Limited clinical utility of intraoperative frozen section during parathyroidectomy for treatment of primary hyperparathyroidism

• Published in: The American journal of surgery 2019-05, Vol.217 (5), p.893-898
• Main Authors: Li, Jennifer, Vasilyeva, Elizaveta, Hiebert, Jake, Britton, Heidi, Walker, Blair, Wiseman, Sam M.
• Format: Article
• Language: English
• Subjects: Calcium - blood; Clinical Decision-Making; Endocrine system; Female; Frozen section; Frozen Sections; Humans; Hypercalcemia; Hypercalcemia - etiology; Hyperparathyroidism; Hyperparathyroidism, Primary - surgery; Identification methods; Intraoperative Care; Localization; Male; Middle Aged; Neck; Parathyroid hormone; Parathyroid Hormone - blood; Parathyroidectomy; Pathology; Patients; Population studies; Retrospective Studies; Studies; Surgeons; Surgery; Thyroid gland; Tumors; Ultrasonic imaging
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.01.032

This study's objective was to evaluate the utility of intraoperative frozen section (IFS) performed during parathyroidectomy for treatment of primary hyperparathyroidism (PHP), and to identify patients for whom it is most helpful. A retrospective chart review was carried out for all patients who underwent parathyroidectomy for treatment of PHP between January 2013 and June 2018. 262 patients made up the final study population. Overall, IFS provided information that influenced the operative plan in 46 patients (17.6%). IFS altered the operative plan in 10.2% of cases that were correctly preoperatively localized, and in 41.5% of cases that were either incorrectly or not preoperatively localized. IFS did not provide information that influenced the operative plan during parathyroidectomy for treatment of PHP for the majority of patients. Patients that present with normal PTH and hypercalcemia, or those who do not localize preoperatively, are most likely to benefit from IFS. •Intraoperative frozen section rarely influenced the plan during parathyroidectomy.•It altered the plan in 10.2% of cases correctly localized.•It also altered the plan in 41.5% of cases that were incorrectly or not localized.•It most likely benefits patients that present with normal PTH and hypercalcemia. This study's objective was to evaluate the utility of intraoperative frozen section (IFS) performed during parathyroidectomy for treatment of primary hyperparathyroidism, and to identify patients for whom it is most helpful. IFS did not provide information that influenced the operative plan for the majority of patients. Patients that present with normal PTH and hypercalcemia, or those who do not localize preoperatively, are most likely to benefit from IFS.