scholarly journals Evaluation of Autofluorescence in Identifying Parathyroid Glands by Measuring Parathyroid Hormone in Fine-Needle Biopsy Washings

2021 ◽  
Author(s):  
Zhen liu ◽  
Run-sheng Ma ◽  
Jun-li Jia ◽  
Tao Wang ◽  
Dao-hong Zuo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Parathyroid Hormone ◽  
Lymph Nodes ◽  
Thyroid Surgery ◽  
Near Infrared ◽  
Parathyroid Glands ◽  
Autofluorescence Imaging ◽  
Node Dissection ◽  
Fine Needle ◽  
Intraoperative Parathyroid Hormone

Abstract Background: Near-infrared autofluorescence imaging has potentially great value for assisting endocrine surgeons in identifying parathyroid glands and may dramatically change the surgical strategy of endocrine surgeons in thyroid surgery. This study is designed to objectively evaluate the role of near-infrared autofluorescence imaging in identifying parathyroid glands during thyroid surgery by measuring intraoperative parathyroid hormone in fine-needle aspiration biopsy washings.Methods: A case series study was conducted at a tertiary referral teaching hospital in China from September 2019 to April 2020. Patients undergoing total thyroidectomy with or without neck lymph node dissection were consecutively included. The surgeon used near-infrared autofluorescence imaging to identify parathyroid glands during thyroid surgery and confirmed suspicious parathyroid tissues by measuring their intraoperative parathyroid hormone. Nanocarbon was injected into the thyroid gland if the thyroid autofluorescence intensity was too strong. The sensitivity and accuracy of near-infrared autofluorescence imaging and vision for identifying parathyroid glands, and the difference in autofluorescence intensity in various tissues were the main outcomes.RESULTS: Overall, 238 patients completed the trial. Based on the pathological and aIOPTH results, the sensitivity of near-infrared autofluorescence imaging for detecting parathyroid glands（568 of 596 parathyroid glands; 95.30%）was significantly higher than that of vision（517 of 596 parathyroid glands; 86.74%, P<.001). The accuracy of near-infrared autofluorescence imaging (764 of 841 tissues; 90.84%) was significantly higher than that of vision (567 of 841 tissues; 67.42%, P<.001) when the evaluations of certain tissues were inconsistent. There was a significant difference between the autofluorescence intensity of the parathyroid glands and that of the lymph nodes (74.19 ± 17.82 vs 33.97 ± 10.64, P<.001).CONCLUSIONS: The use of near-infrared autofluorescence imaging, along with intraoperative parathyroid hormone and nanocarbon for the identification of parathyroid glands in thyroid surgery may increase the number of confirmed parathyroid glands. Using near-infrared autofluorescence imaging can effectively distinguish lymph nodes and parathyroid glands during lymph node dissection.

Potential Role of Carbon Nanoparticles in Guiding Central Neck Dissection and Protecting Parathyroid Glands in Patients with Papillary Thyroid Cancer

2019 ◽  
Vol 15 (3) ◽  
pp. 254-259
Author(s):  
Zhiliang Xu ◽  
Zhiyu Li ◽  
Qi Wu ◽  
Yimin Zhang ◽  
Shan Zhu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Papillary Thyroid Cancer ◽  
Lymph Node Dissection ◽  
Parathyroid Glands ◽  
Control Group ◽  
Papillary Thyroid ◽  
Node Dissection

Background: Carbon nanoparticle (CN) suspensions have been widely used as lymph node tracers in cancers. Here, CN suspension was successfully applied to lymph node dissection. Objective: This study aimed to evaluate the role of CN suspension in identifying lymph nodes and preserving the parathyroid in patients with papillary thyroid cancer (PTC). Method: A total of 96 PTC patients were divided into a CN group (n = 46) and a control group (n = 50). All patients underwent total thyroidectomy with central lymph node dissection from 2014 to 2015. Results: The number of lymph nodes removed in the CN group and the control group was 9.6±2.4 and 7.8±2.2, respectively, and the number of dissected lymph nodes identified as <5 mm in both groups was 4.4±1.3 and 2.4±1.4, respectively. These results were significantly different between the two groups (P < 0.05). However, the number of metastatic lymph nodes was similar in the two groups. In addition, the results further revealed that the level of serum parathyroid hormone (PTH) was significantly lower in the control group than in the CN group on postoperative day 1 and week 1 (P < 0.05), but similar outcomes were observed at postoperative month 1. Conclusion: CN suspension plays an important role in accurately identifying lymph nodes and protecting parathyroid glands. The clinical utilization of CN suspension could increase the accuracy of surgery programs and protect parathyroid function.

