Department of Nuclear Medicine, School of Medicine and Chilgok Hospital, Kyungpook National University, Daegu, South Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.
JAMA Otolaryngol Head Neck Surg. 2021 Aug 1;147(8):692-706. doi: 10.1001/jamaoto.2021.0915.
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.
To compare the performance of different preoperative imaging modalities for the localization of pHPT by performing a network meta-analysis (NMA).
PubMed, Embase, and the Cochrane Library were searched from the earliest available indexing date through September 28, 2020.
The inclusion criteria were diagnostic tests with sensitivities of 2 or more different preoperative imaging modalities for the same indivduals.
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.
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.
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.
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.
原发性甲状旁腺功能亢进症（pHPT）的准确术前定位是甲状旁腺切除术成功的一个重要且具有挑战性的问题。尽管在过去十年中引入了新的成像方式，但对先进成像技术的直接比较研究有限。
通过进行网络荟萃分析（NMA）比较不同术前成像方式定位 pHPT 的性能。
从最早可获得索引日期到 2020 年 9 月 28 日，通过 PubMed、Embase 和 Cochrane 图书馆进行检索。
纳入标准为对同一患者进行 2 种或更多种不同术前成像方式的诊断检测，其敏感度均为 2 或更高。
两名研究人员根据健康保健干预网络荟萃分析系统评价和荟萃分析扩展声明的医疗干预指南的首选报告项目，独立审查文献。
将各种成像方式分为 8 个代表性成像类别后，计算 pHPT 定位的敏感性之间比值比和 95%可信区间（CrI）的汇总估计值。获得累积排序曲线下面积（SUCRA）值，以计算每种成像方式成为最有效诊断方法的概率。
共纳入 119 项直接比较研究的 8495 名患者，这些研究使用 2 种或更多种成像方式定位 pHPT。基于患者和基于病变的分析均显示，胆碱正电子发射断层扫描和计算机断层扫描（PET-CT）的敏感性明显高于锝 99m 甲氧基异丁基异腈单光子发射计算机断层扫描（MIBI SPECT）（基于患者的分析：比值比，5.22；95%CrI，2.36-11.80；基于病变的分析：比值比，17.70；95%CrI，5.79-60.10）。在 8 个代表性成像方式类别中，基于患者和基于病变的分析中，胆碱 PET-CT 的 SUCRA 值均最高。在 2010 年后的基于患者的分析中，胆碱 PET-CT 的 SUCRA 值最高，其次是 CT 类别，尽管在 2009 年前的分析中 MIBI SPECT 的 SUCRA 值最高。
这项网络荟萃分析的结果表明，胆碱 PET-CT 在基于患者和基于病变的分析中表现最佳，胆碱 PET-CT 将是定位 pHPT 的最佳术前成像方式。
