Role of routine frozen sections for parathyroid exploration in a resource poor setting

Removal of parathyroid is recommended for patients suffering from hypercalcemia due to excess parathyroid hormone levels. There are several causes for a hyperfunctioning parathyroid gland out of which parathyroid adenoma is the most common pathological entity. There is great variation in the number and location of parathyroid glands. Hence, intra-operative confirmation of parathyroid tissue makes it easier for the surgeon to be confident of the outcome of the procedure and assure the patient of a permanent cure.

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A descriptive cross sectional study was done in a cohort of 26 patients who presented with elevated total serum calcium and parathyroid hormone concentrations. Intra-operative frozen section diagnoses were correlated with routine histological studies and post-operative parathyroid hormone concentration. The majority of patients were diagnosed as having parathyroid adenoma (88.46%). Three out of 26 patients (11.53%) had parathyroid hyperplasia involving more than one gland. Sensitivity and specificity of intraoperative frozen section diagnosis was 100%. There was a statistically significant association (p<0.05) with postoperative parathyroid hormone concentration was performed from the same laboratory and the intraoperative diagnosis. The concordance between the intraoperative findings and routine histological diagnoses was highly satisfactory.

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In the light of the discussion on parathyroid surgery it is apparent that frozen sections play a pivotal role in resource poor settings, when facilities for novel intra-operative imaging studies such as sestamibi scan and single-photon emission computed tomography are limited. The participants of the study have been followed up during last 5 years with no evidence of residual disease or recurrence up to date