Reliability of cavernous sinus sampling in management of Cushing’s disease

Objectives: The purpose of this study is to find out the accuracy of bilateral cavernous sinus sampling (CSS) for preoperative tumor lateralization within the pituitary in Cushing’s disease (CD). Methods: Sixty-five patients who had undergone transsphenoidal surgery (TSS) following CSS for CD between 2000-2016 at our institution were analyzed retrospectively. All patients underwent bilaterally CSS with corticotropin-releasing hormone (CRH) stimulation. Radiological, preoperative, and pathological findings with remission status were correlated with CSS data. The accuracy of CSS is decided according to compliance with the magnetic resonance imaging (MRI), pathology or remission after surgery of the normal MRI cases. Results: CSS indicated the correct lateralization in 52 (80%) patients. There was the same level elevation of both sides in 3 patients who had central adenoma. Remission rate in the final follow-up was 83.87% for 65 patients. We found out the contralateral pathological side in 13 (20%) of the patients showing false lateralization. Twenty-four patients with normal MRI had a positive accuracy rate of 83%. Of those patients, with a positive accuracy of CSS sampling, 18 (90%) had a positive remission. As a result of the Kappa analysis, statistically significance and relation was found between the final diagnosis and lateralization test (κ=0,63 p < 0.001). Conclusions: Our results showed that CSS is a safe and reliable method for microadenomas which has high diagnostic accuracy (80%) in indicating the correct lateralization in CD, providing us higher remission rates in a challenging pathology.