Assessment and Comparison of 18F-Fluorocholine PET and 99mTc-Sestamibi Scans in Identifying Parathyroid Adenomas: A Metaanalysis

Abstract

Hyperparathyroidism is an endocrine disorder caused by one or more hyperfunctioning parathyroid glands. Current imaging consisting of ultrasound and ^99mTc-sestamibi is imprecise, making localization difficult. ¹⁸F-fluorocholine (¹⁸F-FCH) PET has recently shown promise in presurgical localization of parathyroid adenomas. The primary aim of this study was to summarize the sensitivities and specificities of studies using ¹⁸F-FCH PET to localize hyperparathyroidism. A secondary aim was to summarize a subset of studies in which ^99mTc-sestamibi scans were also used and to compare the performance of the 2 modalities. Methods: We searched the MEDLINE and EMBASE databases following the PRISMA (Preferred Reporting Items for Systematic Review and Metaanalysis) statement. Quality was assessed using the QUADAS-2 tool (Quality Assessment of Diagnostic Accuracy Studies). Twenty studies were included for quantitative assessment in our metaanalysis. A random-effects model and a hierarchic summary receiver-operating-characteristic model was used to summarize the sensitivity of ¹⁸F-FCH PET in detecting abnormal parathyroid adenomas. We used the same methodology to assess sensitivity of ^99mTc-sestamibi, as a comparison to ¹⁸F-FCH PET. Results:¹⁸F-FCH PET had a high sensitivity, 0.97 (range, 0.96-0.98), for the detection of abnormal parathyroid adenomas. In the subpopulation for which both ¹⁸F-FCH and ^99mTc-sestamibi were reported, ¹⁸F-FCH also had a higher sensitivity, 0.96 (0.94-0.98), than the 0.54 (0.29-0.79) reported for ^99mTc-sestamibi (P < 0.001). Conclusion:¹⁸F-FCH PET demonstrates high localization accuracy in patients with hyperparathyroidism. This metaanalysis supports the use of ¹⁸F-FCH over ^99mTc-sestamibi in patients with hyperparathyroidism.

Keywords: 99mTc-sestamibi; PET; adenoma; fluorocholine; hyperparathyroidism.

Graphical abstract

FIGURE 1.

PRISMA (Preferred Reporting Items for Systematic Review and Metaanalysis) flow diagram depicting process for selecting papers included in this metaanalysis.

FIGURE 2.

Summary of sensitivity, specificity, and hierarchic summary receiver-operating-characteristic (HSROC) plot of sensitivity and specificity for ¹⁸F-FCH vs. pathology overall. Effect sizes for sensitivity and specificity were 0.97 (95% CI, 0.96–0.98) and 0.23 (95% CI, 0.11–0.35), respectively. Size of circles represents size of individual studies.

FIGURE 3.

Summary of sensitivity, specificity, and hierarchic summary receiver-operating-characteristic (HSROC) plot of sensitivity and specificity for ^99mTc-sestamibi vs. pathology overall. Effect sizes for sensitivity and specificity were 0.54 (0.29–0.79) and 0.43 (0.30–0.57), respectively. Size of circles represents size of individual studies.

FIGURE 4.

Comparison of diagnostic sensitivities of ¹⁸F-FCH and ^99mTc-sestamibi. Overall effect sizes (ES) were 0.96 (95% CI, 0.94–0.98) for ¹⁸F-FCH PET and 0.54 (95% CI, 0.29–0.79) for ^99mTc-sestamibi. Size of squares represents size of individual studies. Reference numbers are in Supplemental Table 2.