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European Journal of Nuclear Medicine... Mar 2019Hyperparathyroidism (HPT) is a common endocrine disorder caused by hyperfunctioning parathyroid glands (HP). The correct detection and localization of HP is challenging... (Meta-Analysis)
Meta-Analysis
PURPOSE
Hyperparathyroidism (HPT) is a common endocrine disorder caused by hyperfunctioning parathyroid glands (HP). The correct detection and localization of HP is challenging but crucial, as it may guide surgical treatment, particularly in patients with primary HPT. There is a growing body of data regarding the role of radiolabelled choline positron emission tomography (PET) in this setting. Therefore, we performed a systematic review and meta-analysis of the diagnostic performance of this method in detecting HP in patients with HPT.
METHODS
This systematic review and meta-analysis was carried out according to PRISMA guidelines. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE and Cochrane Library databases for studies published through May 2018 was performed using the following search algorithm: (a) "choline" or "fluorocholine" or "F-choline" or "C-choline" or "FCH" or "CH" or "FECH" or "FMCH" and (b) "PET" or "positron emission tomography" and (c) "parathyroid" or "hyperparathyroidism". The diagnostic performance of radiolabelled choline PET was expressed as sensitivity and positive predictive value (PPV) on a per-patient and per-lesion basis and as detection rate (DR) on a per-patient basis, with pooled proportion and 95% confidence interval (95% CI) obtained using a random-effects model.
RESULTS
Eighteen studies were included in the systematic review. Fourteen articles (517 patients) were selected for the meta-analysis. The meta-analysis provided the following results on a per-patient analysis analysis: sensitivity 95% (95% CI: 92-97%), PPV 97% (95% CI: 95-98%) and DR 91% (95% CI: 87-94%). On a per-lesion analysis, pooled sensitivity and PPV were 92% (95% CI: 88-96) and 92% (95% CI: 89-95%), respectively. No significant heterogeneity was found among the selected studies.
CONCLUSIONS
Radiolabelled choline PET demonstrated excellent diagnostic performance in detecting HP in patients with HPT. Large multicentre studies and cost-effectiveness analyses are needed to better define the role of this imaging method in this setting.
Topics: Choline; Humans; Hyperparathyroidism, Primary; Parathyroid Glands; Positron-Emission Tomography
PubMed: 30094461
DOI: 10.1007/s00259-018-4123-z -
Langenbeck's Archives of Surgery Mar 2022To evaluate the diagnostic accuracy of near-infrared autofluorescence-based identification in the identification of parathyroid glands during thyroidectomy or... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the diagnostic accuracy of near-infrared autofluorescence-based identification in the identification of parathyroid glands during thyroidectomy or parathyroidectomy.
METHODS
The clinical studies were retrieved from PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, SCOPUS, and Google Scholar. The study protocol was registered on Open Science Framework ( https://osf.io/um8rj/ ). The search period ranged from the date of each database's inception to May 2021. Cohort studies dealing with patients of whom parathyroid glands were detected by near-infrared autofluorescence and confirmed clinically or pathologically during thyroidectomy or parathyroidectomy were included. Editorials, letters, "how-I-do-it" descriptions, other site head and neck tumors, and articles with lack of diagnostic identification data were excluded. True positive, true negative, false positive, and false negative were extracted. The QUDAS ver. 2 was used to evaluate the methodological quality.
RESULTS
Seventeen studies with 1198 participants were evaluated in this analysis. Near-infrared autofluorescence-based identification of parathyroid glands showed a diagnostic odds ratio of 228.8759 (95% confidence interval, 134.1099; 390.6063). The area under the summary receiver operating characteristic curve was 0.967. The sensitivity, specificity, negative predictive value, and positive predictive value were 0.9693 (0.9491; 0.9816), 0.9248 (0.8885; 0.9499), 0.9517 (0.8981; 0.9778), and 0.9488 (0.9167; 0.9689), respectively. Subgroup analyses were performed to compare two autofluorescence detection methods, because there was high heterogeneity in the outcomes. The diagnostic accuracy was higher in probe-based detection than in image-based detection.
CONCLUSIONS
Near-infrared autofluorescence-based identification is valuable for identifying the parathyroid glands of patients during thyroidectomy or parathyroidectomy.
