Iacobone Maurizio, Scarpa Marco, Lumachi Franco, Favia Gennaro
Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Padova, Italy.
Surgery. 2005 Dec;138(6):1159-64; discussion 1164-5. doi: 10.1016/j.surg.2005.05.026.
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).
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.
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).
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.
由于术中快速甲状旁腺激素（IOqPTH）检测方法已经可用，甲状旁腺探查术中冰冻切片（FS）的作用受到质疑。本研究比较了FS和IOqPTH在原发性甲状旁腺功能亢进症（pHPT）中的结果。
对102例行双侧颈部探查或靶向甲状旁腺切除术治疗pHPT的患者进行了FS和IOqPTH检测。当IOqPTH下降>50%且FS诊断为甲状旁腺腺瘤时，手术被认为完成。
所有患者均治愈。14例多腺体疾病患者和4例切除非甲状旁腺组织的患者遇到了成功手术的潜在陷阱。FS正确预测最终组织学诊断的准确率为81%。FS失败可能在19%（14例探查不足和5例不必要的延长探查）的情况下误导手术治疗，而IOqPTH在100%的病例中识别出所有潜在陷阱并正确指导手术策略，提示进一步探查（P <.0001）。双侧颈部探查后，FS和IOqPTH分别在86%和100%的病例中正确指导手术策略（P <.05），但两种技术都不是必不可少的，因为潜在陷阱在术中肉眼外观上已经很明显。IOqPTH的周转时间和成本更低（P <.001）。
应重新考虑FS的作用，因为它可能误导手术策略。IOqPTH对于有针对性的方法是必不可少的，虽然在双侧颈部探查中不必要，但比FS更有用且更具成本效益。
