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

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

doi:10.1007/s00423-016-1425-0

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

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

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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-[(11)C]Methionine (11C-MET), one [(11)C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[(18)F]fluoro-D-glucose (18F-FDG), one 6-[(18)F] fluoro-L-DOPA (18F-DOPA), and three N-[((18)F)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 I(2) 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.

Original language	English
Pages (from-to)	925-935
Number of pages	11
Journal	Langenbeck's Archives of Surgery
Volume	401
Issue number	7
DOIs	https://doi.org/10.1007/s00423-016-1425-0
Publication status	Published - Nov 2016

Keywords

Primary hyperparathyroidism
Minimal invasive parathyroidectomy
PET/CT
11C-Methionine
18F-Fluorocholine

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title = "Use of PET tracers for parathyroid localization: a systematic review and meta-analysis",

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-[(11)C]Methionine (11C-MET), one [(11)C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[(18)F]fluoro-D-glucose (18F-FDG), one 6-[(18)F] fluoro-L-DOPA (18F-DOPA), and three N-[((18)F)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 I(2) 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.",

keywords = "Primary hyperparathyroidism, Minimal invasive parathyroidectomy, PET/CT , 11C-Methionine, 18F-Fluorocholine",

author = "Kluijfhout, {Wouter P} and Pasternak, {Jesse D} and Drake, {Frederick Thurston} and Toni Beninato and Gosnell, {Jessica E} and Shen, {Wen T} and Quan-Yang Duh and Allen, {Isabel E} and Vriens, {Menno R} and {de Keizer}, Bart and Pampaloni, {Miguel H} and Insoo Suh",

year = "2016",

month = nov,

doi = "10.1007/s00423-016-1425-0",

language = "English",

volume = "401",

pages = "925--935",

journal = "Langenbeck's Archives of Surgery",

issn = "1435-2443",

publisher = "Springer-Verlag",

number = "7",

}

TY - JOUR

T1 - Use of PET tracers for parathyroid localization

T2 - a systematic review and meta-analysis

AU - Kluijfhout, Wouter P

AU - Pasternak, Jesse D

AU - Drake, Frederick Thurston

AU - Beninato, Toni

AU - Gosnell, Jessica E

AU - Shen, Wen T

AU - Duh, Quan-Yang

AU - Allen, Isabel E

AU - Vriens, Menno R

AU - de Keizer, Bart

AU - Pampaloni, Miguel H

AU - Suh, Insoo

PY - 2016/11

Y1 - 2016/11

N2 - 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-[(11)C]Methionine (11C-MET), one [(11)C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[(18)F]fluoro-D-glucose (18F-FDG), one 6-[(18)F] fluoro-L-DOPA (18F-DOPA), and three N-[((18)F)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 I(2) 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.

AB - 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-[(11)C]Methionine (11C-MET), one [(11)C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[(18)F]fluoro-D-glucose (18F-FDG), one 6-[(18)F] fluoro-L-DOPA (18F-DOPA), and three N-[((18)F)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 I(2) 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.

KW - Primary hyperparathyroidism

KW - Minimal invasive parathyroidectomy

KW - PET/CT

KW - 11C-Methionine

KW - 18F-Fluorocholine

U2 - 10.1007/s00423-016-1425-0

DO - 10.1007/s00423-016-1425-0

M3 - Article

C2 - 27086309

SN - 1435-2443

VL - 401

SP - 925

EP - 935

JO - Langenbeck's Archives of Surgery

JF - Langenbeck's Archives of Surgery

IS - 7

ER -

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

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Keywords

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