Ultrasound combined with biochemical parameters can predict parathyroid carcinoma in patients with primary hyperparathyroidism
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Parathyroid cancer (PC) is rare, but fatal condition. Preoperative prediction of PC remains challenging but meaningful. The aim of this study was to determine an effective model to predict PC in patients with parathyroid lesions >1.5 cm.
In this retrospective case-control study, we enrolled 30 patients with PC matched to 60 patients with parathyroid adenoma or hyperplasia by admission year. All patients were diagnosed with primary hyperparathyroidism (pHPT) and had parathyroid lesions >1.5 cm. Ultrasonic features of the two patient groups, as well as demographic, clinical, and biochemical characteristics were retrospectively compared. Best subset selection and multivariate logistic regression analysis were conducted to identify the independent risk factors of PC. ROC curve and decision curve analysis were developed to evaluate the applicability of the new model.
The best subset selection method and multiple logistic regression analysis showed that ultrasonic features of DR (two diameters’ ratio of the lesion) and tumor infiltration in conjunction with intact parathyroid hormone (iPTH) level (collective model) were independent predictors of malignancy. Meanwhile, DR, shape, and tumor infiltration (ultrasound model) were found to be risk factors when only ultrasonic features were included in the multivariate analysis. The decision curve analysis showed that collective model outperforms ultrasound model with a better net benefit and a wider range of threshold probabilities.
Ultrasonic features in combination with iPTH level may be an applicable model for predicting PC and has a better potential to facilitate decision-making preoperatively.
KeywordsParathyroid carcinoma Ultrasonography Diagnosis Primary hyperparathyroidism
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all individual participants included in the study.
- 6.R.V. Lloyd, R.Y. Osamura, G. Klöppel, WHO Classification of Tumours of Endocrine Organs, 4th edn. (International Agency for Research on Cancer, Lyon, 2017), p. 1–355Google Scholar
- 7.S.A. Hundahl, I.D. Fleming, A.M. Fremgen, H.R. Menck, Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86, 538–544 (1999)CrossRefGoogle Scholar
- 9.F. Cheng, E. Konstantatou, N.J. Mulholland, S. Baroncini, M.A. Husainy, K.M. Schulte et al. A retrospective review of the role of B-mode and color Doppler ultrasonography in the investigation of primary hyperparathyroidism: features that differentiate benign from malignant lesions. Ultrasound 26, 110–117 (2018)CrossRefGoogle Scholar