Implementation of a 4-dimensional computed tomography protocol for parathyroid adenoma localization

Jategaonkar, Ameya A.; Lerner, David; Cooke, Peter V.; Kirke, Diana N.; Genden, Eric M.; Trosman, Samuel J.

doi:10.1016/j.amjoto.2021.102907

Cited by 3 publications

(9 citation statements)

References 14 publications

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“…The 26 diagnostic studies (eTable 1 in the Supplement) were all delayed-type cross-sectional studies consisting of 5845 total patients . Of 26 studies, 25 reported on sex distribution with a total of 4176 women (79.2%) compared with 1094 men (20.8%).…”

Section: Resultsmentioning

confidence: 99%

“…The range of median ages reported in 3 studies was 60 to 66 years. A total of 23 studies investigated PHPT patient populations before initial parathyroid surgery . However, 3 studies reported specifically on patients with PHPT with recurrent/reoperative disease .…”

Section: Resultsmentioning

confidence: 99%

“…Various combinations of keywords were used in searches with “AND/OR” as connecting terms to refine results. The comprehensive search strategy used to query the PubMed database is outlined in the Table …”

Section: Methodsmentioning

confidence: 99%

“…A total of 23 studies investigated PHPT patient populations before initial parathyroid surgery. 8,[10][11][12][13][14][15][16][17][19][20][21][22][23][24][26][27][28][29][30][31][32][33] However, 3 studies reported specifically on patients with PHPT with recurrent/reoperative disease. 9,25,28 Characteristics of parathyroid disease are summarized in eTable 2 in the Supplement.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Meta-analyses included 23 studies in this review. [8][9][10][11][12][13][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][32][33] As seen in Figure 2, the pooled sensitivity for 4D-CT in the localization of PHPT in 4695 patients was 81% (95% CI, 77%-84%; I 2 , 88%). In contrast, the pooled sensitivity for sestamibi-SPECT/ CT in 4791 patients was 65% (95% CI, 59%-70%; I 2 , 93%).…”

Section: Meta-analysismentioning

confidence: 99%

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Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism

Kattar

Migneron

Debakey

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Emerging computed tomographic (CT) imaging techniques for the localization of primary hyperparathyroidism (PHPT) may be superior to the current imaging standard, thus necessitating a critical review and pooling of available evidence.OBJECTIVE Primary hyperparathyroidism requires accurate imaging to guide definitive surgical management. Advanced techniques including 4-dimensional computed tomographic (4D-CT) scan have been investigated over the past decade. We sought to evaluate the efficacy of these emerging imaging techniques through pooled analysis of the existing evidence.DATA SOURCES PubMed, Embase, and Web of Science databases were queried for original English articles without any restrictions on date.STUDY SELECTION We included comparative observational studies but excluded animal studies, case reports, and case series. Overall, 353 abstracts were screened independently by 2 investigators along with a third reviewer to resolve conflicts. A total of 26 full-text articles were included in this review.DATA EXTRACTION AND SYNTHESIS This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Data was independently extracted by 2 investigators and subsequently pooled into a metaanalysis using a random-effects model. MAIN OUTCOMES AND MEASURESMeasures of imaging diagnostic performance such as sensitivity, specificity, positive predictive value, and negative predictive value were the primary outcomes of interest.RESULTS Overall, of 34 articles screened, 26 met criteria for qualitative synthesis, and 23 of these were appropriate for meta-analysis. Of the 26 studies included, there were 5845 patients, of which 4176 were women (79.2%). The average of mean ages reported in 23 studies was 60.9 years. Meta-analysis in all patients with PHPT revealed pooled sensitivity that was greater with 4D-CT (81%; 95% CI, 77%-84%; I 2 = 88%) compared with the current first-line modality of sestamibi-single-photon emission CT (SPECT/CT) (65%; 95% CI, 59%-70%; I 2 = 93%). For patients with recurrent PHPT requiring reoperation, 4D-CT pooled sensitivity was 81% (95% CI, 64%-98%; I 2 = 93%) in contrast to 53% (95% CI, 35%-71%; I 2 = 81%) for sestamibi-SPECT/CT. The overall quality of the 26 studies was moderate with a median (range) Methodological Index for Nonrandomized Studies score for all included studies of 15.5 (13)(14)(15)(16)(17)(18)(19). CONCLUSIONS AND RELEVANCEThe findings of this systematic review and with meta-analyses of numerous studies from the past decade suggest that the 4D-CT can be more sensitive and specific than sestamibi-SPECT/CT in localizing PHPT. More research is needed to determine the clinical significance of this improvement in localization.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Meta-analysismentioning

confidence: 99%

See 3 more Smart Citations

Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism

Kattar

Migneron

Debakey

et al. 2022

JAMA Otolaryngol Head Neck Surg

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A mini-invasive approach is feasible in patients with primary hyperparathyroidism and discordant or negative localisation studies

et al. 2022

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Parathyroid carcinoma: Imaging features of initial presentation and recurrence. A single center experience

Eldaya,

Calle,

Wong

et al. 2023

Neuroradiol J

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Background and purpose Parathyroid carcinoma is the rarest endocrine neoplasm with very few published data discussing its imaging appearance with primary focus on ultrasound imaging features. We present our 23 years institutional experience to highlight multimodality imaging evaluation at presentation and at recurrence. Material and Methods Retrospective chart review of clinical and pathological diagnosis of parathyroid carcinoma patients presented for initial or recurrent disease management at M.D. Anderson Cancer Center between the period of January 2000 and February 2023 was performed. Imaging findings on US, CT, PET/CT, and technetium-99m sestamibi were analyzed for initial and local recurrent parathyroid carcinoma. We further assess patterns of distant recurrence and its location. Results Twenty three patients with pathological and clinical diagnosis of initial (14 patients) or recurrent parathyroid carcinoma (14 patients) were included in this study. US findings of parathyroid carcinoma were larger lesions, increased/irregular vascularity, and non-circumscribed margins. Multiphasic CT findings of parathyroid carcinoma included an arterially enhancing lesion that is hypoenhancing relative to the thyroid and demonstrates no washout on delayed imaging. Highly suggestive findings for recurrent disease included a hypoechoic solid nodule (91.67%) with increased vascularity on ultrasound (81.8%) with corresponding enhancement on CT. Conclusion Parathyroid carcinoma is a rare malignancy often diagnosed after surgical resection. We provided CT and US imaging features that are helpful in suggesting the diagnosis of parathyroid carcinoma and detection of early local recurrence.

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Implementation of a 4-dimensional computed tomography protocol for parathyroid adenoma localization

Cited by 3 publications

References 14 publications

Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism

Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism

A mini-invasive approach is feasible in patients with primary hyperparathyroidism and discordant or negative localisation studies

Parathyroid carcinoma: Imaging features of initial presentation and recurrence. A single center experience

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