Aoyama Mariko, Takizawa Hiromitsu, Yamamoto Kiyoshige, Inui Tomohiro, Miyamoto Naoki, Sakamoto Shinichi, Kobayashi Tomoko, Uehara Hisanori, Tangoku Akira
Department of Thoracic, Endocrine Surgery, and Oncology, Institute of Health Biosciences, The University of Tokushima, Kuramoto-cho, Tokushima, Japan.
Department of Pathology, Tokushima University Hospital, Kuramoto-cho, Tokushima, Japan.
Gland Surg. 2020 Oct;9(5):1584-1589. doi: 10.21037/gs-20-386.
The intraoperative identification and preservation of the parathyroid glands are vital techniques, which are largely dependent on a surgeon's experience. Therefore, a simple and reproducible technique to identify the parathyroid glands during surgery is needed. Parathyroid tissue shows near-infrared (NIR) autofluorescence, which enables the intraoperative identification of the parathyroid gland. We herein present two cases that underwent surgery on the parathyroid glands, which were observed using the NIR fluorescence imaging system LIGHTVISION (Shimazu, Kyoto, Japan). In a case of papillary thyroid carcinoma, the system was adopted to preserve normal parathyroid glands during left hemithyroidectomy. The left lower parathyroid gland was identified using the imaging system under white light; however, its autofluorescence was visualized more clearly with the excitation light of NIR. In a case of primary hyperparathyroidism due to MEN1, the system was adopted to identify and remove all of the parathyroid glands during total parathyroidectomy. The autofluorescence of diseased glands was weaker than that of normal glands, even with the excitation light of NIR. When the parathyroid glands were irradiated with a red laser pointer, the intensity of autofluorescence significantly increased. However, the largest gland, which was pathologically proven to contain strongly proliferating chief cells, did not show autofluorescence. These results suggest that normal or less diseased parathyroid glands, which are generally small and difficult to identify during surgery, showed relatively strong autofluorescence. A stronger excitation light increases the autofluorescence of parathyroid glands, which enhances sensitivity for detecting parathyroid glands during surgery. In conclusion, LIGHTVISION is a useful device to identify parathyroid glands and an additional excitation light of a red laser pointer increases the detection sensitivity.
术中甲状旁腺的识别与保护是至关重要的技术，这在很大程度上依赖于外科医生的经验。因此，需要一种简单且可重复的术中识别甲状旁腺的技术。甲状旁腺组织呈现近红外（NIR）自发荧光，这使得术中能够识别甲状旁腺。我们在此报告两例接受甲状旁腺手术的病例，手术中使用了NIR荧光成像系统LIGHTVISION（日本京都岛津公司）进行观察。在一例乳头状甲状腺癌病例中，该系统用于在左半甲状腺切除术中保护正常甲状旁腺。在白光下使用成像系统识别出左下甲状旁腺；然而，用近红外激发光时其自发荧光显示得更清晰。在一例因MEN1导致的原发性甲状旁腺功能亢进病例中，该系统用于在甲状旁腺全切术中识别并切除所有甲状旁腺。即使使用近红外激发光，病变腺体的自发荧光也比正常腺体弱。当用红色激光笔照射甲状旁腺时，自发荧光强度显著增加。然而，经病理证实含有强烈增殖主细胞的最大腺体未显示自发荧光。这些结果表明，通常较小且在手术中难以识别的正常或病变较轻的甲状旁腺显示出相对较强的自发荧光。更强的激发光可增加甲状旁腺的自发荧光，从而提高手术中检测甲状旁腺的灵敏度。总之，LIGHTVISION是一种识别甲状旁腺的有用设备，红色激光笔的额外激发光可提高检测灵敏度。
