scholarly journals Improved intraoperative verification of parathyroid glands by determining their autofluorescence in the infrared spectrum

2021 ◽  
Vol 17 (6) ◽  
pp. 465-471
Author(s):  
M.B. Gorobeiko ◽  
A.V. Dinets ◽  
V.H. Hoperia ◽  
K.M. Abdalla
Keyword(s):  
Infrared Spectrum ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Parathyroid Gland ◽  
Near Infrared ◽  
Parathyroid Glands ◽  
Imaging Systems ◽  
Visual Identification ◽  
Thyroid Adenomas ◽  
Camera Position

Background. Detection of parathyroid glands by spectroscopy of their autofluorescence in the near-infrared spectrum (NIRAF) is considered a promising intraoperative tool in addition to their verification with visual identification. The study was aimed to evaluate the role of NIRAF by using two different imaging systems to confirm parathyroid glands during operations for benign and malignant thyroid and parathyroid tumors. Materials and methods. The study included 62 patients who underwent verification of NIRAF by using two different imaging systems equipped with a near-infrared (NIR) camera during surgery. Intravenous fluorophore of indocyanine green was applied to amplify the NIRAF signal. Results. Normal parathyroid glands were identified and mobilized after a visual inspection in 50 patients (80 %), which was subsequently confirmed by evaluation with NIRAF spectroscopy. Determination of NIRAF in the parathyroid glands and their differentiation from lymph nodes was achieved in 8 (13 %) patients with papillary thyroid carcinoma. In 3 (5 %) patients, the parathyroid gland was identified in the area of the postoperative scar, using NIRAF but not by the visual identification. In 2 (3 %) cases, the appearance of the signal was determined but with a decrease in the intensity of the NIRAF from the parathyroid glands during their unintentional removal. The strong NIRAF signal intensity was observed from the parathyroid gland after changing the position of the NIR camera when using the Fluobeam 800 device at an angle of approximately 45–65° to the area of the parathyroid gland location. The Fluobeam LX demonstrated a satisfactory NIRAF signal without any specific changes in camera position. NIRAF signal was determined in the tissue of toxic thyroid adenomas. NIRAF signal of the low intensity was detected in the invasion of thyroid carcinoma in a capsule of a thyroid gland. No NIRAF signal was observed from metastatic and normal lymph nodes. Conclusions. The use of NIRAF parathyroid spectroscopy technology allows impro-ving their imaging and verification as an additional method during surgery of the neck. The practical value of NIRAF spectroscopy of the parathyroid gland is increased in the case of reoperations due to the risk of accidental removal of the parathyroid gland as well as for differential diagnosis between the parathyroid gland and metastatic lymph nodes.

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.

Parathyroid Glands Hyperplasias Mimicking Medullary Thyroid Carcinoma Metastatic Lymph Nodes on 18F-DOPA PET/CT

2019 ◽  
Vol 44 (8) ◽  
pp. e497-e498
Author(s):  
Marie Terroir ◽  
Serena Grimaldi ◽  
Dana Hartl ◽  
Sophie Leboulleux ◽  
Désirée Deandreis
Keyword(s):  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Medullary Thyroid Carcinoma ◽  
Parathyroid Glands ◽  
Medullary Thyroid ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Pet Ct

scholarly journals Near-infrared auto-fluorescence spectroscopy combining with Fisher’s linear discriminant analysis improves intraoperative real-time identification of normal parathyroid in thyroidectomy

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Junsong Liu ◽  
Xiaoxia Wang ◽  
Rui Wang ◽  
Chongwen Xu ◽  
Ruimin Zhao ◽  
...  
Keyword(s):  
Discriminant Analysis ◽  
Fluorescence Spectroscopy ◽  
Linear Discriminant Analysis ◽  
Real Time ◽  
Parathyroid Gland ◽  
Near Infrared ◽  
Parathyroid Glands ◽  
Linear Discriminant ◽  
Auto Fluorescence ◽  
Fisher’S Linear Discriminant

Abstract Background To evaluate the efficacy of a sensitive, real-time tool for identification and protection for parathyroid glands during thyroidectomy. Methods Near-infrared (NIR) auto-fluorescence was measured intraoperatively from 20 patients undergoing thyroidectomy. Spectra were measured from suspicious parathyroid glands and surrounding neck tissues during the operation with a NIR fluorescence system. Fast frozen sections were performed on the suspicious parathyroid glands. Accuracy was evaluated by comparison with histology and NIR identification. Data were attracted for Fisher’s linear discriminant analysis. Results The auto-fluorescence intensity of parathyroid was significantly higher than that of thyroid, fat and lymph node. The peak intensity of auto-fluorescence from parathyroid was 5.55 times of that from thyroid at the corresponding wave number. Of the 20 patients, the parathyroid was accurately detected and identified in 19 patients by NIR system, compared with their histologic results. One suspicious parathyroid did not exhibit typical spectra, and was proved to be fat tissue by histology. The NIR auto-fluorescence method had a 100% sensitivity of parathyroid glands identification and a high accuracy of 95%. The positive predictive value was 95%. The parathyroid gland have specific auto-fluorescence spectrum and can be separated from the other three samples through the Fisher’s linear discriminant analysis. Conclusions NIR auto-fluorescence spectroscopy can accurately identify normal parathyroid gland during thyroidectomy. The Fisher’s linear discriminant analysis demonstrated the specificity of the NIR auto-fluorescence of parathyroid tissue and its efficacy in parathyroid discrimination.

