Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Laryngoscope. 2021 Jun;131(6):E2097-E2104. doi: 10.1002/lary.29310. Epub 2020 Dec 11.
To examine the role of autofluorescence (AF) monitoring with near-infrared fluorescence imaging (NIFI) in identifying parathyroid lesions in primary or secondary hyperparathyroidism (P-HPT or S-HPT) surgeries.
Prospective study.
Twelve lesions each were resected from 12 and 3 patients with P-HPT and S-HPT, respectively. The mean and maximum AF intensities of the lesions normalized to that of the thyroid tissue for in situ and ex vivo preparations were compared between P-HPT and S-HPT. Subjective visual classifications of AF intensity were compared with postoperative quantitative assessments. The unevenness of AF distribution inside the lesions was assessed by determining the ratio of maximum to mean AF intensity and comparing them with the corresponding ratio for normal parathyroid glands (PGs).
In all quantitative comparisons (in situ/ex vivo, mean, and maximum AF), AF intensities of P-HPT were stronger than those of S-PHT. The AF-positive rate in in situ subjective visual classification was higher for P-HPT (100% vs. 33%). Subjective visual classifications showed a positive correlation with AF intensities. The ratio of maximum to mean AF was higher in P-HPT and S-HPT than in normal PGs.
For P-HPT, AF intensity in both in situ and ex vivo preparations was sufficiently high and correlated with the subjective visual classification, suggesting that NIFI may be useful for confirming P-HPT lesions. In contrast, NIFI may have only a minor role in S-HPT surgeries owing to the weak-AF of S-HPT lesions. HPT lesions show an uneven AF intensity distribution compared with normal PGs.
3 Laryngoscope, 131:E2097-E2104, 2021.
探讨近红外荧光成像（NIFI）中的自发荧光（AF）监测在原发性或继发性甲状旁腺功能亢进症（P-HPT 或 S-HPT）手术中识别甲状旁腺病变中的作用。
前瞻性研究。
分别从 12 例 P-HPT 和 3 例 S-HPT 患者的病变中切除 12 个病变。比较原位和离体标本中病变与甲状腺组织的平均和最大 AF 强度，比较 P-HPT 和 S-HPT 之间的病变。比较主观视觉 AF 强度分类与术后定量评估。通过确定最大与平均 AF 强度的比值来评估病变内 AF 分布的不均匀性，并将其与正常甲状旁腺（PGs）的相应比值进行比较。
在所有定量比较（原位/离体、平均和最大 AF）中，P-HPT 的 AF 强度均强于 S-PHT。原位主观视觉分类的 AF 阳性率在 P-HPT 中更高（100%比 33%）。主观视觉分类与 AF 强度呈正相关。最大与平均 AF 的比值在 P-HPT 和 S-HPT 中均高于正常 PGs。
对于 P-HPT，原位和离体标本中的 AF 强度均足够高，并与主观视觉分类相关，提示 NIFI 可能有助于确认 P-HPT 病变。相比之下，由于 S-HPT 病变的 AF 较弱，NIFI 在 S-HPT 手术中的作用可能较小。与正常 PGs 相比，HPT 病变的 AF 强度分布不均匀。
3 级喉镜，131：E2097-E2104，2021。
