Selective parathyroid venous sampling in primary hyperparathyroidism: A systematic review and meta-analysis

Area of Science:

• Endocrinology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Minimally invasive parathyroidectomy relies on accurate preoperative localization.
• The diagnostic efficacy of selective parathyroid venous sampling (sPVS) in primary hyperparathyroidism (PHPT) is debated.

Purpose of the Study:

• To conduct a meta-analysis evaluating the diagnostic accuracy of sPVS for preoperative localization in PHPT patients.

Main Methods:

• A systematic electronic search of PubMed, EMBASE, Web of Science, and Cochrane databases was performed.
• Twelve studies were included, with quality assessment and heterogeneity analysis.
• Pooled sensitivity, specificity, and positive likelihood ratio (PLR) were calculated.

Main Results:

• The pooled sensitivity, specificity, and PLR for sPVS were 74%, 41%, and 1.55, respectively (AUC = 0.684).
• sPVS demonstrated significantly higher sensitivity, PLR, and positive posttest probability compared to noninvasive imaging modalities.
• Super-selective venous sampling exhibited the highest sensitivity, accuracy, and positive posttest probability among sPVS techniques.

Conclusions:

• This meta-analysis indicates sPVS has superior sensitivity compared to noninvasive methods, particularly for revision parathyroid surgery.
• The invasive nature of sPVS may preclude its routine preoperative use.
• Super-selective venous sampling is the most accurate among parathyroid venous sampling techniques.