Near-infrared autofluorescence for the detection of parathyroid glands

Paras, Constantine; Keller, Matthew D.; White, Lisa M.; Phay, John E.; Mahadevan‐Jansen, Anita

doi:10.1117/1.3583571

Cited by 246 publications

(246 citation statements)

References 21 publications

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“…9 We have previously conducted a pilot study using NIR fluorescence spectroscopy to detect the parathyroid during surgical procedures. 10 NIR wavelengths are attractive in biomedical applications due to their increased penetration depth and decreased scattering and absorption in tissues relative to ultraviolet and visible wavelengths. 11 Furthermore, the NIR region is considered the optical window because there are no naturally occurring fluorophores known to emit peak fluorescence at NIR wavelengths.…”

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confidence: 99%

A novel optical approach to intraoperative detection of parathyroid glands

McWade¹,

Paras²,

White³

et al. 2013

Surgery

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145

137

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Background Inadvertent removal of parathyroid glands is a challenge in endocrine operations. There is a critical need for a diagnostic tool that provides sensitive, real-time parathyroid detection during procedures. We have developed an intraoperative technique using near-infrared (NIR) fluorescence for in vivo, real-time detection of the parathyroid regardless of its pathologic state. Methods NIR fluorescence was measured intraoperatively from 45 patients undergoing parathyroidectomy and thyroidectomy. Spectra were measured from the parathyroid and surrounding neck tissues during the operation with the use of a portable, probe-based fluorescence system at 785-nm excitation. Accuracy was evaluated by comparison with histology or visual recognition by the surgeon. Results NIR fluorescence detected the parathyroid in 100% of patients. Parathyroid fluorescence was stronger (1.2–18 times) than that of the thyroid with peak fluorescence at 822 nm. Surrounding tissues showed no auto-fluorescence. Disease state did not affect the ability to discriminate parathyroid glands but may account for signal variability. Conclusions NIR fluorescence spectroscopy can detect intraoperatively the parathyroid regardless of tissue pathology. The signal may be caused by calcium-sensing receptors present in the parathyroid. The signal strength and consistency indicates the simplicity and effectiveness of this method. Its implementation may limit operative time, decrease costs, and improve operative success rates.

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confidence: 99%

A novel optical approach to intraoperative detection of parathyroid glands

McWade¹,

Paras²,

White³

et al. 2013

Surgery

Self Cite

145

137

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“…Recently, several studies reported the use of autofluorescence characteristics of parathyroid tissue for discrimination between different tissue types using spectroscopy ( 22;23 ). They found autofluorescent properties in parathyroid and thyroid glands with a peak fluorescence at 822 nm when excited with 785 nm light.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative guidance in parathyroid surgery using near-infrared fluorescence imaging and low-dose Methylene Blue

Tummers

Schepers

Hamming

et al. 2015

Surgery

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Background Identification of diseased and normal parathyroid glands during parathyroid surgery can be challenging. The aim of this study was to assess whether near-infrared (NIR) fluorescence imaging using administration of a low-dose Methylene Blue (MB) at the start of surgery could provide optical guidance during parathyroid surgery and assist in the detection of parathyroid adenomas. Methods Patients diagnosed with primary hyperparathyroidism planned for parathyroid resection were included. Patients received 0.5 mg/kg MB intravenously directly after start of anesthesia. During surgery, NIR fluorescence imaging was performed to identify parathyroid adenomas. Imaging results were compared to a previous published feasibility study in which 12 patients received MB after surgical identification of the adenoma. Results 13 patients were included in the current study. In 10/12 patients with a histologically proven adenoma, the adenoma was fluorescent. Mean Signal to Background Ratio (SBR) was 3.1 ± 2.8. Mean diameter of the resected lesions was 17 ± 9 mm (range 5 – 28 mm). Adenomas could be identified up to 145 minutes after administration, which was the longest timespan until resection. Interestingly, in 3 patients, a total of 6 normal parathyroid glands (median diameter 2.5 mm) with a SBR of 1.8 ± 0.4 were identified using NIR fluorescence imaging. Conclusion Early administration of low dose MB provided guidance during parathyroid surgery by identifying both parathyroid adenomas and normal parathyroid glands. In patients where difficult identification of the parathyroid adenoma is expected, or when normal glands have to be identified, administration of MB could improve surgical outcome.

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“…Paras et al (9) found that in vivo parathyroid fluorescence was 2 to 11 times more intense than thyroid fluorescence. In addition, McWade et al (10) obtained spectra from parathyroids and surrounding neck tissues from 45 patients during the operation with the use of a portable, probe-based fluorescence system.…”

Section: Near-infrared Spectroscopymentioning

confidence: 98%

Optical Diagnosis for Thyroid and Parathyroid Tissues—A Review

Brandao

Freitas

Bachmann

2015

Applied Spectroscopy Reviews

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This article presents an overview of optical methodologies to aid the diagnosis and differentiation of thyroid and parathyroid tissues. In particular, we review the several techniques and associated methodologies that allow in vivo and ex vivo optical characterization of thyroid and parathyroid tissues. Emphasis is placed on the research potential of these techniques and whether intrinsic characteristics can provide useful contrast for the diagnosis of human thyroid and parathyroid malignant lesions.

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Near-infrared autofluorescence for the detection of parathyroid glands

Cited by 246 publications

References 21 publications

A novel optical approach to intraoperative detection of parathyroid glands

A novel optical approach to intraoperative detection of parathyroid glands

Intraoperative guidance in parathyroid surgery using near-infrared fluorescence imaging and low-dose Methylene Blue

Optical Diagnosis for Thyroid and Parathyroid Tissues—A Review

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