4D-CT facilitates focused parathyroidectomy in patients with primary hyperparathyroidism by maintaining a high negative-predictive value for uninvolved quadrants

Naqvi, Syeda Uzma; Brooks, Kaitlyn A.; Knackstedt, Mark I.; Eguia, Arturo; Low, Garren; Jacks, Amy; Asi, Karim W.; Patino, Maria O; Friedman, Elliot R.; Karni, Ron J.

doi:10.1016/j.amjoto.2020.102683

Cited by 6 publications

(6 citation statements)

References 33 publications

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“…It was emphasized that BNE can be safely avoided in patients with confirmed solitary gland disease. [ 28 ] Eller et al [ 14 ] reported that 4D CT was the most appropriate imaging modality in pre-operative imaging.…”

Section: Discussionmentioning

confidence: 99%

The Role of 4D-CT for Pre-Operative Localization in Patients with Primary Hyperparathyroidism with Negative Ultrasonography and/or Sestamibi SPECT/CT

Yanar

2023

Sisli Etfal

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Objectives The major cause of primary hyperparathyroidism (pHPT) is parathyroid adenoma. Today, minimally invasive parathyroidectomy (MIP) has become the standard treatment for patients in whom the pathological gland can be localized with pre-operative imaging methods. In this study, we aimed to evaluate the role of 4D-CT in pre-operative localization in patients with pHPT who are negative for ultrasonography (USG) and/or sestamibi single-photon emission computed tomography/CT (SPECT/CT) and will undergo primary surgery. Methods Patients whom were operated between 2018 and 2023 were included to this study. 4D-CT results of patients with one- or two-negative USG and SPECT/CT results were evaluated retrospectively. Results In this study, 19 patients (5 men and 14 women) with a mean age of 57.1±8.5 years were evaluated. Pathology results were consistent with parathyroid adenoma in 18 patients (94.7%) and parathyroid hyperplasia in 1 patient (5.3%). USG was negative in six patients, SPECT/CT was negative in 14 patients, and both were negative in four patients. In 4D-CT, positive images were detected in 15 patients and these results were finalized as true positive in 14 patients and false positive in 1 patient. The sensitivity of 4D-CT was 82.4% (95% CI: 60.4–95.3%), positive predictive value was 93.3% (95% CI: 73.8–99.6%), accuracy was 78.9%, and localization rate was 73.7%. In 14 (73.7%) patients, the pathological glands were removed by MIP. Conclusion In approximately 75% of patients with negative USG and/or SPECT/CT, the pathological gland can be localized with 4D-CT and MIP can be applied in these patients.

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Section: Discussionmentioning

confidence: 99%

The Role of 4D-CT for Pre-Operative Localization in Patients with Primary Hyperparathyroidism with Negative Ultrasonography and/or Sestamibi SPECT/CT

Yanar

2023

Sisli Etfal

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“…This might be attributed to imaging results and the inexperience technicians operating inconvenient shooting techniques. Other factors may also change the effectiveness of 4D-CT, including positioning, large body habitus and position of HPG(s) [28,40,41]. Patients subjected to 4D-CT as a second-line examination always had negative or inconclusive first-line imaging results.…”

Section: Discussionmentioning

confidence: 99%

“…Since some of the studies included herein always assumed that each patient had 4 or more parathyroid glands [11,13,27,28,32], we performed subgroup analysis based on all parathyroid glands attributes and found high specificity (94%, 95CI: 91-96%) and AUC (94%, 95CI: 91-96%). However, other studies focusing on resected parathyroid lesions exhibited significantly lower specificities, possibly due to absence of analysis in negative findings on 4D-CT [30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Among these, 100 duplicate articles as well 92 studies, including 33 not in the field of interest, 8 case reports, 31 abstracts, 15 reviews, one editorial, three congress and meetings, and one without full text were excluded. Among the remaining 46 articles, 16 [11][12][13][20][21][22][23][24][25][26][27][28][29][30][31][32] finally met the inclusion criteria and were subsequently included in our analysis. A flow diagram of eligible literature is shown in Figure 1.…”

Section: Literature Searchmentioning

confidence: 99%

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

et al. 2021

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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.

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“…Naqvi et al found this modality to have exceptionally high sensitivity and specificity for locating ectopic glands, as well as a 93.3% negative predictive value, thereby limiting unnecessary bilateral exploration. 58 Limits of this 4D-CT imaging include the fact that it is not widely available, as well as higher thyroid-specific radiation exposure. There has been a lot written in the literature recently comparing 4D-CT to sestamibi.…”

Section: Part Ii: Managementmentioning

confidence: 99%

Advances in the diagnosis and the management of primary hyperparathyroidism

Islam

2021

Therapeutic Advances in Chronic Disease

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The parathyroid glands, one of the last organs to be discovered, are responsible for maintaining calcium homeostasis, and they continue to present the clinician with diagnostic and management challenges that are reviewed herein. Primary hyperparathyroidism (PHPT) comprises the vast majority of pathology of the parathyroid glands. The classic variant, presenting with elevated calcium and parathyroid hormone levels, has been studied extensively, but the current body of literature has added to our understanding of normocalcemic and normohormonal variants of PHPT, as well as syndromic forms of PHPT. All variants can lead to bone loss, kidney stones, declining renal function, and a variety of neurocognitive, gastrointestinal, and musculoskeletal complaints, although the majority of PHPT today is asymptomatic. Surgery remains the definitive treatment for PHPT, and advances in screening, evolving indications for surgery, new imaging modalities, and improvements in intra-operative methods have greatly changed the landscape. Surgery continues to produce excellent results in the hands of an experienced parathyroid surgeon. For those patients who are not candidates for surgery, therapeutic advances in medical management allow for improved control of the hypercalcemic state. Parathyroid cancer is extremely rare; the diagnosis is often made intra-operatively or on final pathology, and recurrence is common. The mainstay of treatment is normalization of serum calcium via surgery and medical adjuncts.

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4D-CT facilitates focused parathyroidectomy in patients with primary hyperparathyroidism by maintaining a high negative-predictive value for uninvolved quadrants

Cited by 6 publications

References 33 publications

The Role of 4D-CT for Pre-Operative Localization in Patients with Primary Hyperparathyroidism with Negative Ultrasonography and/or Sestamibi SPECT/CT

The Role of 4D-CT for Pre-Operative Localization in Patients with Primary Hyperparathyroidism with Negative Ultrasonography and/or Sestamibi SPECT/CT

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

Advances in the diagnosis and the management of primary hyperparathyroidism

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