Abstract
Background
Parathyroid glands (PGs) exhibit autofluorescence (AF) when excited by near-infrared laser. This multicenter study aims to analyze how this imaging could facilitate the detection of PGs during thyroidectomy and parathyroidectomy procedures.
Methods
This was a retrospective Institutional Review Board-approved analysis of prospectively collected data at three centers. Near-infrared fluorescence imaging (NIFI) was used to detect AF from PGs during thyroidectomy and parathyroidectomy procedures. Logistic regression analysis was performed to assess the utility of NIFI to identify PGs and concordance at these centers.
Results
Overall, 210 patients underwent total thyroidectomy (n = 95), thyroid lobectomy (n = 41), and parathyroidectomy (n = 74) (n = 70 per center). Using NIFI, AF was detected from 98% of visually identified PGs. Upon initial exploration, 46% of PGs were not visible to the naked eye due to coverage by soft tissue, but AF from these glands could be detected by NIFI without any further dissection. Overall, a median of one PG per patient was detected by NIFI in this fashion before being identified visually (p = nonsignificant between centers). On logistic regression, smaller PGs were more likely to be missed visually, but localized by AF on NIFI (odds ratio with increasing size, 0.91; p = 0.02).
Conclusions
In our experience, NIFI facilitated PG identification by detecting their AF, before conventional recognition by the surgeon, in 37–67% of the time. Despite the variability in this rate across centers, there was a concordance in detecting AF from 97 to 99% of the PGs using NIFI. We suggest the incorporation of AF on NIFI alongside conventional visual cues to aid identification of PGs during neck operations.
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References
McWade MA, Paras C, White LM, Phay JE, Mahadevan-Jansen A, Broome JT. A novel optical approach to intraoperative detection of parathyroid glands. Surgery. 2013;154(6):1371–7; discussion 1377.
Kahramangil B, Berber E. The use of near-infrared fluorescence imaging in endocrine surgical procedures. J Surg Oncol. 2017;115(7):848–855.
Falco J, Dip F, Quadri P, de la Fuente M, Prunello M, Rosenthal RJ. Increased identification of parathyroid glands using near infrared light during thyroid and parathyroid surgery. Surg Endosc. 2017;31(9):3737–3742.
Gourgiotis S, Moustafellos P, Dimopoulos N, Papaxoinis G, Baratsis S, Hadjiyannakis E. Inadvertent parathyroidectomy during thyroid surgery: the incidence of a complication of thyroidectomy. Langenbecks Arch Surg. 2006;391(6):557–560.
Grubbs EG, Mittendorf EA, Perrier ND, Lee JE. Gamma probe identification of normal parathyroid glands during central neck surgery can facilitate parathyroid preservation. Am J Surg. 2008;196(6):931–5; discussion 935–6.
Dudley NE. Methylene blue for rapid identification of the parathyroids. Br Med J. 1971;3(5776):680–681.
Prosst RL, Gahlen J, Schnuelle P, Post S, Willeke F. Fluorescence-guided minimally invasive parathyroidectomy: a novel surgical therapy for secondary hyperparathyroidism. Am J Kidney Dis. 2006;48(2):327–331.
Zaidi N, Bucak E, Okoh A, Yazici P, Yigitbas H, Berber E. The utility of indocyanine green near infrared fluorescent imaging in the identification of parathyroid glands during surgery for primary hyperparathyroidism. J Surg Oncol. 2016;113(7):771–774.
Das K, Stone N, Kendall C, Fowler C, Christie-Brown J. Raman spectroscopy of parathyroid tissue pathology. Lasers Med Sci. 2006;21(4):192–197.
Paras C, Keller M, White L, Phay J, Mahadevan-Jansen A. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt. 2011;16(6):067012.
McWade MA, Sanders ME, Broome JT, Solorzano CC, Mahadevan-Jansen A. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery. 2016;159(1):193–202.
Falco J, Dip F, Quadri P, de la Fuente M, Rosenthal R. Cutting edge in thyroid surgery: autofluorescence of parathyroid glands. J Am Coll Surg. 2016;223(2):374–380.
De Leeuw F, Breuskin I, Abbaci M, et al. Intraoperative near-infrared imaging for parathyroid gland identification by auto-fluorescence: a feasibility study. World J Surg. 2016;40(9):2131–2138.
Ladurner R, Sommerey S, Arabi NA, Hallfeldt KKJ, Stepp H, Gallwas JKS. Intraoperative near-infrared autofluorescence imaging of parathyroid glands. Surg Endosc. 2017;31(8):3140–3145.
Benmiloud F, Rebaudet S, Varoquaux A, Penaranda G, Bannier M, Denizot A. Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery. 2018;163(1):23–30.
Disclosure
Bora Kahramangil, Fernando Dip, Fares Benmiloud, Jorge Falco, Martin de La Fuente, Silvina Verna, Raul Rosenthal, and Eren Berber have no conflicts of interest or financial support to declare.
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Kahramangil, B., Dip, F., Benmiloud, F. et al. Detection of Parathyroid Autofluorescence Using Near-Infrared Imaging: A Multicenter Analysis of Concordance Between Different Surgeons. Ann Surg Oncol 25, 957–962 (2018). https://doi.org/10.1245/s10434-018-6364-2
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DOI: https://doi.org/10.1245/s10434-018-6364-2