The Utility of Ultrasound-Guided Microwave and Radiofrequency Ablation in Primary and Secondary Hyperparathyroidism: A Systematic Review and Meta-Analysis.

OBJECTIVE

Hyperparathyroidism is classified into primary (PHPT), secondary (SHPT) and tertiary types. While parathyroidectomy (PTX) is standard treatment, minimally invasive thermal ablation (TA) methods are increasingly being explored, especially in high-risk surgical patients. The objective of this study is to review the evidence on TA techniques, microwave (MWA) and radiofrequency (RFA), and compare them to surgical techniques in hyperparathyroidism.

METHODS

A systematic search was conducted through Medline via six major databases up to February 2025. Meta-analysis was performed using R statistical software (version 2024.04.2 Build 764).

RESULTS

Thirteen studies met the inclusion criteria (8 SHPT, 5 PHPT), involving 652 SHPT and 426 PHPT patients. In PHPT, PTX significantly reduced calcium levels mmol/L at 3 mo compared to MWA (MD = 0.06, 95% CI: [0.01, 0.10]) and RFA (MD = 0.09, 95% CI: [0.04, 0.14]); also outperforming TA at 6 mo for calcium levels mmol/L (MD = 0.07, 95% CI: [0.03, 0.11]) and at 3 mo for iPTH pg/mL (MD = 13.49, 95% CI: [6.12, 20.86]). In SHPT, RFA reduced hospital stay (MD = -4.14), TA lowered infection rates (RR = 0.14) and MWA reduced persistent low PTH (OR = 0.02). In PHPT, MWA reduced hypocalcemia (RR = 0.33), and TA shortened operation time (MD = -46.54). No significant differences were found in ALP, phosphorus, hoarseness, bleeding, severe hypocalcemia, paresthesia or recurrence (p > 0.05).

CONCLUSIONS

MWA and RFA may serve as alternatives for high-risk patients unsuitable for surgery. PTX remains the preferred option for patients with extensive disease or who are eligible for surgery.