JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Use of Intraoperative Frozen Section to Assess Surgical Margins in HPV-Related Oropharyngeal Carcinoma.","authors":"Salma Ramadan, Andrew Bellas, Zaid Al-Qurayshi, Katherine Chang, Paul Zolkind, Patrik Pipkorn, Angela L Mazul, R Alex Harbison, Ryan S Jackson, Sidharth V Puram","doi":"10.1001/jamaoto.2024.4869","DOIUrl":"10.1001/jamaoto.2024.4869","url":null,"abstract":"<p><strong>Importance: </strong>Given the favorable overall prognosis of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and the morbidity of increased adjuvant therapy associated with positive surgical margins, large-scale studies on the accuracy of frozen sections in predicting final surgical margin status in HPV-related OPSCC are imperative. Final surgical margin status is the definitive assessment of tumor clearance as determined through surgeon-pathologist collaboration based on permanent analysis of frozen section margins, main specimens, and supplemental resections.</p><p><strong>Objectives: </strong>To assess the accuracy and testing properties of intraoperative frozen section histology (IFSH) in assessing final surgical margin status in patients undergoing transoral surgery for HPV-related OPSCC.</p><p><strong>Design, setting, and participants: </strong>This retrospective, single-institution cohort study was conducted at the Washington University in Saint Louis School of Medicine and included 299 patients who underwent transoral surgery for HPV-related OPSCC between January 2015 and December 2021 who were identified using an institutional cancer registry. Forty-five patients were excluded due to piecemeal resections, no frozen sections sent during surgery, unknown primaries, or no residual tumor identified during surgery after a diagnostic biopsy. Pathology reports of patients with at least 1 margin assessed by IFSH were reviewed. The data were analyzed between January and February 2024.</p><p><strong>Main outcomes and measures: </strong>The accuracy of IFSH for individual margins and overall final surgical margin status was evaluated through calculating sensitivity, specificity, positive predictive values, and negative predictive values from 1482 margins from 254 patients.</p><p><strong>Results: </strong>Of 254 participants, 29 (11.4%) were female, and the mean (SD) age was 60.7 (9.4) years. IFSH demonstrated an accuracy of 97.1%, sensitivity of 72.2%, and specificity of 99.1% for individual margins compared with final pathology results of the same tissue. However, IFSH had a sensitivity of only 21.7% in determining the overall final surgical margin status, with 18 patients (7.1%) having at least 1 positive margin undetected intraoperatively. Positive final surgical margin status was associated with worse disease-specific survival (hazard ratio, 3.26; 95% CI, 1.05-10.13) and higher rates of locoregional recurrence (hazard ratio, 5.02; 95% CI, 1.25-20.19), while no definitive conclusion can be made about the prognostic effect of final tumor specimen histopathology status due to imprecision in the effect size estimates.</p><p><strong>Conclusion: </strong>The study results suggest that despite high accuracy for individual margins, IFSH has limitations in predicting final surgical margin status in HPV-related OPSCC, particularly for base of tongue primaries and deep margins. However, IFSH remains important f","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"253-262"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noise Exposure History and Age-Related Changes to Hearing.","authors":"Lauren K Dillard, Larry E Humes, Lois J Matthews, Judy R Dubno","doi":"10.1001/jamaoto.2024.4768","DOIUrl":"10.1001/jamaoto.2024.4768","url":null,"abstract":"<p><strong>Importance: </strong>Noise exposure is a major modifiable risk factor for hearing loss, yet it is not known whether it affects the rate of hearing decline in aging.</p><p><strong>Objective: </strong>To determine the association of noise exposure history with the rate of pure-tone threshold change per year.</p><p><strong>Design, setting, and participants: </strong>This longitudinal cohort study was conducted in the ongoing community-based Medical University of South Carolina Longitudinal Cohort Study of Age-Related Hearing Loss (1988 to present with the sample based in Charleston, South Carolina, and surrounding area). Following a comprehensive baseline examination, participants attended annual examinations, during which audiometric data were collected. Participants with audiometric data from at least 2 examinations and noise exposure history data were included in the study. Data were analyzed between September 2023 and July 2024.</p><p><strong>Exposure: </strong>Noise exposure history, determined by a self-reported questionnaire and history of military service, was categorized as no/little, some, or high exposure.