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Original Investigation
June 3, 2021

Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism: A Systematic Review and Network Meta-analysis

Author Affiliations
  • 1Department of Nuclear Medicine, School of Medicine and Chilgok Hospital, Kyungpook National University, Daegu, South Korea
  • 2Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
  • 3Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
  • 4Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, South Korea
  • 5BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
JAMA Otolaryngol Head Neck Surg. 2021;147(8):692-706. doi:10.1001/jamaoto.2021.0915
Key Points

Question  What is the best preoperative imaging modality for localization of primary hyperparathyroidism?

Findings  In this systematic review and network meta-analysis of direct comparative studies using 2 or more imaging modalities, choline positron emission tomography and computed tomography (PET-CT) clearly showed the best performance for localization of primary hyperparathyroidism in both patient-based and lesion-based analyses. Even in chronological analysis to investigate the changes in imaging methods over time, choline PET-CT showed the highest surface under the cumulative ranking curve value, followed by the CT category in patient-based analysis after 2010.

Meaning  This study suggests that choline PET-CT would be the best preoperative imaging modality for localization of primary hyperparathyroidism.

Abstract

Importance  Accurate preoperative localization of primary hyperparathyroidism (pHPT) is an important and challenging issue for a successful parathyroidectomy. Although new imaging modalities have been introduced during the past decade, direct comparative studies on advanced imaging techniques are limited.

Objective  To compare the performance of different preoperative imaging modalities for the localization of pHPT by performing a network meta-analysis (NMA).

Data Sources  PubMed, Embase, and the Cochrane Library were searched from the earliest available indexing date through September 28, 2020.

Study Selection  The inclusion criteria were diagnostic tests with sensitivities of 2 or more different preoperative imaging modalities for the same indivduals.

Data Extraction and Synthesis  Two researchers independently reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension statement of health care intervention guidelines for network meta-analyses.

Main Outcomes and Measures  After classifying various imaging modalities into 8 representative imaging categories, the pooled estimation between the odds ratio and 95% credible intervals (CrIs) was calculated in the sensitivity for localization of pHPT. The surface under the cumulative ranking curve (SUCRA) values were obtained to calculate the probability of each imaging modality being the most effective diagnostic method.

Results  A total of 8495 patients from 119 direct comparative studies using 2 or more imaging modalities for localization of pHPT were included. The sensitivity of choline positron emission tomography and computed tomography (PET-CT) was significantly higher than that of technetium 99m sestamibi single-photon emission computed tomography (MIBI SPECT) in both patient-based and lesion-based analyses (patient-based analysis: odds ratio, 5.22; 95% CrI, 2.36-11.80; lesion-based analysis: odds ratio, 17.70; 95% CrI, 5.79-60.10). Among 8 representative imaging modality categories, choline PET-CT showed the highest SUCRA value in both patient-based and lesion-based analyses. In patient-based analysis after 2010, choline PET-CT showed the highest SUCRA value, followed by the CT category, although MIBI SPECT had the highest SUCRA value in analysis before 2009.

Conclusions and Relevance  The results from this network meta-analysis suggest that choline PET-CT showed the best performance in both patient-based and lesion-based analyses and that choline PET-CT would be the best preoperative imaging modality for localization of pHPT.

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