Department of Surgical, Medical, and Molecular Pathology and Critical Area, University of Pisa, 56124, Pisa, Italy.
Endocrine Unit, University Hospital of Pisa, Pisa, Italy.
Surg Endosc. 2024 Nov;38(11):6930-6937. doi: 10.1007/s00464-024-11314-8. Epub 2024 Oct 9.
Parathyroid gland (PG) surgery is often challenging due to the small size and indistinct nature of these glands. The introduction of intraoperative near-infrared autofluorescence (NIRAF) has shown promise in localizing parathyroid tissue. However, the NIRAF features of parathyroid adenomas remain unclear. The aim of this study is to assess the NIRAF pattern of parathyroid adenomas.
Patients who underwent surgery for primary hyperparathyroidism at the University Hospital of Pisa, Endocrine Surgery Unit, between December 2021 and February 2022 were enrolled in this study. Intraoperative NIRAF patterns of suspected parathyroid adenomas were evaluated, with particular attention given to the presence of a bright cap.
A retrospective study was conducted on 11 patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution. Histopathological examination of the 15 resected specimens confirmed 14 parathyroid adenomas (12 chief cell parathyroid adenomas, 1 oxyphil cell parathyroid adenoma, and 1 mixed cell parathyroid adenoma) and one schwannoma. All adenomas exhibited a heterogeneous NIRAF pattern, distinct from the homogeneous pattern observed in the schwannoma. A bright cap was identified in 9 out of 14 (64.3%) parathyroid adenomas (all chief cell adenomas). On the contrary, all 9 macroscopically normal PGs identified during surgery presented an homogeneous pattern.
Our findings support the integration of NIRAF into parathyroid surgical procedures. The heterogeneous NIRAF pattern observed in parathyroid adenomas, often accompanied by a bright cap, offers a promising intraoperative diagnostic tool to differentiate hyperfunctioning from normal parathyroid tissue. Larger-scale randomized trials are warranted to further validate these findings.
甲状旁腺（PG）手术常常具有挑战性，因为这些腺体体积小且性质不明显。术中近红外自体荧光（NIRAF）的引入已显示出定位甲状旁腺组织的潜力。然而，甲状旁腺腺瘤的 NIRAF 特征尚不清楚。本研究旨在评估甲状旁腺腺瘤的 NIRAF 模式。
我们招募了 2021 年 12 月至 2022 年 2 月期间在比萨大学医院内分泌外科接受原发性甲状旁腺功能亢进手术的患者。评估疑似甲状旁腺腺瘤的术中 NIRAF 模式，特别注意是否存在明亮的帽状结构。
我们对在我院接受甲状旁腺切除术的 11 例原发性甲状旁腺功能亢进患者进行了回顾性研究。对 15 个切除标本的组织病理学检查证实了 14 个甲状旁腺腺瘤（12 个主细胞甲状旁腺腺瘤、1 个嗜酸细胞甲状旁腺腺瘤和 1 个混合细胞甲状旁腺腺瘤）和 1 个神经鞘瘤。所有腺瘤均表现出异质性的 NIRAF 模式，与神经鞘瘤观察到的均一模式不同。在 14 个甲状旁腺腺瘤中有 9 个（64.3%）发现了明亮的帽状结构（均为主细胞腺瘤）。相反，在术中发现的所有 9 个大体上正常的 PG 均表现出均一的模式。
我们的研究结果支持将 NIRAF 整合到甲状旁腺手术中。甲状旁腺腺瘤中观察到的异质性 NIRAF 模式，常伴有明亮的帽状结构，为区分功能亢进与正常甲状旁腺组织提供了一种有前途的术中诊断工具。需要进行更大规模的随机试验来进一步验证这些发现。
