Is routine frozen section necessary for parathyroid surgery?
OBJECTIVE
Successful parathyroidectomy requires identification and excision of 1 or more abnormal parathyroid glands. The pathologist confirms or refutes the intraoperative presence of parathyroid tissue in excised material. With the advent of radionuclide scanning and rapid parathyroid hormone assays, the role of routine frozen section (FS) has once again been called into question. Our aim was to assess the need for routine FS in tissue identification during parathyroidectomy in a series of 50 consecutive cases.


METHODS
We analyzed 50 consecutive parathyroidectomies performed by a single surgeon from December 2002 to August 2003. Diagnoses on gross examination (GE) of both the surgeon and the pathologist were recorded, cytologic smears made, and FSs performed. A cost analysis was also performed.


RESULTS
Of the 50 parathyroidectomies performed (35 adenoma and 15 hyperplasia), both surgeon and pathologist's opinions on GE were concordant. Incorrect gross identification occurred by both in 6% (3) of the cases. GE is a cost-effective means of identifying parathyroid tissue.


CONCLUSIONS
Experienced parathyroid surgeons need not routinely request FS examination. The decision to omit intraoperative FS examination must be balanced against the potential implications of misdiagnosis and a repeat operative procedure.
Dewan
Anil K
AK
Department of Pathology, Pennsylvania State University College of Medicine, USA.
Kapadia
Silloo B
SB
Hollenbeak
Christopher S
CS
Stack
Brendan C
BC
D001706:Biopsy; D015925:Cryopreservation / Q000379:methods*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000473:pathology* / Q000601:surgery; D010280:Parathyroid Glands; D016105:Parathyroidectomy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity