Liang Hua, Li Jinglin, Yang Xin, Ouyang Yunshu, Hu Ya, Li Mei, Xiao Mengsu, Gui Yang, Chen Xueqi, Tan Li, Li Jianchu, Liu He, Lv Ke, Chang Xiaoyan, Jiang Yuxin
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Heliyon. 2024 Jul 2;10(14):e33890. doi: 10.1016/j.heliyon.2024.e33890. eCollection 2024 Jul 30.
Ultrasound (US) is the most economical and widely used method for detecting lesions in parathyroid regions. Identifying typically parathyroid adenomas as hypoechoic nodules with clear margins. However, 10 % of lesions exhibit atypical features, such as the dual concentric sign, and the cognition of them still needs to be improved.
To promote understanding of clinical and histopathological features for parathyroid lesions with the dual concentric echo sign and to investigate its pathogenesis and methods for distinguishing from cervical lymph nodes to improve US diagnostic accuracy.
Retrospectively, patients were categorized into three groups: Group 1, with 36 patients showing parathyroid lesions with dual concentric echo signs; Group 2, with 40 patients displaying classic hypoechoic parathyroid lesions; and Group 3, comprising 36 patients with identified lymph nodes, which were all examined from January 2018 to December 2019. The clinical data on demographics, clinical symptoms, serum levels, histopathologic findings, and US image characteristics were thoroughly reviewed.
According to the clinical data, no significant differences in demographics or lesion sizes were observed in Group 1 and Group 2 (p > 0.05). No significant variances were noted in biochemical markers, including PTH, T-25OHD, and ALP. However, a notable difference was identified in adjusted serum calcium levels, which were significantly lower in Group 1 compared to Group 2 (p < 0.05). Additionally, the proportion of asymptomatic patients was significantly higher in Group 1 compared to Group 2 (p < 0.05). Pathological examination revealed that all lesions with dual concentric echo signs were parathyroid adenomas. The isoechoic central region predominantly corresponded to areas of loose edema, while the hypoechoic peripheral layer was primarily associated with chief and/or oncocytic cells. By comparing the ultrasonography of Groups 1 and 3, the parathyroid lesions with dual concentric echo signs exhibited significant distinctions from lymph nodes in size, blood flow classification, vascular distribution, and anatomical location (p < 0.05).
The parathyroid lesions with dual concentric echo signs in US corresponded to specific histopathological manifestations and relatively mild clinical features in the patients, this finding may increase the likelihood of incidental detection of parathyroid lesions by US. Attention to the details of size, location, and blood flow, especially, may aid US physicians in differentiating parathyroid adenomas from cervical lymph nodes.
超声（US）是检测甲状旁腺区域病变最经济且应用最广泛的方法。典型的甲状旁腺腺瘤表现为边界清晰的低回声结节。然而，10%的病变具有非典型特征，如双同心征，对其认识仍有待提高。
增进对具有双同心回声征的甲状旁腺病变的临床和组织病理学特征的理解，探讨其发病机制以及与颈部淋巴结鉴别的方法，以提高超声诊断准确性。
回顾性地将患者分为三组：第1组，36例有双同心回声征的甲状旁腺病变患者；第2组，40例表现为典型低回声甲状旁腺病变的患者；第3组，36例已确诊为淋巴结的患者，所有患者均于2018年1月至2019年12月接受检查。对人口统计学、临床症状、血清水平、组织病理学结果和超声图像特征等临床资料进行了全面回顾。
根据临床资料，第1组和第2组在人口统计学或病变大小方面未观察到显著差异（p>0.05）。在包括甲状旁腺激素（PTH）、25-羟基维生素D（T-25OHD）和碱性磷酸酶（ALP）等生化指标方面也未发现显著差异。然而，在调整后的血清钙水平上发现了显著差异，第1组明显低于第2组（p<0.05）。此外，第1组无症状患者的比例明显高于第2组（p<0.05）。病理检查显示，所有具有双同心回声征的病变均为甲状旁腺腺瘤。等回声中央区域主要对应疏松水肿区域，而低回声外周层主要与主细胞和/或嗜酸性细胞相关。通过比较第1组和第3组的超声检查结果，具有双同心回声征的甲状旁腺病变在大小、血流分级、血管分布和解剖位置方面与淋巴结有显著差异（p<0.05）。
超声检查中具有双同心回声征的甲状旁腺病变对应特定的组织病理学表现和患者相对较轻的临床特征，这一发现可能增加超声偶然发现甲状旁腺病变的可能性。特别是关注大小、位置和血流细节，可能有助于超声医生将甲状旁腺腺瘤与颈部淋巴结区分开来。
