title: Multiparametric ultrasonography and ultrasound elastography in the differentiation of parathyroid lesions from ectopic thyroid lesions or lymphadenopathies.
abstract: To evaluate the accuracy of ultrasound elastography with ElastoscanTMCore Index in the differential diagnosis of parathyroid lesions from ectopic thyroid nodules and lymph nodes. Seventy nine patients with repeatedly high levels of circulating intact parathyroid hormone, normal vitamin D and renal function tests, with an ultrasound scan showing a neck lesion, sharply demarcated from the thyroid lobules, were consecutively enrolled. Ultrasound with and without Color Doppler and ultrasound elastography were performed before histological examination. All ultrasound features, vascularization and ultrasound elastography diagnostic performance were assessed using ROC curves. Histological examination confirmed 47 parathyroid lesions, 18 thyroid ectopic nodules and 14 reactive lymph nodes. In distinguishing parathyroid from thyroid nodules, shape had a 100 % sensitivity (95 % CI 92.4-100) and 50 % specificity (95 % CI 37.2-64.7), cleavage had a 85.1 % sensitivity (95 % CI 72.3-92.6) and 77.8 % specificity (95 % CI 65.1-88) while peripheral vascularization had a sensitivity of 91.5 (95 % CI 79.6-97.6) and specificity of 72.2 (95 % CI 46.5-90.3). An ElastoscanTMCore Indexof 1.28 was 46 % sensitive (95 % CI 33.4-58.7) and 77 % specific (95 % CI 66.2-89.1) in discriminating parathyroid lesions from thyroid nodules. An ElastoscanTMCore Index of 1.0 was 78 % sensitive (95 % CI 65.1-88) and 71 % specific (95 % CI 56-81.3) in discriminating parathyroid lesions from lymph nodes (p = 0.045). An ElastoscanTMCore Index greater than 2.58 had a 100 % sensitivity (95 % CI 43.8-100) and 95.4 % specificity (95 % CI 38.3-99.7) in discriminating malignant from benign parathyroid nodules. ElastoscanTMCore Index was significantly higher in thyroid nodules than in reactive lymph nodes (1.18 ± 0.62, p = 0.008). The ultrasound features of cleavage and peripheral vascularization help to differentiate parathyroid from thyroid nodules. ElastoscanTMCore Index can improve ultrasound discrimination of parathyroid lesions from lymph nodes. The ElastoscanTMCore Index is significantly higher in malignant than in benign parathyroid lesions.
authors.affiliation: Department of Experimental Medicine Sapienza University of Rome, Rome, Italy. andrea.isidori@uniroma1.it.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Isidori
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Cantisani
authors.affiliation: Department of Experimental Medicine Sapienza University of Rome, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Giannetta
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Diacinti
authors.affiliation: Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico "G. Martino", University of Messina, Messina, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: David
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Forte
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Elia
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: De Vito
authors.affiliation: Department of Experimental Medicine Sapienza University of Rome, Rome, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Sbardella
authors.affiliation: Department of Experimental Medicine Sapienza University of Rome, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Gianfrilli
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Monteleone
authors.affiliation: Department of Internal Medicine and Medical Disciplines Sapienza University of Rome, Rome, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Pepe
authors.affiliation: Department of Internal Medicine and Medical Disciplines Sapienza University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Minisola
authors.affiliation: Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico "G. Martino", University of Messina, Messina, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ascenti
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: D'Andrea
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: D'Ambrosio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003199:Computer Systems; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging; D000072281:Lymphadenopathy / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000098:blood supply / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D050033:Thyroid Dysgenesis / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult
keywords: Ectopic thyroid; ElastoscanTM; Hyperparathyroidism; Lymph nodes; Real-time ultrasound elastography; Thyroid nodules; Ultrasonography