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Intraoperative Parathyroid Autofluorescence Detection in Patients with Primary Hyperparathyroidism

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Intrinsic near-infrared (NIR) autofluorescence of the parathyroid gland may improve intraoperative gland identification without the need for contrast agent injection. Compared with patients undergoing surgery for thyroid disease, identification of pathologic parathyroid tissue in patients with hyperparathyroidism is essential. This study analyzed the utility of a novel real-time autofluorescence imaging system in patients with primary hyperparathyroidism enrolled in a prospective feasibility clinical trial.

Methods

Data on patients undergoing surgery for primary hyperparathyroidism by two experienced endocrine surgeons were prospectively collected. Intraoperative imaging was performed with a handheld NIR device, and images were captured for analysis. The collected data included the surgeon’s confidence in parathyroid identification, both with ambient light and use of NIR imaging, as well as how the imaging affected the surgical procedure. Images were quantified by Image J software, with autofluorescence reported as mean values ± SD.

Results

From 2017 to 2018, 59 consecutive patients with a diagnosis of primary hyperparathyroidism underwent resection of 69 parathyroid glands. Use of NIR imaging increased the intraoperative confidence of parathyroid identification (on a scale of 0–5) from an average of 4.1 to an average of 4.4 (+0.3, p = 0.003), all of which were confirmed pathologically. The addition of autofluorescence helped to identify the parathyroid gland in 12 patients (20%), and to rule out other soft tissue as not parathyroid in an additional 9 patients (15%). The mean autofluorescence for the parathyroid in situ (75.9 ± 21.3) was significantly greater than that for the thyroid (61.1 ± 17.4) or soft tissue (53.3 ± 19.2) (p < 0.001 for both). The mean absolute difference in parathyroid versus background thyroid autofluorescence was +15.2 (range, 2.4–53.1).

Conclusion

This is the first prospective trial to examine the utility of parathyroid autofluorescence for identifying glands exclusively in patients with parathyroid disease. Intraoperative identification and localization of parathyroid glands by real-time, NIR imaging using their intrinsic autofluorescence is feasible and may provide a useful adjunct during parathyroid surgery.

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References

  1. Chakedis JM, Maser C, Brumund KT, Bouvet M. Indocyanine green fluorescence-guided redo parathyroidectomy. BMJ Case Rep. 2015. https://doi.org/10.1136/bcr-2015-211778.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sound S, Okoh A, Yigitbas H, Yazici P, Berber E. Utility of indocyanine green fluorescence imaging for intraoperative localization in reoperative parathyroid surgery. Surg Innov. 2015. https://doi.org/10.1177/1553350615613450.

    Article  PubMed  Google Scholar 

  3. Zaidi N, Bucak E, Okoh A, Yazici P, Yigitbas H, Berber E. The utility of indocyanine green near-infrared fluorescent imaging in the identification of parathyroid glands during surgery for primary hyperparathyroidism. J Surg Oncol. 2016;113:771–4.

    Article  PubMed  CAS  Google Scholar 

  4. Zaidi N, Bucak E, Yazici P, et al. The feasibility of indocyanine green fluorescence imaging for identifying and assessing the perfusion of parathyroid glands during total thyroidectomy. J Surg Oncol. 2016;113:775–8.

    Article  PubMed  CAS  Google Scholar 

  5. Tummers QR, Schepers A, Hamming JF, et al. Intraoperative guidance in parathyroid surgery using near-infrared fluorescence imaging and low-dose methylene blue. Surgery. 2015;158:1323–30.

    Article  PubMed  PubMed Central  Google Scholar 

  6. van der Vorst JR, Schaafsma BE, Verbeek FP, et al. Intraoperative near-infrared fluorescence imaging of parathyroid adenomas with use of low-dose methylene blue. Head Neck. 2014;36:853–8.

    Article  PubMed  Google Scholar 

  7. Paras C, Keller M, White L, Phay J, Mahadevan-Jansen A. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt. 2011;16:067012.

    Article  PubMed  Google Scholar 

  8. Reinhart MB, Huntington CR, Blair LJ, Heniford BT, Augenstein VA. Indocyanine green: historical context, current applications, and future considerations. Surg Innov. 2016;23:166–75.

