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

BACKGROUND

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.

METHODS

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).

RESULTS

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%.

CONCLUSIONS

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.