Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France -
Department of Nuclear Medicine, University Hospital of Brest, Brest, France.
Q J Nucl Med Mol Imaging. 2023 Jun;67(2):122-129. doi: 10.23736/S1824-4785.23.03512-4. Epub 2023 Feb 9.
Primary hyperparathyroidism (pHPT) is a common endocrine disorder caused by an autonomous overproduction of parathyroid hormone (PTH) by a parathyroid gland. Over the last decade, F-choline (FCH) PET has emerged as a highly performant imaging technique for guiding parathyroidectomy. As cure is the goal of surgery, the main aims of this study were to summarize patient-based sensitivity, positive predictive value (PPV), and cure rate of FCH PET guided surgery in the surgical management of pHPT.
We conducted a systematic review and metaanalysis according to the PRISMA Guidelines. A literature search was performed in the PubMed, Web of Science and Cochrane databases, last updated November 2022. Original articles on choline PET in patients with pHPT mentioning patient-based sensitivity, PPV and cure rate were retained. Quality of included studies was assessed using the QUADAS-2 Tool. Patient-based sensitivity, PPV and cure rate were pooled by using a random-effects model.
Twenty-three studies including 1716 patients were included for quantitative assessment. FCH PET showed a pooled patient-based sensitivity of 93.8% (95% CI: 89.8-96.3) and PPV of 97% (95% CI: 92.8-98.8) in patients with pHPT. Parathyroid surgery was performed in 1129 patients. The pooled cure rate of PET-guided surgery was 92.8% (95% CI: 87.4-96.0). Heterogeneity was shown to be moderate for all effect sizes.
FCH PET showed a high patient-based sensitivity, PPV and cure rate of PET guided surgery in patients with pHPT.
原发性甲状旁腺功能亢进症（pHPT）是一种常见的内分泌疾病，由甲状旁腺自主分泌过多甲状旁腺激素（PTH）引起。在过去十年中，F-胆碱（FCH）PET 已成为指导甲状旁腺切除术的一种高性能成像技术。由于手术的目标是治愈，因此本研究的主要目的是总结 FCH PET 引导手术在 pHPT 手术治疗中的基于患者的敏感性、阳性预测值（PPV）和治愈率。
我们根据 PRISMA 指南进行了系统评价和荟萃分析。在 PubMed、Web of Science 和 Cochrane 数据库中进行了文献检索，最后一次更新时间为 2022 年 11 月。保留了关于 pHPT 患者胆碱 PET 的原始文章，这些文章提到了基于患者的敏感性、PPV 和治愈率。使用 QUADAS-2 工具评估纳入研究的质量。使用随机效应模型汇总基于患者的敏感性、PPV 和治愈率。
纳入了 23 项研究，共纳入 1716 名患者进行定量评估。FCH PET 显示 pHPT 患者的基于患者的敏感性为 93.8%（95%CI：89.8-96.3），PPV 为 97%（95%CI：92.8-98.8）。在 1129 名患者中进行了甲状旁腺手术。PET 引导手术的总体治愈率为 92.8%（95%CI：87.4-96.0）。所有效应量均显示出中度异质性。
FCH PET 显示 pHPT 患者的基于患者的敏感性、PPV 和 PET 引导手术的治愈率均较高。