</p><p><strong>Main outcomes and measures: </strong>Outcome measures were individual audiometric thresholds (0.25 kHz to 8.0 kHz) and pure-tone average (PTA) of thresholds at frequencies 0.5 kHz, 1.0 kHz, 2.0 kHz, and 4.0 kHz, averaged bilaterally. Linear mixed regression models were used to estimate the association of age (per every 1 additional year) with the rate of threshold change at each frequency and PTA, for each noise exposure category. The association of noise exposure with the rate of annual threshold change was determined by an interaction term of age (longitudinal time variable) and noise exposure in regression models.</p><p><strong>Results: </strong>Of 1347 participants, the mean (SD) baseline age was 63 (14) years, and 772 (57%) were female. The mean (SD) follow-up time was 5.1 (5.7) years. Compared to the no/little noise exposure group, groups with some and high noise exposure had significantly higher baseline thresholds from 2.0 kHz to 8.0 kHz and PTA, and 1.0 kHz to 8.0 kHz and PTA, respectively. Those with high noise exposure (vs no/little) showed higher rates of threshold change per year at 1.0 kHz and 2.0 kHz. Participants with some and high noise exposure showed lower rates of change per year at 3.0 kHz to 8.0 kHz and 4.0 kHz to 8.0 kHz, respectively, where hearing loss had already occurred. The rate of PTA change per year did not differ across noise exposure groups.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, noise exposure was associated with poorer baseline hearing and higher rates of annual decline at some midfrequencies. Noise exposure can have immediate and potentially long-term negative impacts on hearing.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"228-235"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Text and References.","authors":"","doi":"10.1001/jamaoto.2025.0250","DOIUrl":"10.1001/jamaoto.2025.0250","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":"151 3","pages":"285"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fascial Forearm Free Flap for Large Tracheal Defect Closure.","authors":"Sara Donvito, Chiara Alberti, Alessandro Marchioni, Massimo Pinelli, Daniele Marchioni, Francesco Mattioli","doi":"10.1001/jamaoto.2024.4980","DOIUrl":"10.1001/jamaoto.2024.4980","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"280-281"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shedding Light on How to Use Intraoperative Measurement of Parathyroid Hormone-Sunny Miami.","authors":"Martin Almquist","doi":"10.1001/jamaoto.2024.4454","DOIUrl":"10.1001/jamaoto.2024.4454","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"200-201"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1RA Use and Thyroid Cancer Risk.","authors":"Juan P Brito, Jeph Herrin, Kavya Sindhu Swarna, Naykky M Singh Ospina, Victor M Montori, David Toro-Tobon, Guillermo E Umpierrez, Rodolfo J Galindo, Yihong Deng, Mindy M Mickelson, Hui Shao, Eric C Polley, Rozalina G McCoy","doi":"10.1001/jamaoto.2024.4852","DOIUrl":"10.1001/jamaoto.2024.4852","url":null,"abstract":"<p><strong>Importance: </strong>The increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RA) demands a better understanding of their association with thyroid cancer.</p><p><strong>Objective: </strong>To estimate the risk of incident thyroid cancer among adults with type 2 diabetes being treated with GLP-1RA vs other common glucose-lowering medications.</p><p><strong>Design, setting, and participants: </strong>This was a prespecified secondary analysis of a target trial emulation of a comparative effectiveness study using claims data for enrollees in commercial, Medicare Advantage, and Medicare fee-for-service plans across the US. Eligible participants were adults with type 2 diabetes at moderate risk for cardiovascular disease and without history of thyroid cancer who had newly filled prescriptions for GLP-1RA, sodium-glucose cotransporter 2 inhibitor (SGLT2i), dipeptidyl peptidase-4 inhibitor (DPP4i), or sulfonylurea from January 1, 2014, to December 31, 2021. Data were analyzed February 1 to October 31, 2024.</p><p><strong>Main outcomes and measures: </strong>Overall and piecewise (<1, 1-2, and ≥2 years since treatment initiation) hazard ratios (HRs) for thyroid cancer with use of GLP-1RA vs the other 3 drug classes were estimated using inverse propensity score weighted Cox proportional hazards models. Modified intention-to-treat (mITT) (primary) and as-treated (sensitivity) analyses were performed.</p><p><strong>Results: </strong>Of 351 913 patients (mean [SD] age, 65.3 [8.5] years; 173 391 [49.3%] females and 178 522 [50.7%] males), 41 112 started treatment with GLP-1RA; 76 093, with DPP4i; 43 499, with SGLT2i; and 191 209, with sulfonylurea therapy. The numbers of patients diagnosed with thyroid cancer were 69 (0.17%) in the GLP-1RA group, 172 (0.23%) in the DPP4i group, 72 (0.17%) in the SGLT2i group, and 381 (0.20%) in the sulfonylurea group. In the mITT analysis, GLP-1RA initiation was not significantly associated with increased overall risk for thyroid cancer compared to the other 3 diabetes drugs (HR, 1.24; 95% CI, 0.88-1.76). However, the risk for thyroid cancer was significantly higher within the first year after GLP-1RA initiation (HR, 1.85; 95% CI, 1.11-3.08) and was amplified in the overall as-treated analysis that censored patients when therapy was discontinued or another medication was added (HR, 2.07; 95% CI, 1.10-3.95).