Percutaneous microwave ablation of hyperfunctioning parathyroid lesions under multiparametric ultrasound guidance for primary hyperparathyroidism: a systematic review and meta-analysis

Background Multiparametric ultrasound (MPUS)-guided percutaneous microwave ablation (MWA) has emerged as a minimally invasive treatment option for primary hyperparathyroidism (PHPT), but pooled evidence on longitudinal biochemical outcomes and safety remains limited. Objective This meta-analysis aimed to evaluate the efficacy and safety of percutaneous MWA performed under ultrasound guidance for PHPT. Methods Following PRISMA guidelines, eligible cohort studies were retrieved from five electronic databases. Pooled cure rates, serial changes in intact parathyroid hormone (iPTH), serum calcium and phosphorus, overall complication rates, and adenoma volume reduction were calculated via random-effects models. Leave-one-out sensitivity analyses were performed to assess the robustness of the pooled estimates. Results Nine cohorts enrolling 355 PHPT patients were included. Technical success was 100%. Pooled clinical cure rates reached 86.0% at 6 months, 82.0% at 12 months, and 75.0% at the last available follow-up. Serum calcium and iPTH declined significantly, and serum phosphorus rose across all time points. The pooled patient-level overall complication rate was 11.0%, with transient hoarseness and transient hypocalcemia being the most commonly reported event-specific complications, whereas permanent recurrent laryngeal nerve injury was rare. Conclusion Current evidence suggests that percutaneous MWA performed under ultrasound guidance may be a minimally invasive treatment option for appropriately selected patients with PHPT, providing acceptable mid-term biochemical improvement with a tolerable safety profile. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42025644973 , identifier CRD42025644973