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

Abstract

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.

Preoperative imaging and intraoperative navigation of the parathyroid glands neoplasms in primary hyperparathyroidism

“…Выбор какого-то одного оптимального диагностического метода крайне затруднителен, поскольку ни один из них не обладает 100 %-ной диагностической точностью. К тому же каждое исследование имеет ограничения, а его результативность в значительной степени зависит от квалификации специалиста [4,5,7]. Полученные нами данные позволили выделить комбинацию наиболее информативных диагностических методов, использующихся на предоперационном этапе, а также показали возможность применения современных технологий интраоперационной навигации в эндокринной хирургии.…”

“…Выбор одного оптимального исследования крайне затруднителен, поскольку ни одно из них не обладает 100 %-ной диагностической точностью. К тому же каждый метод имеет ограничения и, безусловно, всегда в значительной степени операторозависим [7,8]. Важными факторами, обусловливающими выбор последовательности и метода топической диагностики образований ОЩЖ, являются оснащенность клиники и опыт специалистовдиагностов.…”

Indocyanine green fluorescence for parathyroid gland identification and function prediction: Systematic review and meta‐analysis

“…In addition to ICG fluorescence, there are reports regarding parathyroid autofluorescence using NIR light in identification of parathyroid glands. Both methods are promising methods that provide higher parathyroid detection rates, and each has its own advantages and disadvantages 33,34 . For the ICG method, the thyroid background signal may decrease the ability to identify the parathyroid glands.…”

“…However, autofluorescence imaging cannot assess perfusion. In addition, parathyroid autofluorescence has been associated with a higher incidence of hypocalcemia (9%) compared to ICG (5%) 33,35 …”

PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia

“…Preservation of the parathyroid glands during thyroid resection requires accuracy, experience, and expert knowledge of the neck anatomy [ 3 ]. The parathyroid glands vary in position (inferior parathyroid glands being more widely distributed than the superior glands), number, size, shape, and color [ 4 ]. If a parathyroid gland is clearly ischemic or hemorrhagic, auto-transplantation should be considered after confirmatory histological examination.…”