The value of intraoperative cytology during transsphenoidal surgery for ACTH-secreting microadenoma.
BACKGROUND
Microsurgical selective adenomectomy is the best established method available for the treatment of Cushing's disease. However, this surgical method warrants still more efforts to improve the results in minute microadenomas. In this paper the authors evaluate a method of intraoperative cytological investigations during transsphenoidal surgery.


METHODS
Between January 1997 and September 1999, transsphenoidal surgery was performed in 75 patients with the diagnosis of Cushing's disease. Fifty-one cases of proven microadenomas were reviewed.


RESULTS
Of 51 cases, 33 tumors were 3 mm or less in diameter, here after called minute adenomas. In 49 of 51 (96.1%) microadenomas, adenoma tissue was identified by intraoperative cytological techniques. Postoperatively, only 35 of 51 ACTH-secreting microadenomas (68.6%) were confirmed by immunostaining methods. This lower percentage was most probably due to the small amount of tissue obtained. Therefore, in 14 cases (including 12 minute adenomas) the presence of the adenoma was only proven by cytological preparation and clinical outcome. The sensitivity of cytological preparations in cases of confirmed Cushing's disease was 100%.


CONCLUSIONS
The method described here was particularly well suited for the intraoperative discrimination and documentation of minute adenomas. Cytological preparation appears to be effective in improving the adenoma finding rate and the surgical outcome in cases of Cushing's disease.
Kurosaki
M
M
Division of Neurosurgery, Institute of Neurological Sciences, Tottori University School of Medicine, Yonago, Japan.
Luedecke
D K
DK
Knappe
U J
UJ
Flitsch
J
J
Saeger
W
W
D000236:Adenoma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000328:Adult; D000368:Aged; D002648:Child; D003480:Cushing Syndrome / Q000209:etiology / Q000601:surgery*; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D006964:Hyperpituitarism / Q000601:surgery; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone