Diagnostic Value of Elastography in Differentiating Parathyroid Adenoma from Hyperplasia: A Systematic Review and Meta-Analysis

BackgroundDifferentiating parathyroid adenoma from hyperplasia is critical for surgical planning, but conventional imaging often cannot reliably distinguish these lesions. Ultrasound elastography offers quantitative assessment of tissue stiffness and may improve preoperative characterization. PurposeTo evaluate the diagnostic accuracy of ultrasound elastography in differentiating parathyroid adenoma from hyperplasia. MethodsA systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Embase were searched through July 2025, for studies assessing elastography for parathyroid lesion differentiation. Data on sensitivity, specificity, and other diagnostic metrics were extracted and pooled using a bivariate random-effects model in R software. ResultsFive studies comprising 579 parathyroid lesions were included, of which four studies with 352 adenomas and 202 hyperplasias were eligible for pooled analysis. Pooled sensitivity and specificity of elastography were 83.3% (95% CI: 74.3-89.6%) and 79.1% (95% CI: 65.5-88.3%), respectively, with an area under the SROC curve of 0.88 (95% CI: 0.79-0.92). Pooled likelihood ratios were 4.14 for a positive test and 0.216 for a negative test. Fagan nomogram analysis showed that, for a patient with a 50% pre-test probability of adenoma, a positive result increased post-test probability to 81%, while a negative result decreased it to 18%. ConclusionUltrasound elastography demonstrates good diagnostic performance in distinguishing parathyroid adenomas from hyperplasia and may help inform preoperative planning.