title: Are frozen sections useful and cost-effective in the era of intraoperative qPTH assays?
abstract: BACKGROUND
  Since intraoperative quick parathormone (IOqPTH) assays are available, the role of frozen sections (FS) during parathyroid exploration has become questionable. This study compares the results of FS and IOqPTH in primary hyperparathyroidism (pHPT).
  
  
  METHODS
  FS and IOqPTH assays were performed in 102 patients who underwent bilateral neck explorations or targeted parathyroidectomy for pHPT. The operation was considered complete when both an IOqPTH drop >50% and a FS diagnosis of parathyroid adenoma were obtained.
  
  
  RESULTS
  Cure was achieved in all patients. Potential pitfalls for successful operation were encountered in 14 patients with multiglandular diseases and in 4 patients who had nonparathyroid tissue removed. FS correctly predicted the definitive histologic diagnosis with an accuracy of 81%. FS failures potentially misguided the operative therapy in 19% (14 insufficient explorations and 5 unnecessarily prolonged explorations), while IOqPTH identified all potential pitfalls and correctly guided the operative strategy, suggesting further exploration, in 100% of cases (P < .0001). After bilateral neck exploration, FS and IOqPTH correctly guided operative strategy in 86% and 100% of cases, respectively (P < .05), but both techniques were never indispensable, because potential pitfalls were already evident by macroscopic intraoperative appearance. The turnaround time and costs for IOqPTH were lower (P < .001).
  
  
  CONCLUSIONS
  The role of FS should be reconsidered, since it can misguide the operative strategy. IOqPTH is indispensable for a focused approach and, although unnecessary in bilateral neck exploration, is more useful and cost-effective than FS.
authors.affiliation: Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Padova, Italy. maurizioiacobone@hotmail.com
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacobone
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
authors.forename: Gennaro
authors.initials: G
authors.lastname: Favia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005629:Frozen Sections / Q000191:economics*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000191:economics*; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone