Is frozen section routinely necessary in patients with well- localized solitary parathyroid adenoma?

Introduction Today, the treatment of primary hyperparathyroidism (pHPT) is mainly surgical and pHPT is the result of a single adenoma in 85% of patients (1-6). Historically, until the 1990s, for localization of all four parathyroid glands, bilateral cervical exploration had been the standard surgical treatment for pHPT. In the past two decades however, significant improvements in localization techniques have facilitated further advances in surgical management. Today, minimally invasive parathyroidectomy is one of the most preferred technique among endocrine surgeons (36). Many adjunct methods such as intraoperative parathyroid hormone (IOPTH) measurement, gamma probe usage, and frozen section (FS) examination recommended to find and excise abnormal parathyroid(s) (7-14). FS is one of the most popular method and routinely used by many surgeons (6-16). On the other hand, FS is an unreliable technique for distinguishing adenomas from multiglandular disease (12). An adenoma can be diagnosed with confidence if only one gland of the four glands is enlarged. In FS evaluation, the pathologist does not make a diagnostic definition of the disease. In fact, FS is generally used for distinguishing the parathyroid tissue from non-parathyroid tissue, not to diagnose parathyroid adenoma (12-20). Nevertheless, the use of FS to distinguish parathyroid tissue from non-parathyroid tissue has an accuracy of 99.2% (3). An experienced endocrine surgeon, during daily practice, distinguishes parathyroid tissues and protects them in every thyroid operation. From this stand point; we asked the question; Is FS really necessary for a well-localized solitary parathyroid adenoma?