[Primary hyperparathyroidism: usefulness of high resolution echography in local diagnosis]

Recent reports show a better surgical outcome in primary hyperparathyroidism when an accurate preoperative localization of the lesion in available. We performed high resolution sonography in 23 consecutive patients (20 women) with biochemically proven hyperparathyroidism. Twenty two of them were operated on and their sonographic reports were compared to the surgical and pathological findings (20 adenomas, 1 carcinoma and 1 hyperplasia). One patient did not have surgery but the sonogram was compared to a Tl 201-Tc99 scintigram that suggested an adenoma. Sonography showed a single parathyroid tumor in 17 patients and failed to demonstrate a lesion in six. There were two false positives and 6 false negatives. The sensitivity was 71.5% and the positive predictive value was 88%. Three out of 6 patients with a negative sonography had an adenoma located out of reach for the method. Our results show that the high resolution sonography is a useful, non invasive method to localize abnormally enlarged parathyroid glands in hyperparathyroidism and we think it should be performed in every patient with a biochemical diagnosis of this disease.