Topics: Cohort Studies; Humans; Optical Imaging; Parathyroid Glands; Parathyroidectomy; Thyroidectomy
PubMed: 34322746
DOI: 10.1007/s00423-021-02269-8 -
The Laryngoscope Jul 2021To estimate the impact of optical techniques on prevention of post-operative hypocalcemia and hypoparathyroidism after total thyroidectomy. (Meta-Analysis)
Meta-Analysis
OBJECTIVES/HYPOTHESIS
To estimate the impact of optical techniques on prevention of post-operative hypocalcemia and hypoparathyroidism after total thyroidectomy.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
A literature search was conducted in Pubmed, EMBASE, SCOPUS, and Cochrane databases. The main inclusion criteria for eligible articles for meta-analysis were patients with benign or malignant thyroid pathologies who underwent total thyroidectomy, utilization of optical techniques to support PGs preservation, the availability of calcium and/or PTH levels. The primary outcome was to evaluate the variation of calcium and PTH levels when adopting optical technologies compared to standard naked-eye surgery.
RESULTS
In total, 13 papers with 1484 procedures were included. Pooled proportion for short- and medium-term hypocalcemia rates were 8% (95% CI, 5%:11%) and 1% (95% CI, 0%:4%) for optical techniques, while for naked-eye surgery were 15% (95% CI, 9%:23%) and 5% (95% CI, 2%:9%), respectively.
CONCLUSIONS
Optical technologies reduced short and medium term hypocalcemia compared to conventional surgery.
LEVEL OF EVIDENCE
NA Laryngoscope, 131:1683-1692, 2021.
Topics: Calcium; Coloring Agents; Humans; Hypocalcemia; Hypoparathyroidism; Indocyanine Green; Intraoperative Care; Optical Imaging; Parathyroid Glands; Parathyroid Hormone; Postoperative Complications; Thyroid Gland; Thyroidectomy
PubMed: 33247620
DOI: 10.1002/lary.29297 -
Nuclear Medicine Communications Mar 2021To compare the diagnostic accuracy of dual-phase 99mTc-MIBI single photon emission computed tomography/computed tomography (SPECT/CT) and 4D CT for the localization of... (Meta-Analysis)
Meta-Analysis
PURPOSE
To compare the diagnostic accuracy of dual-phase 99mTc-MIBI single photon emission computed tomography/computed tomography (SPECT/CT) and 4D CT for the localization of hyperfunctioning parathyroid glands, a systematic review and meta-analysis was performed. Whether 4D CT combined to SPECT/CT [contrast-enhanced (CE)-SPECT/CT] had a better diagnostic performance than SPECT/CT alone in this scenario was also evaluated.
MATERIAL AND METHODS
PubMed and Embase databases were searched for eligible studies. To reduce interstudy heterogeneity, only studies with clear head-to-head comparison were included. Publication bias was assessed by the Deeks funnel plot. The pooled sensitivity, specificity and the area under the curve (AUC) for 4D CT, SPECT/CT and CE-SPECT/CT were determined by random-effect analysis, respectively.
RESULTS
Nine studies met the inclusion criteria, with a total of 911 participants. The sensitivity and specificity of 4D CT were 0.85 [95% confidence interval (CI), 0.69-0.94] and 0.93 (95% CI, 0.88-0.96), whereas the sensitivity and specificity for SPECT/CT were 0.68 (95% CI, 0.51-0.82; P = 0.048 compared with 4D CT) and 0.98 (95% CI, 0.95-0.99; P = 0.014 compared with 4D CT), respectively. CE-SPECT/CT is comparable to SPECT/CT in specificity and AUC, but it may improve the sensitivity (although there was a lack of statistical difference, 0.87 vs. 0.78; P = 0.125).
CONCLUSION
Although 4D CT shows comparable AUC and borderline better sensitivity than SPECT/CT, its clinical application is confined by relatively low specificity and high radiation exposure. CE-SPECT/CT may improve the sensitivity without compromising the specificity and AUC of SPECT/CT.
