World Journal of Endocrine Surgery

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VOLUME 9 , ISSUE 2 ( May-August, 2017 ) > List of Articles

RESEARCH ARTICLE

Frozen Tissue Examination: Is It really no Longer of Use in Parathyroid Surgery? Single-center Retrospective Study on 97 Patients treated by minimally Invasive Approach

Thomas Furderer,, Nicolas Bouviez,, Brice Paquette,, Gerard Landecy,, Bruno Heyd, Gabriel Vienney,, Zaher Lakkis,, Mael Tauziede

Citation Information : Furderer, T, Bouviez, N, Paquette, B, Landecy, G, Heyd B, Vienney, G, Lakkis, Z, Tauziede M. Frozen Tissue Examination: Is It really no Longer of Use in Parathyroid Surgery? Single-center Retrospective Study on 97 Patients treated by minimally Invasive Approach. World J Endoc Surg 2017; 9 (2):55-60.

DOI: 10.5005/jp-journals-10002-1211

License: CC BY 3.0

Published Online: 01-08-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

Surgery, by minimally invasive approach, has become the gold standard in the treatment of primary hyperparathyroidism. However, the preoperative and intraoperative examinations to be performed are still subject to debate. The frozen tissue examination of the parathyroidectomy specimen is often criticized, as it is deemed difficult and noninformative in case of multiglandular disease. The primary objective was to study the result of the frozen tissue examination and its benefit in the operative strategy in minimally invasive surgery.

Materials and methods

This is a single-centre retrospective descriptive study on patients who underwent surgery for primary hyperparathyroidism between January 2011 and September 2013 at Besançon Centre Hospitalier Régional Universitaire (CHRU) [Regional University Hospital Center]. Inclusion criteria consisted of: At least one contributory preoperative imaging test, a focused approach, and an intraoperative frozen tissue examination with microscopic analysis of the surgical specimen.

Results

A total of 157 patients were treated for hyperparathyroidism and 97 were enrolled in the study. The mean age was 62.3 ± 13.7 years, mean serum calcium was 2.81 ± 0.24 mmol/L and the mean parathyroid hormone (PTH) level was 175 ± 120 pg/mL. Around 53 patients (54.6%) had concordant scintigraphic and ultrasound examinations while 20 patients (20.6%) had an isolated contributory scintigraphic examination, 21 patients (21.6%) had an isolated contributory cervical ultrasound and 3 patients had discordant examinations. The sensitivity of the preoperative imaging in case of concordance was 84.9% for the location of the diseased gland, and 92.4% for its lateralization. The sensitivity to ultrasound alone and scintigraphy alone was 61.9% and 65% respectively. Nearly 23 false positive imaging results were found in which 11 were corrected during surgery by the surgeon based on the macroscopic appearance. The frozen tissue examination of the surgical specimen changed the surgical strategy in 12 cases (12.4%): Six results of normal parathyroid gland (50%), four results of thyroid tissue (33.3%), and two cases of hyperplastic gland (16.7%). The results of the frozen tissue examination thus led to 12 exploratory cervicotomies, which revealed three ipsilateral adenomas (25%), six contralateral adenomas, and one adenoma included in the thyroid lobe, and enabled the surgeon to perform two subtotal parathyroidectomies for parathyroid hyperplasia. The mean duration of the frozen tissue examination was 24.2 ± 8.6 minutes and the cure rate is 100% for the population treated by minimally invasive approach.

Conclusion

In our experience, the frozen tissue examination enabled the surgeon to intraoperatively correct 12 erroneous imaging diagnoses, including two cases of parathyroid hyperplasia and thus to continue the exploration of other glands and immediately carry out the appropriate treatment. This is an interesting technique, but it is conditioned by the pathologist’s expertise.

How to cite this article

Furderer T, Bouviez N, Paquette B, Landecy G, Heyd B, Vienney G, Lakkis Z, Tauziede M. Frozen Tissue Examination: Is It really no Longer of Use in Parathyroid Surgery? Single-center Retrospective Study on 97 Patients treated by minimally Invasive Approach. World J Endoc Surg 2017;9(2):55-60.


