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Ultrasound combined with biochemical parameters can predict parathyroid carcinoma in patients with primary hyperparathyroidism

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Abstract

Purposes

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China

    Ruifeng Liu, Yu Xia, Cheng Chen, Tiantian Ye, Xuepei Huang, Li Ma & Yuxin Jiang

  2. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China

    Ya Hu

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  1. Ruifeng Liu
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  2. Yu Xia
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  3. Cheng Chen
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Correspondence to Ya Hu or Yuxin Jiang.

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The authors declare that they have no conflict of interest.

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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.

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Written informed consent was obtained from all individual participants included in the study.

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These authors contributed equally: Ruifeng Liu, Yu Xia

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Liu, R., Xia, Y., Chen, C. et al. Ultrasound combined with biochemical parameters can predict parathyroid carcinoma in patients with primary hyperparathyroidism. Endocrine 66, 673–681 (2019). https://doi.org/10.1007/s12020-019-02069-7

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  • DOI: https://doi.org/10.1007/s12020-019-02069-7

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