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

[BACKGROUND] 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.

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

[METHODS] 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.

[RESULTS] 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.

[CONCLUSION] 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.