Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Ann Surg Oncol. 2019 Apr;26(4):1142-1148. doi: 10.1245/s10434-019-07161-w. Epub 2019 Jan 23.
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.
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.
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).
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.
甲状旁腺的固有近红外（NIR）自发荧光可以提高术中腺体的识别能力，而无需注射造影剂。与接受甲状腺疾病手术的患者相比，甲状旁腺组织的病理识别对于甲状旁腺功能亢进症患者至关重要。本研究分析了一种新型实时自发荧光成像系统在接受甲状旁腺切除术的原发性甲状旁腺功能亢进症患者中的应用。
前瞻性收集了两位经验丰富的内分泌外科医生对原发性甲状旁腺功能亢进症患者进行手术的数据。术中使用手持近红外设备进行成像，并采集图像进行分析。收集的数据包括外科医生在自然光和使用近红外成像时对甲状旁腺识别的信心，以及成像对手术过程的影响。使用 Image J 软件对图像进行量化，自发荧光以平均值 ± 标准差表示。
2017 年至 2018 年，59 例诊断为原发性甲状旁腺功能亢进症的患者接受了 69 个甲状旁腺的切除术。使用近红外成像技术将术中甲状旁腺识别的信心（0-5 级）从平均 4.1 分提高到平均 4.4 分（+0.3，p=0.003），所有的甲状旁腺均得到病理证实。自发荧光的加入有助于在 12 例患者（20%）中识别甲状旁腺，并在另外 9 例患者（15%）中排除其他软组织为非甲状旁腺组织。原位甲状旁腺的平均自发荧光强度（75.9±21.3）明显大于甲状腺（61.1±17.4）或软组织（53.3±19.2）（p<0.001）。甲状旁腺与背景甲状腺自发荧光的平均绝对差值为+15.2（范围，2.4-53.1）。
这是首次专门在甲状旁腺疾病患者中检查甲状旁腺自发荧光识别腺体的前瞻性试验。使用近红外技术实时、自发荧光识别和定位甲状旁腺是可行的，并可能在甲状旁腺手术中提供有用的辅助。
