Comparison of the diagnostic accuracy of 18F-Fluorocholine PET and 11C-Methionine PET for parathyroid localization in primary hyperparathyroidism: a systematic review and meta-analysis

in European Journal of Endocrinology
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  • 1 Endocrinology, Diabetes and Metabolism
  • 2 Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy

Correspondence should be addressed to F Bioletto Email fabio.bioletto@gmail.com
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Background

Primary hyperparathyroidism is characterized by an autonomous hypersecretion of parathyroid hormone by one or more parathyroid glands. Preoperative localization of the affected gland(s) is of key importance in order to allow minimally invasive surgery. At the moment, 11C-Methionine and 18F-Fluorocholine PET studies appear to be among the most promising second-line localization techniques; their comparative diagnostic performance, however, is still unknown.

Methods

PubMed/Medline and Embase databases were searched up to October 2020 for studies estimating the diagnostic accuracy of 11C-Methionine PET or 18F-Fluorocholine PET for parathyroid localization in patients with primary hyperparathyroidism. Pooled sensitivity and positive predictive value were calculated for each tracer on a 'per-lesion' basis and compared using a random-effect model subgroup analysis.

Results

In total, 22Twenty-two studies were finally considered in the meta-analysis. Of these, 8 evaluated the diagnostic accuracy of 11C-Methionine and 14 that of 18F-Fluorocholine. No study directly comparing the two tracers was found. The pooled sensitivity of 18F-Fluorocholine was higher than that of 11C-Methionine (92% vs 80%, P  < 0.01), while the positive predictive value was similar (94% vs 95%, P  = 0.99). These findings were confirmed in multivariable meta-regression models, demonstrating their apparent independence from other possible predictors or confounders at a study level.

Conclusion

This was the first meta-analysis that specifically compared the diagnostic accuracy of 11C-Methionine and 18F-Fluorocholine PET for parathyroid localization in patients with primary hyperparathyroidism. Our results suggested a superior performance of 18F-Fluorocholine in terms of sensitivity, while the two tracers had comparable accuracy in terms of positive predictive value.

Supplementary Materials

    • Supplementary Figure 1. Forest plot for the comparison of the diagnostic performance of 11C-Methionine PET and 18F-Fluorocholine PET, in terms of (left) sensitivity and (right) PPV, after the exclusion of the study by Gauthé et al. (45); as stated in text, true positive, false positives and false negative are considered and computed on a per-gland basis; dashed vertical lines correspond to the hypothetical pooled estimates of sensitivity and PPV that would have been obtained if all studies for both tracers had been grouped together. Abbreviations: TP, true positives; FN, false negatives; FP, false positives; PPV, positive predictive value; 95%-CI, 95% confidence interval; 11C-MET, 11C-Methionine; 18F-FCH, 18F-Fluorocholine.
    • Supplementary Figure 2. Forest plot for the comparison of the diagnostic performance of 11C-Methionine PET in mixed vs selected (i.e. negative/equivocal first-line imaging) study population, in terms of (left) sensitivity and (right) PPV; as stated in text, true positive, false positives and false negative are considered and computed on a per-gland basis. Abbreviations: TP, true positives; FN, false negatives; FP, false positives; PPV, positive predictive value; 95%-CI, 95% confidence interval.
    • Supplementary Figure 3. Forest plot for the comparison of the diagnostic performance of 18F-Fluorocholine PET in mixed vs selected (i.e. negative/equivocal first-line imaging) study population, in terms of (left) sensitivity and (right) PPV; as stated in text, true positive, false positives and false negative are considered and computed on a per-gland basis. Abbreviations: TP, true positives; FN, false negatives; FP, false positives; PPV, positive predictive value; 95%-CI, 95% confidence interval.

 

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