Topics: Four-Dimensional Computed Tomography; Humans; Parathyroid Glands; Sensitivity and Specificity; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Sestamibi
PubMed: 33306636
DOI: 10.1097/MNM.0000000000001331 -
OncoTargets and Therapy 2017To investigate whether carbon nanoparticles (CNs) are helpful in identifying lymph nodes and metastatic lymph nodes and in parathyroid protection during thyroid cancer...
PURPOSE
To investigate whether carbon nanoparticles (CNs) are helpful in identifying lymph nodes and metastatic lymph nodes and in parathyroid protection during thyroid cancer surgery.
METHODS
English and Chinese literature in PubMed, Cochrane Database of Systematic Reviews, EMBASE, ClinicalTrials.gov, China Biology Medicine Database, China National Knowledge Infrastructure, China Master's and Doctoral Theses Full-Text Database, Wanfang database, and Cqvip database were searched (till March 22, 2016). Randomized controlled trials (RCTs) that compared the use of CNs with a blank control in patients undergoing thyroid cancer surgery were included. Quality assessment and data extraction were performed, and a meta-analysis was conducted using RevMan 5.1 software. The primary outcomes were the number of retrieved central lymph nodes and metastatic lymph nodes, and the rate of accidental parathyroid removal.
RESULTS
We obtained 149 relevant studies, and only 47 RCTs with 4,605 patients (CN group: n=2,197; blank control group: n=2,408) met the inclusion criteria. Compared with the control group, the CN group was associated with more retrieved lymph nodes/patient (weighted mean difference [WMD]: 3.39, 95% confidence interval [CI]: 2.73-4.05), more retrieved metastatic lymph nodes (WMD: 0.98, 95% CI: 0.61-1.35), lower rate of accidental parathyroid removal, and lower rates of hypoparathyroidism and hypocalcemia. However, the total metastatic rate of the retrieved lymph nodes did not differ between the groups (odds ratio: 1.13, 95% CI: 0.87-1.47, =0.35).
CONCLUSION
CNs can improve the extent of neck dissection and protect the parathyroid glands during thyroid cancer surgery. And the number of identified metastatic lymph nodes can be simultaneously increased.
PubMed: 28280359
DOI: 10.2147/OTT.S131012 -
Cirugia Espanola Nov 2018The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices...
The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery.
Topics: Coloring Agents; Endocrine Surgical Procedures; Endocrine System Diseases; Humans; Indocyanine Green; Optical Imaging
PubMed: 30327136
DOI: 10.1016/j.ciresp.2018.09.005 -
Diagnostics (Basel, Switzerland) Apr 2021We sought to systematically evaluate diagnostic performance of four-dimensional computed tomography (4D-CT) in the localization of hyperfunctioning parathyroid glands... (Review)
Review
Diagnostic Role of Four-Dimensional Computed Tomography for Preoperative Parathyroid Localization in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis.
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 (I = 79%) and specificity (I = 94.7%), and obtained a pooled sensitivity of 81% (95%CI: 70-90%) with heterogeneity of 81.9% ( < 0.001) and PPV of 91% (95%CI: 82-98%) with heterogeneity of 80.8% ( < 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.
PubMed: 33917261
DOI: 10.3390/diagnostics11040664 -
The British Journal of Surgery Oct 2012Methylene blue is an intraoperative adjunct for localization of enlarged parathyroid glands. The availability of preoperative and other intraoperative localization... (Review)
Review
BACKGROUND
Methylene blue is an intraoperative adjunct for localization of enlarged parathyroid glands. The availability of preoperative and other intraoperative localization methods, and the reported adverse effects of methylene blue make its routine use debatable. The aim of this study was to perform a systematic review of the use of methylene blue in parathyroidectomy.
METHODS
A systematic review of English-language literature in MEDLINE and Scopus databases on the use of intravenous methylene blue in parathyroid surgery was carried out.
RESULTS
There were no randomized clinical trials. Thirty-nine observational studies were identified, of which 33 did not have a control arm. The overall median staining rate for abnormal parathyroid glands was 100 per cent. The median cure rates in the methylene blue and no-methylene blue arms were 100 and 98 per cent respectively. Neurotoxicity was reported in 25 patients, all of whom were taking serotonergic medication.
CONCLUSION
Observational evidence suggests that methylene blue is efficacious in identifying enlarged parathyroid glands. Toxicity appears to be mild in the absence of concomitant use of serotonin reuptake inhibitors. The effectiveness of methylene blue in the context of currently used preoperative and intraoperative localization techniques has yet to be shown.
