Efficacy and safety of US-guided thermal ablation for primary hyperparathyroidism: a systematic review and meta-analysis

Figures & data

Figure 1. Flow diagram outlining article selection process. Article may had been excluded for multiple reasons, but only one major reason per article was presented.

Table 1. Characteristics of the included studies.

Publication, year	Country	Institution	Design	Participants (N, age, female%)	Conducted period	Follow period (months)	Thermoablative procedure	Available outcome time-point (months)	Complication (N)
Andrioli et al., 2012	Italy	Istituto di Ricovero e Cura a Carattere Scientifico	Retrospective study	6, 58.5 ± 8.2, 100%	2003 ∼ 2010	54 ± 34	Laser ablation	1, 3, 6, 12	Transient dysphonia (1)
Kovatcheva et al., 2014	Bulgaria	University Hospital of Endocrinology, Sofia Medical University	Prospective study	13, 55.2 ± 12.4, 84.6%	February 2008 ∼ May 2011	13.6 ± 6.2	High-intensity focused ultrasound	1, 3, 6, 9	Transient dysphonia (5), subcutaneous edema (5)
Liu et al., 2016	China	The Second Affiliated Hospital of Zhejiang University	Retrospective study	15, 55.6 ± 14.0, 60%	2011 ∼ 2014	32.8 ± 17.9	Microwave ablation	1, 3, 6	Transient dysphonia (1)
Fan et al., 2019	China	The First Affiliated Hospital of Nanjing Medical University	Retrospective study	22, 55.9 ± 12.9, 86.4%	November 2014 ∼ February 2016	12.5 ± 5.2	Microwave ablation	1, 3, 6, 12	Transient dysphonia (8), needle tract bleeding (2), transitory hypocalcemia (1)
Liu et al., 2019	China	Chinese PLA General Hospital	Retrospective study	28, 56.6 ± 10.8, 78.6%	May 2013 ∼ December 2018	6.3 ± 2.0	Microwave ablation	1, 3, 6	Transient dysphonia (2), transitory hypocalcemia (4)

Figure 2. Forest plot and meta-analysis of comparison between PTH levels at 3 months after ablation and that of pre-ablation (a), and funnel plot for change of PTH levels at 3 months after thermal ablation (b). PTH: parathyroid hormone.

Figure 3. Forest plot and meta-analysis of comparison between PTH levels at 6 months after ablation and that of pre-ablation (a), and funnel plot for change of PTH levels at 6 months after thermal ablation (b). PTH: parathyroid hormone.

Figure 4. Forest plot, meta-analysis of comparison between serum calcium levels at 3 months after ablation and that of pre-ablation.

Figure 5. Forest plot and meta-analysis of comparison between serum calcium levels at 6 months after ablation and that of pre-ablation.

Figure 6. Forest plot and meta-analysis of comparison between volume of parathyroid gland at 6 months after ablation and that pre-ablation.

Table 2. Publication bias analyses with Egger’s test based on primary outcomes.

Primary outcomes	Follow-up time point	t	p value
Serum parathyroid hormone	3 months	1.62	0.204
	6 months	0.93	0.421
Serum calcium	3 months	0.47	0.668
	6 months	−0.05	0.967
Volume of parathyroid gland	6 months	0.42	0.716