Ignat Mihaela, Lindner Veronique, Vix Michel, Marescaux Jacques, Mutter Didier
1 University Hospital of Strasbourg, Strasbourg, France.
2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France.
Surg Innov. 2019 Apr;26(2):141-148. doi: 10.1177/1553350618814078. Epub 2018 Nov 23.
Frozen section is the standard method to histologically distinguish parathyroid tissue from thyroid tissue during endocrine neck surgery. Frozen section can be time-consuming and costly. Its drawback is that it is to be performed only after the removal of a suspected pathological tissue. This study demonstrates the use of probe-based confocal laser endomicroscopy (pCLE) to confirm histology prior to tissue resection.
A prospective, single-institution, nonrandomized study was conducted. No sample size calculation was performed for this observational trial. The primary objective was the description of histological rendering of normal and pathological tissues through pCLE. Real-time in vivo fluorescence microscopy imaging was performed with the CystoFlex UHD probe after intravenous injection of 2.5 mL of 10% fluorescein sodium.
Eleven patients with hyperparathyroidism and thyroid conditions were included. A total of 104 videos showing thyroid, parathyroid, adipose tissue, muscle, laryngeal nerve, and lymph nodes were recorded. Videos were compared with visual information and pathological samples (when sampling was indicated). Thyroid tissue could be identified based on the presence of colloid follicles (intensely fluorescent area surrounded by a small ridge of low-fluorescence epithelial cells) including the pathognomonic aspect of resorption vacuole. Parathyroid tissue could be identified based on a regular, "diamond-shaped" capillary network encompassing parathyroid chief cells. Blinded reinterpretation of pCLE videos demonstrated an 89.3% sensitivity and a 90% specificity as compared with histology in tissue recognition.
This pilot study describes representative renderings of intraoperative pCLE to nontraumatically differentiate thyroid, parathyroid, and lymph nodes before surgical removal.
在颈部内分泌手术中，冰冻切片是从甲状腺组织中组织学区分甲状旁腺组织的标准方法。冰冻切片可能耗时且成本高。其缺点是仅在切除疑似病理组织后才能进行。本研究展示了使用基于探头的共聚焦激光内镜显微镜（pCLE）在组织切除前确认组织学情况。
进行了一项前瞻性、单机构、非随机研究。该观察性试验未进行样本量计算。主要目的是描述通过pCLE对正常和病理组织的组织学呈现。静脉注射2.5 mL 10%荧光素钠后，使用CystoFlex UHD探头进行实时体内荧光显微镜成像。
纳入了11例患有甲状旁腺功能亢进和甲状腺疾病的患者。共记录了104段显示甲状腺、甲状旁腺、脂肪组织、肌肉、喉返神经和淋巴结的视频。将视频与视觉信息和病理样本（当需要采样时）进行比较。甲状腺组织可根据存在胶体滤泡（由低荧光上皮细胞的小嵴包围的强荧光区域）来识别，包括吸收空泡的特征性表现。甲状旁腺组织可根据围绕甲状旁腺主细胞的规则“菱形”毛细血管网络来识别。与组织学在组织识别方面相比，对pCLE视频进行盲法重新解读显示敏感性为89.3%，特异性为90%。
这项初步研究描述了术中pCLE在手术切除前非创伤性区分甲状腺、甲状旁腺和淋巴结的代表性呈现。