scholarly journals Ultrasonography of Injury to the Parathyroids During a Thyroidectomy

2019 ◽  
Vol 35 (6) ◽  
pp. 460-464
Author(s):  
Jun-hua Zhang
Keyword(s):  
Lymph Node ◽  
Total Thyroidectomy ◽  
Lymph Node Dissection ◽  
Thyroid Surgery ◽  
Clinical Symptoms ◽  
Parathyroid Glands ◽  
Medical Laboratory ◽  
Case Review ◽  
Node Dissection ◽  
Central Lymph Node Dissection

Objective: Explore the characteristics of parathyroid injury during thyroid surgery and the potential for sonography to reduce the risk of parathyroid injury. Methods: Retrospective analysis was conducted on 39 patient cases, with parathyroid injury (including 29 cases of total thyroidectomy plus central lymph node dissection and 10 cases of total thyroidectomy). Sonography and related medical laboratory testing were performed pre- and postsurgery. Clinical symptoms and associated postsurgical gland changes were compared and analyzed according to the relevant laboratory values. Results: The patient case review demonstrated that the total number of glands decreased by 43 compared with preoperation, with 25 glands in the upper pair and 18 glands in the lower. There were 33 glands with uneven echo and blurred edges, with 20 in the upper pair and 13 in the lower pair. The damage rate of the upper gland (45/76) was higher than that of the lower gland (31/76) ( P < .05). A total of 69.7% (23/33) of gland blood flow signals were reduced compared with preoperation, of which 10 showed uneven enhancement when the contrast-enhanced ultrasound reached its peak. Conclusion: Thyroid surgery can easily damage parathyroid glands, especially during a total thyroidectomy, with lymph node dissection. Sonography of the parathyroid glands in patients with postoperative hypocalcemia can provide imaging surveillance and mitigate the damage of these glands postsurgically.

scholarly journals Intraoperative detection of parathyroid glands by autofluorescence identification using image-based system: report of 15 cases

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Maksym Gorobeiko ◽  
Andrii Dinets
Keyword(s):  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Parathyroid Gland ◽  
Visual Inspection ◽  
Near Infrared ◽  
Parathyroid Glands ◽  
Autofluorescence Imaging ◽  
Additional Tool ◽  
Area Of Interest ◽  
Increased Risk

Abstract Background A detection of parathyroid glands by the evaluation of their autofluorescence in the near-infrared spectrum is considered as a promising tool in addition to their visual verification. The aim of this study was to evaluate the role of near-infrared autofluorescence application by using two different image-based systems for the identification of parathyroid glands during surgery of thyroid and parathyroid benign and malignant lesions. Methods Evaluation of near-infrared autofluorescence was performed in 15 patients by using two different image-based systems equipped with a near-infrared laser camera. Intravenous injection of fluorophore indocyanine green was used for the enhancement of near-infrared autofluorescence signal. Results Normal parathyroid glands were identified and mobilized after visual inspection in 12 (80%) patients, which was confirmed by near-infrared autofluorescence evaluation. Confident recognition of parathyroid glands by near-infrared autofluorescence signal and their subsequent distinction from lymph nodes was achieved in two (13%) patients with prior surgery for papillary thyroid carcinoma. In one (7%) case, parathyroid gland was identified as fragments of tissue within the postoperative scarring area by near-infrared autofluorescence evaluation, but not by visual inspection. A less intensive near-infrared autofluorescence signal was detected in the parathyroid gland owing to unintentional excision in one (7%) case. Better signal intensity from parathyroid glands was noticed after changes of the near-infrared camera in Fluobeam 800 image-based system in position to an angle of approximately 45–65° in relation to area of interest in all cases as compared with holding straight on the parathyroid gland. Fluobeam LX demonstrated a good near-infrared autofluorescence signal without any specific changes in the camera angle. Thyroid carcinoma demonstrated low-intensity signal in the case of invasion to thyroid capsule. No fluorescent signal was identified from metastatic, or from normal, lymph nodes. Conclusions The application of near-infrared autofluorescence imaging is considered as a useful, but additional, tool for the visual assessment of parathyroid gland in the case of primary neck exploration. The utility of near-infrared autofluorescence imaging for parathyroid detection is increased in the case of repeated surgical intervention owing to increased risk of unintentional parathyroid removal as well as for discrimination of parathyroids from the lymph nodes in cases of thyroid malignancy.

