Ultrasound in the topical diagnosis of primary hyperparathyroidism

Background. Ultrasound is the first-line method in the topical diagnosis of primary hyperparathyroidism (PHPT). However, its diagnostic capabilities in the context of diverse echostructure and variable locations of parathyroid glands (PTG) remain insufficiently studied. Optimization of the diagnostic algorithm requires further development and evaluation.

Objective. To determine the diagnostic and prognostic value of ultrasound in primary hyperparathyroidism, taking into account the diversity of echostructure and location of abnormal parathyroid glands.

Materials and methods. A prospective cohort study was conducted in 294 patients with laboratory-confirmed PHPT. All patients underwent preoperative ultrasound of the neck and upper mediastinum using expert-class equipment. In cases where PTG were not visualized, single- photon emission computed tomography (SPECT) was additionally performed. The diagnosis was confirmed by pathological examination of surgical specimens.

Results. Abnormal PTG were detected by ultrasound in 278 patients (94.6%). The sensitivity of the method was 94.72%, accuracy – 93.20%, positive predictive value – 98.29%, specificity – 16.67% (attributed to the study cohort with an already established diagnosis). The area under the ROC curve (AUC) was 0.760. Comprehensive examination revealed 303 abnormal PTG (solitary in 285 patients, double in 9 patients). False-negative results were primarily associated with ectopic location (retrotracheal, retroesophageal, mediastinal, intrathyroidal) and small adenoma size. False- positive findings were due to misinterpretation of thyroid nodules or lymph nodes as abnormal PTG, especially in the presence of concomitant nodular thyroid pathology (66.7% of patients).

Conclusion. Ultrasound has high sensitivity and positive predictive value, confirming its utility as the first-step method in the topical diagnosis of PHPT. Detailed analysis of ultrasound features (shape, margin, echogenicity, vascular pattern, presence of calcifications and cystic component) revealed no statistically significant correlation with the morphological substrate or clinical variants of the disease. When PTG are not visualized or ectopia is suspected, SPECT should be added to the diagnostic workup.

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