Kim Sung Won, Song Seo Hyun, Lee Hyoung Shin, Noh Woong Jae, Oak Chulho, Ahn Yeh-Chan, Lee Kang Dae
Department of Otolaryngology-Head and Neck Surgery (S.W.K., H.S.L., W.J.N., K.D.L.), Kosin University College of Medicine, and Innovative Biomedical Technology Research Center (S.W.K., S.H.S., H.S.L., W.J.N., C.O., Y.-C.A., K.D.L.), College of Medicine, Kosin University, 49267 Busan, South Korea; Department of Internal Medicine (C.O.), Kosin University College of Medicine, 49267 Busan, South Korea; and Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (S.H.S., Y.-C.A.), Pukyong National University, 48513 Busan, South Korea.
J Clin Endocrinol Metab. 2016 Dec;101(12):4646-4652. doi: 10.1210/jc.2016-2558. Epub 2016 Sep 20.
This biomedical investigation is valuable for identification and localization of parathyroid glands during thyroidectomy, which can provide an intraoperative real-time visual guidance.
The objective of the study was to investigate the feasibility of real-time autofluorescence imaging of the parathyroid glands without exogenous contrast dye for their localization and demonstration of relation to the background tissues.
This research was undertaken at Kosin University Gospel Hospital.
Sixteen normal parathyroid glands from eight patients with papillary thyroid carcinoma were enrolled. Photo images of the surgical field including the parathyroid and background tissues were taken with a digital camera, 780 nm light-emitting diode to excite the parathyroid, and infrared illuminator to visualize the entire neck. The area-averaged autofluorescence intensity of parathyroid over the area-averaged fluorescence intensity of background tissues was measured.
The location of the parathyroid gland was verified with a single image.
The area-averaged autofluorescence intensity of parathyroid over the area-averaged fluorescence intensity of background tissues for all parathyroid glands was higher than 1, with a minimum of 1.95 and a maximum of 5.20 (average 2.76, SD 0.79). By our technique, all 16 parathyroid glands were detected (positive predictive value of 100%), and the entire surgical field including the parathyroid and background tissues was visualized as well. The parathyroid glands that were exposed or even covered by connective tissues or blood vessels could be detected with strong emission.
This method showed the precise localization of the parathyroid glands and demonstrated their relation to background tissue. We believe that this simple, nonexogenous dye technique of anatomical guidance can aid surgeons to preserve parathyroid glands during thyroidectomy.
这项生物医学研究对于在甲状腺切除术中识别和定位甲状旁腺具有重要价值，可为术中提供实时视觉引导。
本研究旨在探讨甲状旁腺实时自体荧光成像在不使用外源性造影剂的情况下对其进行定位以及显示与周围组织关系的可行性。
本研究在韩国加图立大学福音医院进行。
纳入8例甲状腺乳头状癌患者的16个正常甲状旁腺。使用数码相机、780纳米发光二极管激发甲状旁腺以及红外照明器来观察整个颈部，拍摄包括甲状旁腺和周围组织的手术视野照片。测量甲状旁腺的面积平均自体荧光强度与周围组织的面积平均荧光强度之比。
通过单张图像验证甲状旁腺的位置。
所有甲状旁腺的甲状旁腺面积平均自体荧光强度与周围组织面积平均荧光强度之比均高于1，最小值为1.95，最大值为5.20（平均2.76，标准差0.79）。通过我们的技术，所有16个甲状旁腺均被检测到（阳性预测值为100%），整个包括甲状旁腺和周围组织的手术视野也清晰可见。即使被结缔组织或血管覆盖的甲状旁腺也能通过强发射信号被检测到。
该方法显示了甲状旁腺的精确定位，并展示了它们与周围组织的关系。我们认为这种简单的、不使用外源性染料的解剖学引导技术可以帮助外科医生在甲状腺切除术中保护甲状旁腺。
