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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.

Authors
 Jung Soo Lim  ;  Seung Ku Lee  ;  Se Hoon Kim  ;  Eun Jig Lee  ;  Sun Ho Kim 
Citation
 ENDOCRINE, Vol.40(3) : 452-461, 2011 
Journal Title
ENDOCRINE
ISSN
 1355-008X 
Issue Date
2011
MeSH
Adolescent ; Adult ; Cushing Syndrome/blood ; Cushing Syndrome/pathology ; Cushing Syndrome/surgery* ; Female ; Frozen Sections ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Microsurgery/methods ; Middle Aged ; Monitoring, Intraoperative/methods ; Neurosurgical Procedures/methods* ; Petrosal Sinus Sampling/methods ; Pituitary Neoplasms/blood ; Pituitary Neoplasms/pathology ; Pituitary Neoplasms/surgery* ; Treatment Outcome ; Young Adult
Keywords
Cushing’s disease ; Localization ; High-resolution MRI ; Inferior petrosal sinus sampling ; Surgical and histological identification
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.
Full Text
http://link.springer.com/article/10.1007%2Fs12020-011-9499-5
DOI
10.1007/s12020-011-9499-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Lim, Jung Soo(임정수)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94671
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