Near-Infrared Autofluorescence Image-Guided Parathyroid Gland Mapping in Thyroidectomy

Kim, Sung Won; Lee, Hyoung Shin; Ahn, Yeh‐Chan; Park, Chan Woo; Jeon, Seok Won; Kim, Chang Hoi; Ko, Jeong Hoon; Oak, Chulho; Kim, Yikeun; Lee, Kang Dae

doi:10.1016/j.jamcollsurg.2017.10.015

Cited by 75 publications

(62 citation statements)

References 20 publications

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“…The procedure required the darkening of the operation field [53,54]. An improvement of this method was a user-friendly clinical prototype of a device that uses near-infrared spectroscopy -PTeye [55,65]. It was adopted to perform measurements even with operating room lights turned on.…”

Section: Near-infrared Autofluorescencementioning

confidence: 99%

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Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas

et al. 2020

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Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease the incidence of mistakenly injuring the parathyroid glands and allow for the timely diagnosis of various abnormalities, including parathyroid adenomas. This article reviews 139 studies conducted between 1970 and 2020 (49 years). Studies that were reviewed focused on several techniques including application of carbon nanoparticles, carbon nanoparticles with technetium sestamibi (99m Tc-MIBI), Raman spectroscopy, near-infrared autofluorescence, dynamic optical contrast imaging, laser speckle contrast imaging, shear wave elastography, and indocyanine green to test their potential in providing proper parathyroid glands’ localization. Apart from reviewing the aforementioned techniques, this study focused on the applications that helped in the detection of parathyroid adenomas. Results suggest that applying all the reviewed techniques significantly improves the possibility of providing proper localization of parathyroid glands, and the application of indocyanine green has proven to be the ‘ideal’ approach for the diagnosis of parathyroid adenomas.

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Section: Near-infrared Autofluorescencementioning

confidence: 99%

“…In 2016, Kim et al performed a study that modified the technique of visualization of PGs called NIR-IR imaging [55]. The surrounding structures and surgical tools could be easily visible because of the additional infrared illumination in broadband (700-1400 nm).…”

Section: Near-infrared Autofluorescencementioning

confidence: 99%

Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas

et al. 2020

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“…The studies that describe the used concentration all use 2.5 mg/ml. 19,33,34,40,46,[49][50][51][52] This is remarkable since the leaflet that comes with ICG advises to dilute the ICG to a solution of 5 mg/ml. However, a concentration of 2.5 mg/ml is more feasible in daily practice since 1 ml can be retrieved more precise than just 0.5 ml.…”

Section: Discussionmentioning

confidence: 99%

“…The studies that do provide information on ICG concentration use 2.5 mg/ml. 19,33,34,40,46,[49][50][51][52] In all, except two studies, the fluorescent dye was administered intravenously.…”

Section: Chaptermentioning

confidence: 99%

“…Autofluorescence is another promising method for intra-operative parathyroid identification. [48][49][50] Using this technique, no exogenous fluorescent dye administration is needed. However, for perfusion assessment of the remaining parathyroid gland an intravenously administered fluorescent dye is still needed and might then as well be used for identification of the parathyroid glands, instead of using multiple systems and techniques.…”

Section: Part III Near Infrared Fluorescence Imaging In Thyroid Surgerymentioning

confidence: 99%

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Near infrared fluorescence imaging in surgery

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Intraoperative Autofluorescence Parathyroid Identification in Patients With Multiple Endocrine Neoplasia Type 1

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et al. 2019

JAMA Otolaryngol Head Neck Surg

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infrared (NIR) autofluorescence of the parathyroid gland enables intraoperative gland identification without the need for contrast agent injection. However, whether real-time autofluorescence imaging is useful in patients with multiple endocrine neoplasia type 1 (MEN1) and primary hyperparathyroidism is unknown.OBJECTIVE To compare quantified intraoperative parathyroid autofluorescence imaging results for patients with MEN1-associated vs those with non-MEN1 sporadic primary hyperparathyroidism. DESIGN, SETTING, AND PARTICIPANTSA retrospective analysis of prospectively collected data on a cohort of 71 consecutive patients undergoing surgery for primary hyperparathyroidism by 2 experienced endocrine surgeons between June 1, 2017, and July 31, 2018, was conducted. Intraoperative imaging was performed with a handheld NIR autofluorescence device and images were captured for analysis. Post hoc blinded imaging analysis was conducted with Image J software to quantify representative areas of greatest autofluorescence from the parathyroid, thyroid, and adjacent soft tissue. MAIN OUTCOMES AND MEASURESPrimary end points were parathyroid autofluorescence and background thyroid and soft tissue autofluorescence, reported as median values with interquartile ranges. Rates of false-negative (lack of significant parathyroid gland autofluorescence compared with background autofluorescence, defined as parathyroid autofluorescence-background autofluorescence ratio <1.10) and false-positive autofluorescence (aberrant autofluorescence of nonparathyroid tissue confirmed by pathologic testing) were analyzed. RESULTSOf the 71 consecutive patients with primary hyperparathyroidism who underwent parathyroidectomy during the study period, 6 patients had genetically or clinically diagnosed MEN1 and 65 had sporadic non-MEN1 hyperparathyroidism. Most patients were women (MEN1: 4 [67%]; non-MEN1: 51 [78%]). Median (interquartile range) age was 49.0 (38.0-53.8) years in the MEN1 cohort and 61.0 (54.0-67.0) years in the non-MEN1 cohort. No clinically significant differences in serum preoperative parathyroid hormone level or parathyroid gland size or weight on pathologic examination were observed between the 2 cohorts. The median absolute value of in situ parathyroid autofluorescence was significantly lower in the MEN1 cohort than the non-MEN1 cohort (54.4 vs 74.3; Hedges g = −1.03; 95% CI, −1.89 to −0.17), as was the ratio of parathyroid to background autofluorescence (1.08 vs 1.59; g = −1.59; 95% CI, −2.23 to −0.96). Three patients (50%) with MEN1 had false-negative nonfluorescent parathyroid adenomas vs 6 patients (9%) without MEN1. Nonparathyroid fibroadipose tissue of patients with MEN1 exhibited greater background autofluorescence, leading to high false-positive rates (5 of 6 patients [83%]) vs only 3 of 65 (5%) false-positive autofluorescence nonparathyroid specimens among patients without MEN1. CONCLUSIONS AND RELEVANCEIntraoperative identification of parathyroid glands using their autofluorescence by real-time NIR imaging appears to have uti...

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Near-Infrared Autofluorescence Image-Guided Parathyroid Gland Mapping in Thyroidectomy

Cited by 75 publications

References 20 publications

Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas

Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas

Near infrared fluorescence imaging in surgery

Intraoperative Autofluorescence Parathyroid Identification in Patients With Multiple Endocrine Neoplasia Type 1

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