Diagnostic accuracy of elastography in differentiating parathyroid lesions from cervical tissues: A systematic review...

Accurate identification of parathyroid lesions is essential for diagnosis and management, yet conventional imaging techniques, including ultrasound and ^99mTc-sestamibi scintigraphy, can be discordant with the reference standard.

To evaluate the diagnostic accuracy of elastography in differentiating parathyroid lesions from surrounding cervical tissues.

PubMed, Embase, and Scopus were searched through July 2025. Studies assessing elastography in patients with suspected or confirmed parathyroid lesions-including adenomas, hyperplasia, and carcinoma-and reporting diagnostic accuracy against histopathology or consistent follow-up were included. Pooled sensitivity, specificity, and summary receiver operating characteristic (SROC) curves were calculated using a bivariate random-effects model.

Ten studies (739 patients) met inclusion criteria. Pooled sensitivity and specificity were 86.5% (95% CI, 79.8-91.3%) and 82.8% (95% CI, 76.0-87.9%), with an SROC area under the curve (AUC) of 0.91. Shear wave elastography outperformed strain elastography (AUC 0.94 vs 0.74, p = 0.009), and kPa-based stiffness measurements were superior to velocity measures (AUC 0.96 vs 0.83, p < 0.01). Accuracy was higher when parathyroid was compared with thyroid parenchyma/muscle (AUC 0.94) than with thyroid nodules (AUC 0.89), and in secondary versus primary hyperparathyroidism (AUC 0.96 vs 0.89, p = 0.004). High-frequency probes (≥10 MHz) further improved performance.

Elastography, particularly shear wave elastography with kPa-based measurements, demonstrates high diagnostic accuracy for differentiating parathyroid lesions from surrounding cervical tissues and may serve as a valuable adjunct to conventional imaging. Standardized protocols and larger multicenter studies are needed to confirm its clinical utility.