Pertinence des examens peropératoires dans la chirurgie ciblée des hyperparathyroïdies primaires

Abstract : Introduction: Frozen section (FS), traditionally associated with bilateral neck exploration in surgical decision has become questionable since Intra operative parathyroid hormone assay(IOPTH). This study compares the results of FS and IOPTH in minimal invasive parathyroidectomy for primary hyperparathyroidism (HPTP). Methods: FS and IOPTH were performed on 27 patients with concordant localization imaging. They all benefited from minimally invasive parathyroidectomy for HPTP. The surgery was considered complete when both an IOq PTH drop >50% and a FS diagnosis of parathyroid adenoma or parathyroid tissue were obtained. Results: Twenty-five patients were cured. FS accurately predicts the definitive histological diagnosis but is imprecise in 44.5% and does not guide the surgical decision. It helps in the continuation of the intervention in case of doubt about parathyroid tissue. Failure of the FS would have potentially misdirected the operational strategy in 11% of cases whereas IOPTH confirmed the removal of the hyperfunctional tissue and identified the potential traps in 97% of the cases. There was an operative pitfall and an error of the IOPTH. Considering examinations together when they are discordant can help to detect possible traps. The performance of the performed with sensitivity, specificity, positive predictive value and negative predictive value of 100%, 50%, 96.2%, 100% for IOPTH and 88%, 100%, 100% , 40% for the FS. Conclusion: The role of FS may diverge from the operational strategy but may remain an aid to surgical decision-making. IOPTH is essential for a targeted approach and is more useful than FS but has a longer completion time.
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Master Thesis
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Florian Rivieccio. Pertinence des examens peropératoires dans la chirurgie ciblée des hyperparathyroïdies primaires. Organes des sens. 2017. ⟨dumas-02265161⟩

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