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

Abstract

Ultrasonographic features such as irregular shape, heterogeneous echogenicity, cystic change, and vascularity are nondiscriminatory features between benign or malignant lesions. Large lesion size together with the presence of calcification, capsular thickening, or infiltrative margin strongly raises the suspicion of a malignant parathyroid lesion, and management should be altered.

Preoperative prediction of parathyroid carcinoma in an Asian Indian cohort

“…Still the >30 mm tumor diameter had 87% specificity only. This corroborated with previous studies that isolated tumor size as PC predictor showed some overlap 14,20 . Sidhu et al had proposed a 15 mm cutoff for suspicion of PC but in our cohort, the 100% sensitive cutoff (>21 mm) had only 57% specificity 17 .…”

“…Similar to other studies irregular shape had low sensitivity, high specificity, and high NPV for diagnosis of PC 17,20,26 . In contrast, tumor infiltration had lower specificity and NPV compared to other studies 17,18,20,26 .…”

“…Intratumoral calcification was the only parameter with 100% specificity and PPV for PC diagnosis, but as previously reported the sensitivity was poor 17 . Two previous studies with larger benign PHPT cohorts showed the presence of calcification in few benign lesions, again emphasizing the role of the overall tumor picture over a single parameter 20,26 …”

“…Few studies have described the role of ultrasound (US) features as an aid to clinical and biochemical parameters. However, varying numbers of asymptomatic PHPT cases in comparative cohorts add caution while applying the results to an individual patient with sPHPT 15‐20 . Recently, contrast‐enhanced computed tomography (CECT) has emerged as a first‐line imaging modality for parathyroid localization due to higher sensitivity than other available modalities and lower radiation dose as compared to 99m Tc‐sestamibi SPECT/CT 21‐25 .…”

“…However, varying numbers of asymptomatic PHPT cases in comparative cohorts add caution while applying the results to an individual patient with sPHPT. [15][16][17][18][19][20] Recently, contrastenhanced computed tomography (CECT) has emerged as a first-line imaging modality for parathyroid localization due to higher sensitivity than other available modalities and lower radiation dose as compared to 99m Tc-sestamibi SPECT/CT. [21][22][23][24][25] But the data regarding CT characteristics of PC remain limited to two studies with small sample size.…”