scholarly journals Shortcomings of ultrasound-guided fine needle aspiration in the axillary management of women with breast cancer

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Michel Attieh ◽  
Faek Jamali ◽  
Ghina Berjawi ◽  
Mothana Saadeldine ◽  
Fouad Boulos
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Fine Needle Aspiration ◽  
Axillary Lymph Node ◽  
Needle Aspiration ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Ultrasound Guided ◽  
Fine Needle

Abstract Background Ultrasound, along with ultrasound-guided fine needle aspiration, is currently used for the axillary evaluation of breast cancer patients in order to identify candidates for axillary lymph node dissection. The aim of this study is to evaluate the accuracy of this tool in correctly identifying patients who may or may not benefit from axillary clearance in light of the ACOSOG Z0011 trial recommendations. Methods One hundred one patients (65 with positive US-FNA with corresponding axillary lymph node dissection (ALND), and 36 with negative US-FNA with corresponding ALND/sentinel lymph node biopsy) were studied for the number of involved axillary lymph nodes, tumor clinicopathologic features, and axillary radiologic findings. Results From the positive US-FNA group, 43% of patients had two or fewer positive lymph nodes upon ALND pathologic examination. In the US-FNA negative group, the negative predictive value for detecting axillary disease was 72.7%. With both groups combined, the sensitivity, specificity, PPV, and NPV of US-FNA for selecting patients based on axillary disease burden were 86%, 51.7%, 57%, and 83.3%, respectively. Conclusion Based on Z0011 guidelines, US-FNA is not a reliable tool in triaging patients in need for ALND and leads to overtreatment of 43% patients when positive, while depriving a small but significant percentage of patients from necessary therapy, when negative.

Spare Parathyroid Glands During Thyroid Surgery with Perioperative Autofluorescence Imaging: A Diagnostic Study

2021 ◽  
Author(s):  
Alexandre Bellier ◽  
Yann Wazne ◽  
Thibaut Chollier ◽  
Nathalie Sturm ◽  
Philippe Chaffanjon
Keyword(s):  
Thyroid Surgery ◽  
Parathyroid Glands ◽  
Diagnostic Study ◽  
Autofluorescence Imaging

scholarly journals The Findings of SPECT/CT Concerning Bypass Lymph Circulation in Lymphedema Following Breast Cancer Surgery

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 471
Author(s):  
Min Young Lee ◽  
Eunjung Kong ◽  
Dong Gyu Lee
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymphatic Drainage ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Positive Group

This study aimed to determine whether bypass circulation was present in lymphedema and its effect. This was a retrospective, cross-sectional study. Patients who underwent unilateral breast cancer surgery with axillary lymph node dissection were recruited and underwent single-photon emission tomography/computed tomography (SPECT/CT). SPECT/CT was performed to detect the three-dimensional locations of radio-activated lymph nodes. Patients with radioactivity in anatomical locations other than axillary lymph nodes were classified into a positive group. All patients received complete decongestive therapy (CDT). Exclusion criteria were as follows: History of bilateral breast cancer surgery, cervical lymph node dissection history, and upper extremity amputation. The difference in the upper extremity circumference (cm) was measured at four points: Mid-point of the upper arm, elbow, and 10 and 15 cm below the elbow. Twenty-nine patients were included in this study. Fifteen patients (51.7%) had bypass lymphatic systems on the affected side, six (20.7%) had a bypass lymphatic system with axillary lymph nodes on the unaffected side, and 11 (37.9%) showed new lymphatic drainage. The positive group showed significantly less swelling than the negative group at the mid-arm, elbow, and 15 cm below the elbow. Bypass lymphatic circulation had two patterns: Infraclavicular lymph nodes and supraclavicular and/or cervical lymph nodes. Changes in lymph drainage caused by surgery triggered the activation of the superficial lymphatic drainage system to relieve lymphedema. Superficial lymphatic drainage has a connection through the deltopectoral groove.

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