Application of a Fluorescence Imaging System with Indocyanine Green to Protect the Parathyroid Gland Intraoperatively and to Predict Postoperative Parathyroidism
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Identifying the parathyroid gland during surgery may be difficult for surgeons. It is critical for them to be able to locate it during thyroidectomy or parathyroidectomy because of the significant function of the parathyroid in the calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the fluorescence via imaging technology. In this study, a newly invented intraoperative fluorescence imaging system and indocyanine green (ICG) dye were applied to detect the parathyroid glands and evaluate the vascularization of the parathyroid.
From 1 May to 8 August 2018, 26 patients underwent total thyroidectomy in Zhuhai People’s Hospital. These 26 subjects were recruited in our research. All identified parathyroid glands were scored visually from grade 0 to grade 2 according to the vascularity of the parathyroid before ICG angiography was performed. After ICG angiography, the parathyroid glands were scored from 0 to 2 according to the fluorescence intensity (FI).
Visual scores were significantly higher than ICG angiography scores. In the 22 patients with at least one parathyroid gland with an ICG score of 2, postoperative parathyroidism (PTH) levels were in the normal range. Of the four patients with no parathyroid gland with an ICG score of 2, two developed transient hypoparathyroidism, with recovery on postoperative day (POD) 7 for the first patient and after 3 months for the second.
This study has shown that a fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative parathyroidism.
Chinese Clinical Trial Registry no. ChiCTR1800016864.
KeywordsFluorescence imaging system Indocyanine green Parathyroid Postoperative parathyroidism
We thank the patients and their families for participating in this study. Zhuhai People’s Hospital provided the necessary support of this study. Medical writing support in the form of development of the draft outline and manuscript drafts in consultation with the authors, editorial suggestions for draft versions of this paper, assembling tables and figures, collating author comments, copyediting, referencing and graphic services were provided by Chongwei Chi, PhD, of the Chinese Academy of Science, and Adjunct Assistant Prof. Dr. Karen M. von Deneen from the University of Florida for the modification of this paper.
No funding or sponsorship was received for this study or publication of this article. The article processing charges were funded by the authors.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval for the version to be published.
Hao Jin and Min Cui designed the study and drafted the manuscript. Qichao Dong, Jinrui Fan, Zhuocheng He and Kun Liao collected and analyzed the data and carried out the literature search. All authors interpreted the data, wrote/reviewed the manuscript and gave final approval of the manuscript.
Hao Jin, Qichao Dong, Zhuocheng He, Jinrui Fan, Kun Liao and Min Cui declare no conflict of interest.
Compliance with Ethics Guidelines
The study protocol was reviewed and approved by the relevant investigational center ethics committee or institutional review board, in accordance with the International Council on Harmonisation. The study was conducted in accordance with the Declaration of Helsinki and all participants provided written informed consent.
The data sets during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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