</p><p><strong>Conclusions and relevance: </strong>This secondary analysis of a target trial emulation of a comparative effectiveness study found that despite the low absolute risk of thyroid cancer among patients receiving GLP-1RA therapy, there was an increased risk of new thyroid cancer diagnoses within the first year of GLP-1RA initiation compared to 3 other diabetes drugs. This finding may have been due to enhanced early detection; therefore, further research is necessary to understand the underlying causes of this association.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"243-252"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head and Neck Cancer Mortality in the Appalachian Region.","authors":"Todd Burus, Pamela C Hull, Krystle A Lang Kuhs","doi":"10.1001/jamaoto.2024.4514","DOIUrl":"10.1001/jamaoto.2024.4514","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"278-279"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speech Perception in Noise After Cochlear Implantation for Single-Sided Deafness: A Randomized Clinical Trial.","authors":"Jan A A van Heteren, Anne W Wendrich, Jeroen P M Peters, Wilko Grolman, Robert J Stokroos, Adriana L Smit","doi":"10.1001/jamaoto.2024.4760","DOIUrl":"10.1001/jamaoto.2024.4760","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;There is a lack of high level of evidence studies comparing the effect of different treatment options for single-sided deafness (SSD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the effect of a cochlear implant (CI), bone conduction device (BCD), contralateral routing of signals hearing aid (CROS), and no treatment on speech perception in noise outcomes in patients with SSD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this single-center randomized clinical trial, adult patients with SSD were randomized into 3 groups: CI; a trial period with first a BCD on a headband and then a CROS; or a trial period with first a CROS and then a BCD on a headband. After the trial periods, patients opted for a BCD, CROS, or no treatment. Measurements were completed at baseline and at 3, 6, 12, and 24 months of follow-up. Data were collected from July 2014 to October 2021, and data were analyzed from December 2022 to May 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;CI, BCD then CROS, or CROS then BCD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was the speech reception threshold in noise (SRTn), measured with speech and noise from the front (S0N0), speech directed to the poor ear and noise to the better ear (SpeNbe), and vice versa (SbeNpe). The secondary outcome was disease-specific quality of life (QOL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 120 included patients, 60 (50.0%) were female, and the mean (SD) age at inclusion was 53.0 (12.1) years. At the start of follow-up, 28 patients received a CI, 25 a BCD, 34 a CROS, and 26 chose no treatment. At 24 months, the CI group had significantly better speech perception in noise scores than the BCD group (difference in SRTn: SbeNpe, -4.7 dB; 95% confidence interval, -6.6 to -3.0; SpeNbe, -2.2 dB; 95% confidence interval, -4.6 to -1.1), the CROS group (difference in SRTn: S0N0, -1.3 dB; 95% confidence interval, -1.7 to -0.2; SbeNpe, -5.3 dB; 95% confidence interval, -6.0 to -3.1), and the no treatment group (difference in SRTn: SpeNbe, -6.3 dB; 95% confidence interval, -7.5 to -4.9). Compared with the no treatment group, the BCD and CROS groups showed significantly better (difference in SRTn for SpeNbe, -4.1 dB [95% confidence interval, -5.2 to -1.5] and -4.1 dB [95% confidence interval, -6.1 to -3.3], respectively) or worse (difference for SbeNpe, 4.0 dB [95% confidence interval, 2.6 to 6.2] and 4.6 dB [95% confidence interval, 2.8 to 5.7], respectively) speech perception in noise. Self-reported speech perception abilities were significantly better for the CI group compared with the BCD, CROS, and no treatment groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this randomized clinical trial, the CI group outperformed the BCD, CROS, and no treatment groups in terms of speech perception in noise and disease-specific QOL in patients with SSD after 24 months of follow-up. These results indicate that patients with SSD can partially regain t","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"211-219"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Perspectives on the Pathophysiology of Facial Synkinesis: A Narrative Review.","authors":"Benjamin Rail, Dominic Henn, Y Edward Wen, Diana Tavares-Ferreira, Shai M Rozen","doi":"10.1001/jamaoto.2024.4489","DOIUrl":"10.1001/jamaoto.2024.4489","url":null,"abstract":"<p><strong>Importance: </strong>Facial synkinesis refers to pathologic cocontraction and baseline hypertonicity of muscles innervated by the facial nerve, commonly attributed to the aberrant regeneration of nerve fibers following injury. The pathomechanism and optimal treatment of facial synkinesis remain unclear. The goal of this review is to highlight current understanding of the epidemiology, pathophysiology, clinical presentation, assessment, and treatment of facial synkinesis.