Wang X Y, Zhong Q, Fang J G, Shi Q, Guo W, Ding S, Zhao Y M, He Y R, Li Q J
Department of Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University/Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2024 Mar 26;104(12):938-943. doi: 10.3760/cma.j.cn112137-20231016-00762.
To investigate the effect of dual fluorescence imaging in identifying central lymph nodes and parathyroid glands during thyroid cancer surgery. This study was a cross-sectional study. Patients who underwent surgery for papillary thyroid cancer (PTC) at the Department of Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University between January 2022 and September 2023 were included. All patients underwent thyroid lobectomy or total resection, and central lymph node dissection was performed at the same time. During the operation, tracing injection of mitoxantrone hydrochloride and 785 nm and 660 nm dual fluorescence imaging technique were used to measure the fluorescence intensity (FI) of parathyroid glands, central lymph nodes and background. After correcting to obtain the standardized FI, the paired -test was used to compare the standardized FI of the parathyroid glands and central lymph nodes, and the Spearman's rank correlation analysis was used to analyze the relationship between the standardized FI and various clinical indicators. The study included 30 patients (8 males and 22 females), with a mean age of (41.8±10.4) years. A total of 76 parathyroid glands and 234 central lymph nodes were identified under dual fluorescence imaging, and the standardized FI of parathyroid glands was less than that of central lymph nodes (44.7±16.8 vs 99.5±28.4, <0.001). The visualization rate, false rate and miscut rate of parathyroid glands under 785 nm wavelength excitation light were 98.7% (76/77), 0 (0/77) and 1.3% (1/77), respectively (one case with no visualization and miscutting parathyroid gland was the encapsulated type). The visualization rate of central lymph nodes under 660 nm wavelength excitation light was 98.7% (234/237). There was no significant correlation between FI and clinical indicators such as gender, age, height, weight, body mass index, preoperative thyroid stimulating hormone, thyroglobulin antibody, thyroid microsomal antibody, serum calcium, parathyroid hormone level and surgical procedure (all >0.05). Dual fluorescence imaging of central lymph nodes and parathyroid glands can improve the ability to identify parathyroid gland while assisting central lymph node dissection.
探讨双荧光成像在甲状腺癌手术中识别中央淋巴结及甲状旁腺的效果。本研究为横断面研究。纳入2022年1月至2023年9月在首都医科大学附属北京同仁医院头颈外科接受甲状腺乳头状癌（PTC）手术的患者。所有患者均行甲状腺叶切除术或全切除术，并同时进行中央淋巴结清扫。术中采用盐酸米托蒽醌示踪注射及785nm和660nm双荧光成像技术测量甲状旁腺、中央淋巴结及背景的荧光强度（FI）。校正后得到标准化FI，采用配对t检验比较甲状旁腺与中央淋巴结的标准化FI，并采用Spearman等级相关分析标准化FI与各项临床指标的关系。本研究共纳入30例患者（男8例，女22例），平均年龄（41.8±10.4）岁。双荧光成像共识别出76枚甲状旁腺及234枚中央淋巴结，甲状旁腺的标准化FI低于中央淋巴结（44.7±16.8 vs 99.5±28.4，<0.001）。785nm波长激发光下甲状旁腺的可视化率、假阳性率及误切率分别为98.7%（76/77）、0（0/77）及1.3%（1/77）（1例甲状旁腺未可视化及误切为包膜型）。660nm波长激发光下中央淋巴结的可视化率为98.7%（234/237）。FI与性别、年龄、身高、体重、体重指数、术前促甲状腺激素、甲状腺球蛋白抗体、甲状腺微粒体抗体、血钙、甲状旁腺激素水平及手术方式等临床指标均无显著相关性（均>0.05）。中央淋巴结及甲状旁腺的双荧光成像在辅助中央淋巴结清扫时可提高甲状旁腺的识别能力。