Topics: Coloring Agents; False Positive Reactions; Humans; Infusions, Intravenous; Methylene Blue; Operative Time; Parathyroid Diseases; Parathyroidectomy; Treatment Outcome
PubMed: 22961511
DOI: 10.1002/bjs.8814 -
A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003.Otolaryngology--head and Neck Surgery :... Mar 2005To systematically review the current preoperative diagnostic modalities, surgical treatments, and glandular pathologies associated with primary hyperparathyroidism. (Review)
Review
OBJECTIVE
To systematically review the current preoperative diagnostic modalities, surgical treatments, and glandular pathologies associated with primary hyperparathyroidism.
STUDY DESIGN
A systematic literature review.
RESULTS
Of the 20,225 cases of primary hyperparathyroidism reported, solitary adenomas (SA), multiple gland hyperplasia disease (MGHD), double adenomas (DA), and parathyroid carcinomas (CAR) occurred in 88.90%, 5.74%, 4.14%, and 0.74% of cases respectively. Tc 99m -sestamibi and ultrasound were 88.44% and 78.55% sensitive, respectively, for SA, 44.46% and 34.86% for MGHD, and 29.95% and 16.20% for DA, respectively. Postoperative normocalcemia was achieved in 96.66%, 95.25%, and 97.69% of patients offered minimally invasive radio-guided parathyroidectomy (MIRP), unilateral, and bilateral neck exploration (BNE). Intraoperative PTH assays (IOPTH) were helpful in approximately 60% of bilateral neck exploration conversion (BNEC) surgeries.
CONCLUSION
The overall prevalence of multiple gland disease (MGD and DA) was lower than often suggested by conventional wisdom. Furthermore, preoperative imaging was less accurate than it is often perceived for accurately imaging MGD. MIRP and UNE were more successful in achieving normocalcemia than is typically quoted. IOPTH was a helpful but not "fool-proof" adjunct in parathyroid exploration surgery.
SIGNIFICANCE
These results support a greater role for the treatment of primary hyperparathyroidism using less invasive approaches. EMB rating: B-3.
Topics: Humans; Hyperparathyroidism
PubMed: 15746845
DOI: 10.1016/j.otohns.2004.10.005 -
World Journal of Surgery Nov 2009The management of hyperparathyroidism (HPT) in the familial setting is complex. Due to the rarity of familial HPT and its different presentation within and between the... (Review)
Review
BACKGROUND
The management of hyperparathyroidism (HPT) in the familial setting is complex. Due to the rarity of familial HPT and its different presentation within and between the familial syndromes and individual kindreds, treatment recommendations based on high levels of evidence cannot be made. However, based on the molecular genetic studies and case series from institutions with significant experience, important management principles (grade C recommendations) have been developed.
METHODS
We conducted a systematic review of the literature using evidence-based criteria.
RESULTS
Issue 1: initial operation in multiple endocrine neoplasia type 1 (MEN1), a grade C recommendation can be made for subtotal parathyroidectomy. Issue 2: initial surgery in MEN 2A, a grade C recommendation can be made for excision of enlarged glands only. Issue 3: surgery in familial isolated HPT and HPT-jaw tumor (HPT-JT) syndrome may be treated with parathyroidectomy that is subtotal or less, although the risk of parathyroid cancer in HPT-JT requires attention (no grade of recommendation). Issue 4: parathyroid surgery in familial HPT syndromes in the setting of underlying mutations in the calcium receptor (CASR) gene involves subtotal parathyroidectomy (no grade of recommendation). Issue 5: the use of intraoperative PTH measurements in familial HPT may guide the extent of parathyroid resection (no grade of recommendation).
CONCLUSIONS
The goals of parathyroidectomy in familial HPT are to achieve and maintain normocalcemia for the longest time possible, avoid both iatrogenic hypocalcemia and operative complications, and facilitate future surgery for recurrent disease.
Topics: Humans; Hyperparathyroidism; Multiple Endocrine Neoplasia; Parathyroid Neoplasms
PubMed: 19184636
DOI: 10.1007/s00268-009-9924-6