A simple preoperative nomogram for predicting high-risk parathyroid lesions: a tool to guide surgical strategy in...

Distinguishing benign from high-risk parathyroid lesions [atypical parathyroid tumor (APT) and parathyroid carcinoma (PC)] preoperatively is crucial for surgical strategy, yet remains difficult in tertiary referral centers confronting an enriched risk profile. This study sought to develop and validate a practical nomogram for individualized risk quantification in this specific clinical context.

We conducted a single-center, retrospective cohort study of patients with biochemically active solitary parathyroid lesions who underwent surgery between January 2009 and May 2024 at Beijing Shijitan Hospital, Capital Medical University. A total of 175 patients were included in the final analysis. A nomogram was developed via multivariable logistic regression and underwent internal validation assessing discrimination, calibration, and clinical utility via decision curve analysis (DCA).

Three independent preoperative predictors comprised the final model: age at onset [adjusted odds ratio (aOR) =0.970; 95% confidence interval (CI): 0.944-0.996; P=0.02], serum calcium (aOR =7.233; 95% CI: 2.242-23.333; P=0.001), and parathyroid hormone (PTH) level (aOR =1.001; 95% CI: 1.000-1.002; P=0.03). The nomogram showed good discrimination [area under the receiver operating characteristic curve (AUC) =0.805; 95% CI: 0.730-0.880], satisfactory calibration (Hosmer-Lemeshow P=0.75), and yielded a positive net clinical benefit across threshold probabilities of 5-40%.

This preoperative nomogram effectively quantifies individual risk for high-risk parathyroid lesions. Designed for specialized, high-prevalence settings, it offers surgeons an evidence-based metric to inform initial surgical planning and to stratify patients for tailored operative approaches.