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Intraoperative Near-infrared Imaging for Parathyroid Gland Identification by Auto-fluorescence: A Feasibility Study

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Abstract

Background

Parathyroid glands (PGs) can be particularly hard to distinguish from surrounding tissue and thus can be damaged or removed during thyroidectomy. Postoperative hypoparathyroidism is the most common complication after thyroidectomy. Very recently, it has been found that the parathyroid tissue shows near-infrared (NIR) auto-fluorescence which could be used for intraoperative detection, without any use of contrast agents. The work described here presents a histological validation ex vivo of the NIR imaging procedure and evaluates intraoperative PG detection by NIR auto-fluorescence using for the first time to our knowledge a commercially available clinical NIR imaging device.

Methods

Ex vivo study on resected operative specimens combined with a prospective in vivo study of consecutive patients who underwent total or partial thyroid, or parathyroid surgery at a comprehensive cancer center. During surgery, any tissue suspected to be a potential PG by the surgeon was imaged with the Fluobeam 800 ® system. NIR imaging was compared to conventional histology (ex vivo) and/or visual identification by the surgeon (in vivo).

Results

We have validated NIR auto-fluorescence with an ex vivo study including 28 specimens. Sensitivity and specificity were 94.1 and 80 %, respectively. Intraoperative NIR imaging was performed in 35 patients and 81 parathyroids were identified. In 80/81 cases, the fluorescence signal was subjectively obvious on real-time visualization. We determined that PG fluorescence is 2.93 ± 1.59 times greater than thyroid fluorescence in vivo.

Conclusions

Real-time NIR imaging based on parathyroid auto-fluorescence is fast, safe, and non-invasive and shows very encouraging results, for intraoperative parathyroid identification.

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Acknowledgments

The authors wish to thank the technicians of the Biopathology Department and the operating room staff of Head and Neck Surgery Department of Gustave Roussy for their precious help. This work was supported by the French National Cancer League (Ligue National Contre le Cancer: 1FI11687PIAE).

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Authors and Affiliations

  1. Plateforme d’Imagerie et Cytométrie, UMS AMMICa, Gustave Roussy, Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805, Villejuif, France

    Frederic De Leeuw, Muriel Abbaci & Corinne Laplace-Builhé

  2. UMR CNRS 8081- IR4M, Université Paris-Sud, Université Paris-Saclay, 91401, Orsay, France

    Frederic De Leeuw, Muriel Abbaci & Corinne Laplace-Builhé

  3. Département de Chirurgie ORL, Unité Thyroïde, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France

    Ingrid Breuskin, Haïtham Mirghani & Dana Hartl

  4. Département de Pathologie, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France

    Odile Casiraghi & Aïcha Ben Lakhdar

Authors
  1. Frederic De Leeuw
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  2. Ingrid Breuskin
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  3. Muriel Abbaci
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  4. Odile Casiraghi
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  7. Corinne Laplace-Builhé
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  8. Dana Hartl
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Corresponding author

Correspondence to Frederic De Leeuw.

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The authors have no conflicts of interest or competing financial interests in the subject matter or materials discussed in the manuscript.

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De Leeuw, F., Breuskin, I., Abbaci, M. et al. Intraoperative Near-infrared Imaging for Parathyroid Gland Identification by Auto-fluorescence: A Feasibility Study. World J Surg 40, 2131–2138 (2016). https://doi.org/10.1007/s00268-016-3571-5

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  • DOI: https://doi.org/10.1007/s00268-016-3571-5

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