Supplementary Material for: The Application of Radiofrequency Ablation on Primary Hyperparathyroidism: A Scoping Review

Introduction: Primary hyperparathyroidism is an endocrine disorder characterized by the dysregulation of phosphocalcium metabolism resulting from the primary hyperfunction of the parathyroid glands. In recent years, routine laboratory evaluation has changed the disease paradigm, mainly presenting as an incidental finding, with patients being asymptomatic at diagnosis. Primary hyperparathyroidism may be caused by an adenoma, hyperplasia (multiglandular), carcinoma, or cyst(s) of the parathyroid glands. The treatment typically involves the surgical removal of the parathyroid lesion responsible for the hypercalcemia, making surgery the primary curative therapeutic option. Recently, ultrasound-guided percutaneous ablation methods, especially thermal ablation techniques such as radiofrequency ablation, have shown promising results in patients who do not meet surgical criteria, refuse surgery, or have relapsed or persistent disease.
Methods: This study aims to map and summarize the most recent evidence on the ultrasound-guided percutaneous application of radiofrequency for treating primary hyperparathyroidism, detailing this method's efficacy, safety, and unique characteristics. Three platforms—PubMed, Scopus, and Web of Science—were used to search for relevant evidence, following the PRISMA-ScR guidelines. Inclusion and exclusion criteria were applied consecutively, and the results obtained were organized into a table. Results: Of the 139 articles initially identified, 16 were included in the final analysis: 9 descriptive studies (clinical cases and case series) and 7 analytical studies (all observational). Overall, the articles indicated that the application of radiofrequency in primary hyperparathyroidism is both effective and safe, enabling disease control in the medium and potentially in the long term.
Conclusion: This review showed that much literature on this topic consists of descriptive studies presenting a low level of evidence. Therefore, larger prospective randomized studies and clinical trials with longer follow-up duration are recommended to validate the technique.