</p><p><strong>Observations: </strong>Research into the epidemiology and risk factors of facial synkinesis is limited due to a lack of large databases tracking patients with facial palsy, inherent selection bias, and the wide range of symptom severity. Misguided nerve regeneration, polyneuronal innervation, and cortical changes are implicated in the development of synkinesis, and a better understanding of these mechanisms is required to develop new treatments. The clinical presentation of facial synkinesis varies considerably among patients, and important prognostic questions regarding timing of onset and progression of symptoms remain incompletely answered. Current management options for facial synkinesis include noninvasive modalities, chemodenervation, myectomy, and selective neurectomy. Potential new treatments for facial synkinesis are being investigated in animal models, but few have been tested in humans.</p><p><strong>Conclusions and relevance: </strong>The treatment of facial synkinesis is currently hindered by limitations in clinical research and understanding of pathomechanism. Current studies predominantly yield level 4 evidence or lower. The development of large datasets of patients with facial palsy and the translation of basic science evidence to humans will facilitate the advancement of new treatments.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"268-275"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Parathyroid Hormone Monitoring Criteria in Primary Hyperparathyroidism: A Network Meta-Analysis of Diagnostic Test Accuracy.","authors":"Phillip Staibano, Michael Au, Han Zhang, Sheila Yu, Winnie Liu, Jesse D Pasternak, Xing Xing, Carolyn D Seib, Lisa Orloff, Nhu-Tram Nguyen, Michael K Gupta, Eric Monteiro, Sameer Parpia, Tyler McKechnie, Alex Thabane, J E M Ted Young, Mohit Bhandari","doi":"10.1001/jamaoto.2024.4453","DOIUrl":"10.1001/jamaoto.2024.4453","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Intraoperative parathyroid hormone (IOPTH) monitoring is recommended by the American Association of Endocrine Surgeons for use during parathyroidectomy for patients with primary hyperparathyroidism (PHPT), but there is no clinician consensus regarding the IOPTH monitoring criteria that optimize diagnostic accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate and rank the diagnostic properties of IOPTH monitoring criteria used during surgery for patients with PHPT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;A bayesian diagnostic test accuracy network meta-analysis (DTA-NMA) was performed, in which peer-reviewed citations from January 1, 1990, to July 22, 2023, were searched for in MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;All full-text study designs that evaluated any IOPTH monitoring criteria as a diagnostic test were included in this meta-analysis. Any studies evaluating adult patients diagnosed with PHPT undergoing parathyroidectomy were also included. The reference standard used in this study was normalization of calcium and/or parathyroid hormone levels within 1 year of surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;This DTA-NMA was reported in accordance with the applicable Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two reviewers evaluated all abstracts and full-text articles using a piloted extraction form. A third author resolved any conflicts. There are no published Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) resources for DTA-NMA. The following conventional monitoring criteria were included: Halle, Miami, Rome, Vienna, and PTH normalization, and the following modified criteria were included: Miami and PTH normalization, modified Miami, and modified Vienna. A bayesian hierarchical DTA-NMA model with corresponding 95% credible intervals (CrIs) was used to describe the pooled diagnostic characteristics of the evaluated IOPTH monitoring criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Main outcomes included pooled diagnostic test properties, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 72 studies, which included 19 072 patients, met the inclusion criteria. Sixty-nine studies (95.8%) investigated classic PHPT. In PHPT, the Miami criteria were investigated most often and had the best diagnostic properties (diagnostic odds ratio, 60.00 [95% CrI, 32.00-145.00]) when compared to other conventional criteria. Moreover, the modified Miami criteria, which measures a postexcision IOPTH level 15 minutes or more postexcision of all hyperfunctioning parathyroid tissue, were the overall best criteria (diagnostic odds ratio, 79.71 [95% CrI, 22.46-816.67]). There was a low risk of study bias and no publication bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevan","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"190-200"},"PeriodicalIF":6.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}