  1. . The surgical management of asymptomatic primary hyperparathyroidism : proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 2014 Oct ;99(10) :3595-3606
  2. Mini-invasive video-assisted surgery of the thyroid and parathyroid glands: a 2011 update. J Endocrinol Invest 2011 Jun;34(6):473-480.
  3. Endoscopic parathyroidectomy through a lateral approach. J Chir (Paris) 2008 Sep-Oct;145(5):470-474.
  4. Intraoperative extemporaneous examination of the parathyroid gland : what is the role of the pathologist in parathyroid pathology ? Acta Otorhinolaryngol Ital 1991. Jul-Aug;11(4):395-404.
  5. Primary hyperparathyroidism. A surgical perspective. Endocrinol Metab Clin North Am 1989 Sep;18(3):701-714.
  6. Reoperation for persistent or recurrent primary hyperparathyroidism. Seventy-seven cases among 1888 operated patients. Ann Chir 2004 May;129(4):224-231
  7. Reoperation for primary hyperparathyroidism: tips and tricks. Langenbecks Arch Surg 2010 Feb ;395(2) :103-109
  8. The value of intraoperative parathyroid hormone monitoring in localized primary hyperparthyroidism: a cost analysis. Ann Surg Oncol 2010 Mar;17(3):679-685
  9. Akerström G, Bondeson L, Juhlin C, Johansson H, Ljunghall S, Rastad J. The role of the pathologist in diagnosis and surgical decision making in hyperparathyroidism. World J Surg 1991 Nov-Dec;15(6) :698-705
  10. The role of the pathologist in the surgical treatment of hyperparathyroidism. Surg Gynecol Obst 1985 Aug;16(2):101-105.
  11. Parathyroid exploration. A review of 125 cases. Arch Otolaryngol Head Neck Surg 1991;117:1237-1241.
  12. 1000 minimally invasive parathyroidectomies without intra-operative parathyroid hormone measurement: lessons learned. ANZ J Surg 2011 May;81(5):362-365.
  13. CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism. Langenbecks Arch Surg 2010 Jan;395(1):73-80.
  14. Incidence of multiglandular disease in sporadic primary hyperparathyroidism. B-ENT 2014;10(1):1-6.
  15. Bilateral neck exploration in patients with primary hyperparathyroidism and discordant imaging results: a single-centre study. Eur J Endocrinol 2014 Apr 10;170(5):719-725.
  16. Can localization studies be used to direct focused parathyroid operations? Surgery 2001 Jun;129(6):720-729.
  17. Three-dimensional metabolic and radiologic gathered evaluation using VR-RENDER fusion: a novel tool to enhance accuracy in the localization of parathyroid adenomas. World J Surg 2013 Jul;37(7):1618-1625.
  18. Computed tomography of the parathyroids: the value of density measurements to distinguish between parathyroid adenomas of the lymph nodes and the thyroid parenchyma. Diagn Interv Imaging 2012 Jul;93(7-8):597-603.
  19. Direct comparison of neck pinhole dual-tracer and dual-phase MIBI accuracies with and without SPECT/CT for parathyroid adenoma detection and localization. Clin Nucl Med 2015 Jun;40(6):476-482.
  20. Intraoperative parathyroid hormone monitoring. World J Surg 2004 Dec;28(12):1212-1215.
  21. Evaluation of different intraoperative iPTH assay criteria in monitoring of minimally invasive parathyroidectomy for primary hyperparathyroidism. Przegl Lek 2014;71(1):14-18.
  22. Interpretation of intraoperative PTH changes in patients with multi-glandular primary hyperparathyroidism (pHPT). Surgery 2007 Dec;142(6):845-850;
  23. Significance of biochemical parameters in differentiating uniglandular from multiglandular disease and limiting use of intraoperative parathormone assay. World J Surg 2009 Jun;33(6):1219-1223.
  24. Intraoperative parathyroid hormone assay during focused parathyroidectomy: the importance of 20 minutes measurement. BMC Surg 2013 Sep 18;13:36.
  25. Intraoperative parathyroid hormone assay during focused parathyroidectomy for primary hyperparathyroidism: is it really mandatory? Minerva Chir 2012 Aug;67(4):337-342.
  26. A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases. Eur J Endocrinol 2002 Jun;146(6):783-788.
  27. No need to abandon focused unilateral exploration for primary hyperparathyroidism with intraoperative monitoring of intact parathyroid hormone. J Am Coll Surg 2015 Aug;221(2):518-523.
  28. Validation of a method to replace frozen section during parathyroid exploration by using the rapid parathyroid hormone assay on parathyroid aspirates. Arch Surg 2005 Apr;140(4):371-373.
  29. Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification. World J Surg 2000 Nov;24(11):1319-1322.
  30. et al. Experience of the reliability of intraoperative sampling of tissue PTH in parathyroid surgery: letter to the editor. World J Surg 2010 Sep;34(9):2254.
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