Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
World J Surg. 2019 Jun;43(6):1532-1537. doi: 10.1007/s00268-019-04929-9.
The inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2-5%. The poorly understood characteristic of parathyroid tissue to manifest autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery.
Consecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition.
Ninety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially 'visualisable' glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF.
Autofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.
由于手术时无法识别病理性腺体，导致 2-5%的患者甲状旁腺功能亢进症无法治愈。甲状旁腺组织在近红外（NIR）光下表现出自荧光（AF）的特性，但目前尚不完全清楚，这一特性已被推广为甲状旁腺手术中的术中辅助手段。本研究旨在探讨 AF 的潜在临床相关性，并评估 AF 在甲状旁腺手术中的临床应用价值。
连续纳入因原发性和肾脏疾病而行甲状旁腺手术的患者。术中使用近红外成像，由手术医生对甲状旁腺的 AF 程度进行分级。评估与 AF 相关的变量包括：术前血清钙和 PTH、SestaMIBI 阳性、腺体重量和组织成分。
在 8 个月的时间里，96 例患者接受了甲状旁腺切除术：49 例双侧探查，41 例单侧探查，6 例侧方聚焦探查：总共 284 个潜在“可观察”腺体。257 个腺体（90.5%）用 NIR 观察到。AF 程度与术前血清钙和 PTH 相关，但与腺体重量和 SestaMIBI 阳性之间无相关性。在患有肾性甲状旁腺功能亢进的患者中，嗜酸性细胞的优势与 AF 增加相关。
AF 强度与血清钙、PTH 和腺体成分相关。在临床环境中，需要进一步改进这些信息才有价值。需要改进技术，使 NIR 能够观察到另外 9.5%的甲状旁腺，并克服由于进入深度不同而导致的信号强度变化，以便该技术得到常规应用。目前，不能将其常规用于临床环境。