    Article  PubMed  Google Scholar 

  9. McWade MA, Paras C, White LM, et al. Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging. J Clin Endocrinol Metab. 2014;99:4574–80.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. McWade MA, Sanders ME, Broome JT, Solorzano CC, Mahadevan-Jansen A. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery. 2016;159:193–202.

    Article  PubMed  Google Scholar 

  11. Kahramangil B, Dip F, Benmiloud F, et al. Detection of parathyroid autofluorescence using near-infrared imaging: a multicenter analysis of concordance between different surgeons. Ann Surg Oncol. 2018;25:957–62.

    Article  PubMed  Google Scholar 

  12. Kim SW, Song SH, Lee HS, et al. Intraoperative real-time localization of normal parathyroid glands with autofluorescence imaging. J Clin Endocrinol Metab. 2016;101:4646–52.

    Article  PubMed  CAS  Google Scholar 

  13. Kahramangil B, Berber E. Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy. Gland Surg. 2017;6:644–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Falco J, Dip F, Quadri P, de la Fuente M, Prunello M, Rosenthal RJ. Increased identification of parathyroid glands using near-infrared light during thyroid and parathyroid surgery. Surg Endosc. 2017;31:3737–42.

    Article  PubMed  Google Scholar 

  15. Shinden Y, Nakajo A, Arima H, et al. Intraoperative identification of the parathyroid gland with a fluorescence detection system. World J Surg. 2017;41:1506–12.

    Article  PubMed  Google Scholar 

  16. Falco J, Dip F, Quadri P, de la Fuente M, Rosenthal R. Cutting edge in thyroid surgery: autofluorescence of parathyroid glands. J Am Coll Surg. 2016;223:374–80.

    Article  PubMed  Google Scholar 

  17. Kim SW, Lee HS, Ahn YC, et al. Near-infrared autofluorescence image-guided parathyroid gland mapping in thyroidectomy. J Am Coll Surg. 2018;226:165–72.

    Article  PubMed  Google Scholar 

  18. Ladurner R, Al Arabi N, Guendogar U, Hallfeldt K, Stepp H, Gallwas J. Near-infrared autofluorescence imaging to detect parathyroid glands in thyroid surgery. Ann R Coll Surg Engl. 2018;100:33–6.

    Article  PubMed  CAS  Google Scholar 

  19. Benmiloud F, Rebaudet S, Varoquaux A, Penaranda G, Bannier M, Denizot A. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery. 2018;163:23–30.

    Article  PubMed  Google Scholar 

  20. Hall NC, Plews RL, Agrawal A, et al. Intraoperative scintigraphy using a large field-of-view portable gamma camera for primary hyperparathyroidism: initial experience. Biomed Res Int. 2015;2015:930575.

    PubMed  PubMed Central  Google Scholar 

  21. McWade MA, Paras C, White LM, Phay JE, Mahadevan-Jansen A, Broome JT. A novel optical approach to intraoperative detection of parathyroid glands. Surgery. 2013;154:1371–7 discussion 1377.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ladurner R, Sommerey S, Arabi NA, Hallfeldt KKJ, Stepp H, Gallwas JKS. Intraoperative near-infrared autofluorescence imaging of parathyroid glands. Surg Endosc. 2017;31:3140–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Malcolm H. Squires MD, MS, Rachel Jarvis CNP, Lawrence A. Shirley MD, FACS & John E. Phay MD, FACS

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  1. Malcolm H. Squires MD, MS
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  2. Rachel Jarvis CNP
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  3. Lawrence A. Shirley MD, FACS
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  4. John E. Phay MD, FACS
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Correspondence to John E. Phay MD, FACS.

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Squires, M.H., Jarvis, R., Shirley, L.A. et al. Intraoperative Parathyroid Autofluorescence Detection in Patients with Primary Hyperparathyroidism. Ann Surg Oncol 26, 1142–1148 (2019). https://doi.org/10.1245/s10434-019-07161-w

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  • DOI: https://doi.org/10.1245/s10434-019-07161-w

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