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Intraoperative multiple-staged resection and tumor tissue identification using frozen sections provide the best result for the accurate localization and complete resection of tumors in Cushing’s disease

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Abstract

The treatment of choice in Cushing’s disease (CD) is surgical removal; however, most tumors are too small to be detected. The objective was to establish a method to achieve the complete removal of tumors on the basis of the results of high-resolution magnetic resonance imaging (MRI), inferior petrosal sinus sampling (IPSS), and a surgical resection technique using frozen biopsy. Eighteen patients who underwent transsphenoidal surgery from 2004 to 2010 were included. High-resolution MRI and IPSS, multiple-staged resection, and tumor tissue identification in frozen sections (surgical and histological identification, SHI) were performed. All patients achieved surgical remission, as confirmed by 24 h urinary free cortisol excretion tests. Visible microlesions were identified on the initial MRI in 11 patients (61%). The SHI findings agreed with the MRI findings in 10 of the 11 patients (90.9%) and with IPSS lateralization in 6 of the 11 patients (54.5%). In the 7 patients whose lesions were not visible on the initial MRI, only 1 (14.3%) showed an agreement between IPSS and SHI. In 3 of the 7 patients, the microlesions were identified by additional MRI. The rate of concordance with SHI was 77.8% for the overall MRI and 38.9% for IPSS. High-resolution MRI is better than IPSS for localizing corticotroph adenomas. In patients with lesions not visible on the initial MRI, additional MRI should be performed using a different protocol. Although high-resolution MRI is better for localizing tumors, SHI remains an important approach for removing the tumors completely.

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Authors and Affiliations

  1. Endocrinology, Brain Korea 21 Project for Medical Science, and Severance Integrative Research Institute for Cerebral & Cardiovascular Disease, Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea

    Jung Soo Lim & Eun Jig Lee

  2. Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, 120-752, Korea

    Jung Soo Lim, Eun Jig Lee & Sun Ho Kim

  3. Department of Radiology, Yonsei University College of Medicine, Seoul, 120-752, Korea

    Seung Ku Lee

  4. Department of Pathology, Yonsei University College of Medicine, Seoul, 120-752, Korea

    Se Hoon Kim

  5. Neurosurgery & Yonsei Brain Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, South Korea

    Sun Ho Kim

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  1. Jung Soo Lim
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Correspondence to Eun Jig Lee or Sun Ho Kim.

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Lim, J.S., Lee, S.K., Kim, S.H. et al. Intraoperative multiple-staged resection and tumor tissue identification using frozen sections provide the best result for the accurate localization and complete resection of tumors in Cushing’s disease. Endocrine 40, 452–461 (2011). https://doi.org/10.1007/s12020-011-9499-5

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  • DOI: https://doi.org/10.1007/s12020-011-9499-5

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