics11040664

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Abstract

We sought to systematically evaluate diagnostic performance of four-dimensional computed tomography (4D-CT) in the localization of hyperfunctioning parathyroid glands (HPGs) in patients with primary hyperparathyroidism (pHPT). We calculated the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratios (DOR) of 4D-CT on a per-lesion level, as well as pooled sensitivity and positive predictive value (PPV) on a per-patient level with 95% confidence intervals (CIs). Additionally, we plotted summary receiver operating characteristic (SROC) curves and evaluated the areas under the curves (AUC). A total of 16 studies were included in the analysis. Their pooled sensitivity, specificity, PLR, NLR, and DOR of 4D-CT on per-lesion level were 75% (95%CI: 66–82%), 85% (95%CI: 50–97%), 4.9 (95%CI: 1.1–21.3), 0.30 (95%CI: 0.19–0.45), and 17 (95%CI: 3–100), respectively, with an AUC of 81% (95%CI: 77–84%). We also observed heterogeneity in sensitivity (I2 = 79%) and specificity (I2 = 94.7%), and obtained a pooled sensitivity of 81% (95%CI: 70–90%) with heterogeneity of 81.9% (p < 0.001) and PPV of 91% (95%CI: 82–98%) with heterogeneity of 80.8% (p < 0.001), based on a per-patient level. Overall, 4D-CT showed moderate sensitivity and specificity for preoperative localization of HPG(s) in patients with pHPT. The diagnostic performance may improve with 4D-CT’s promotion to first-line use on a lesion-based level, further research is needed to confirm the results.

Highlights

Primary hyperparathyroidism is a common endocrine disorder, defined as hypercalcemia secondary to excessive secretion of parathyroid hormone by 1 or more hyperfunctioning parathyroid glands (HPGs) [1,2]
Studies that met the following criteria were included in the analysis: (1) patients with primary hyperparathyroidism undergoing 4D-CT for localization of HPG(s); (2) surgery and histology as the gold standard; (3) the outcome was diagnostic accuracy expressed as sensitivity and specificity on lesion-based basis and sensitivity on patient-bases basis; and (4) reported sensitivity and/or specificity for a correct quadrant or typical parathyroid sites or in ectopic areas
Our search strategy resulted in a total of 238 studies, 76, 97, and 65 from PubMed, Embase, and Web of science, respectively

Summary

Introduction

Primary hyperparathyroidism (pHPT) is a common endocrine disorder, defined as hypercalcemia secondary to excessive secretion of parathyroid hormone by 1 or more hyperfunctioning parathyroid glands (HPGs) [1,2]. It more commonly affects elderly individuals, and women four times as often as men [3,4]. Parathyroidectomy (PTx) represents the best line of action for management of parathyroid adenoma(s). It is advised for patients with systematic pHPT and those who meet the surgery guideline criteria. Clinicians need to be preoperatively precise in the localization of HPG(s) before surgery [5]

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