title: Ultrasound features of malignancy in the preoperative diagnosis of parathyroid cancer: a retrospective analysis of parathyroid tumours larger than 15 mm.
abstract: OBJECTIVE
  Nearly all reported parathyroid cancers are >15 mm at presentation. The objective was to identify ultrasound criteria of malignancy in parathyroid lesions of >15 mm in size.
  
  
  METHODS
  This study was approved by a local ethics committee. A retrospective review of patients identified from a database from 2004-2009 was performed. All patients underwent ultrasound imaging according to the protocol. Two trained observers categorized findings using the pre-determined features: shape, calcification, pattern of vascularity, local infiltration and internal lesion gray scale appearances.
  
  
  RESULTS
  Sixty-nine patients (mean age 54.3 years, range 19-79 years; male = 16, female = 53) fulfilled the criteria of a parathyroid lesion >15 mm; 8/69 (11.6%) with parathyroid cancer and 61/69 (88.4%) with benign solitary parathyroid adenoma. A high positive predictive value (PPV) for cancer was identified for infiltration (PPV 100%) and calcification (PPV 100%), whilst a high negative predictive value (NPV) was found for the absence of suspicious vascularity (NPV 97.6%), a thick capsule (NPV 96.7) and inhomogeneity (NPV 100%).
  
  
  CONCLUSIONS
  In lesions >15 mm systematic ultrasound assessment of specific features provides a valuable tool to identify parathyroid cancers before surgery.
authors.affiliation: Department of Radiology, King's College Hospital, King's Health Partners, London, UK.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Sidhu
authors.forename: Nadia
authors.initials: N
authors.lastname: Talat
authors.forename: Preena
authors.initials: P
authors.lastname: Patel
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Mulholland
authors.forename: Klaus-Martin
authors.initials: KM
authors.lastname: Schulte
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology*; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D047368:Tumor Burden; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult