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Open Access 01-11-2016 | Systematic Reviews and Meta-analyses

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Authors: Wouter P. Kluijfhout, Jesse D. Pasternak, Frederick Thurston Drake, Toni Beninato, Jessica E. Gosnell, Wen T. Shen, Quan-Yang Duh, Isabel E. Allen, Menno R. Vriens, Bart de Keizer, Miguel H. Pampaloni, Insoo Suh

Published in: Langenbeck's Archives of Surgery | Issue 7/2016

Abstract

Purpose

The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized parathyroid glands. We performed a systematic review of the evidence regarding all investigated tracers.

Methods

A study was considered eligible when the following criteria were met: (1) adults ≥17 years old with non-familial pHPT, (2) evaluation of at least one PET isotope, and (3) post-surgical and pathological diagnosis as the gold standard. Performance was expressed in sensitivity and PPV.

Results

Twenty-four papers were included subdivided by radiopharmaceutical: 14 studies investigated l-[¹¹C]Methionine (11C-MET), one [¹¹C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[¹⁸F]fluoro-d-glucose (18F-FDG), one 6-[¹⁸F] fluoro-l-DOPA (18F-DOPA), and three N-[(¹⁸F)Fluoromethyl]-2-hydroxy-N,N-dimethylethanaminium (18F-FCH). The 14 studies investigating MET included a total of 327 patients with 364 lesions. Sensitivity for the detection of a lesion in the correct quadrant had a pooled estimate of 69 % (95 % CI 60–78 %). Heterogeneity was overall high with I² of 51 % (p = 0.01) for all 14 studies. Pooled PPV ranged from 91 to 100 % with a pooled estimate of 98 % (95 % CI 96–100 %). Of the other investigated tracers, 18-FCH seems the most promising with high diagnostic performance.

Conclusions

The results of our meta-analysis show that 11C-MET PET has an overall good sensitivity and PPV and may be considered a reliable second-line imaging modality to enable minimally invasive parathyroidectomy. Our literature review suggests that 18F-FCH PET may produce even greater accuracy and should be further investigated using both low-dose CT and MRI for anatomical correlation.

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Title: Use of PET tracers for parathyroid localization: a systematic review and meta-analysis
Authors: Wouter P. Kluijfhout
Jesse D. Pasternak
Frederick Thurston Drake
Toni Beninato
Jessica E. Gosnell
Wen T. Shen
Quan-Yang Duh
Isabel E. Allen
Menno R. Vriens
Bart de Keizer
Miguel H. Pampaloni
Insoo Suh
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 7/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1425-0

At a glance: The STEP trials

Springer Medicine

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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