scholarly journals The role of carbon nanoparticle in lymph node detection and parathyroid gland protection during thyroidectomy for non-anaplastic thyroid carcinoma- a meta-analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0223627
Author(s):  
Shaowei Xu ◽  
Zhifeng Li ◽  
Manbin Xu ◽  
Hanwei Peng
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Parathyroid Gland ◽  
Anaplastic Thyroid Carcinoma ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Significant Difference ◽  
Transient Hypoparathyroidism

Objective To assess the efficiency of the carbon nanoparticles (CNs) in lymph node identification and parathyroid gland (PG) protection during thyroidectomy for non-anaplastic thyroid carcinoma (N-ATC). Methods A systematic literature search for relevant literatures published up to December 2018 in PubMed, EMBASE, Web of Science and Cochrane Library was performed. Both English and Chinese literatures were retrieved and analyzed. Randomized controlled trials or nonrandomized controlled trials comparing the use of CNs with the use of methylene blue or a blank control in patients undergoing thyroidectomy for N-ATC were enrolled in this study. The primary outcomes included the number of lymph nodes harvested, the rate of lymph nodes involved, and the rates of accidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Weighted mean differences (WMDs), odds ratios (ORs) and risk differences (RDs) were calculated for the dichotomous outcome variables. Between study heterogeneity was tested using the Q tests and the I2 statistics. All analyses were performed using Review Manager (version 5.3.5). Results 25 studies comprising 3266 patients were included in this analysis. The total number of lymph nodes harvested in the CNs groups was significantly higher than that in the control groups (WMD, 2.36; 95% CI, 1.40 to 3.32; P <0.01). Administrating CNs was associated with a lower incidence of accidental PG removal (OR = 0.28, 95% CI = 0.21 to 0.37, P<0.01) and lower rates of both postoperative transient hypoparathyroidism (OR = 0.46, 95% CI = 0.33 to 0.64, P <0.01) and transient hypocalcemia (OR = 0.46, 95% CI = 0.33 to 0.65, P <0.01). No significant difference was found concerning lymph node metastatic rates between CNs group and control group. Subgroup analysis indicated that the application of CNs in reoperation thyroidectomy reduced both the rate of transient hypoparathyroidism (OR = 0.21, 95% CI = 0.06 to 0.75, P = 0.02) and the possibility of accidental PGs removal (OR = 0.21, 95% CI = 0.07 to 0.62, P = 0.004, P<0.05). Conclusions The application of CNs in thyroidectomy for N-ATC results in higher number of lymph node harvested and better PG protection during both initial and reoperation thyroidectomy.

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.

scholarly journals Determination of the Optimum Excitation Wavelength for the Parathyroid Gland Using a Near-Infrared Camera

2021 ◽  
Vol 7 ◽  
Author(s):  
Isao Tabei ◽  
Azusa Fuke ◽  
Astushi Fushimi ◽  
Hiroshi Takeyama
Keyword(s):  
Parathyroid Gland ◽  
Near Infrared ◽  
Light Emitting Diode ◽  
Infrared Camera ◽  
Video Camera ◽  
Parathyroid Glands ◽  
Excitation Wavelength ◽  
Success Rates ◽  
Fluorescent Intensity ◽  
Light Emitting

When performing thyroid/parathyroid surgery, difficulty detecting the parathyroid gland is a common experience because it is frequently mistaken with surrounding structures, including the thyroid gland, lymph nodes, and fat. To obtain successful surgical results, the auto fluorescent property of the parathyroid gland occurring at 820–830 nm has been used. Intraoperative visualization and detection by fluorescence enable protection of the gland from damage and unintended removal. Use of a near-infrared (NIR) camera has been proposed to indicate the parathyroid gland, but the devices and success rates have varied. This study aimed to define optimum excitation wavelength (EWL) by measuring the EWL of the parathyroid gland for its autofluorescence. Glands were exposed to EWL at 10-nm intervals from 670–790 nm with a light-emitting diode monochromator; autofluorescence intensity was recorded with a conventional NIR video camera. Autofluorescence intensity curves of three normal parathyroid glands were depicted; the optimum EWL was measured as 760–770 nm. Also, the illumination of the surrounding structures were compared at the optimum EWL. The auto fluorescent intensity of the parathyroid gland was 2-fold greater than for surrounding structures. This difference in fluorescence intensity should enable distinction of the parathyroid gland from surrounding structures. The clarification of the optimum EWL can guide refinements of the NIR camera for better surgical outcomes by improving detection of the parathyroid glands. Also, an understanding of optimum EWL should lead to developments for microscopic devices to unravel the still unknown mechanisms of the intrinsic autofluorescence of the parathyroid gland.

Infrared fluorescence lymphography in experimental and clinical practice

2018 ◽  
Vol 17 (2) ◽  
pp. 84-91 ◽  
Author(s):  
G. V. Papayan ◽  
A. L. Akopov ◽  
P. A. Antonyan ◽  
A. A. Ilin ◽  
N. N. Petrishchev
Keyword(s):  
Lymph Nodes ◽  
Near Infrared ◽  
Lymphatic System ◽  
Lymphatic Vessels ◽  
Diagnostic System ◽  
Biological Tissues ◽  
Peritumoral Injection ◽  
Intradermal Administration ◽  
Nir Fluorescence ◽  
Real Time Visualization

Introduction. Near infrared (NIR) fluorescent diagnostics is promising due to a deeper penetration into biological tissues. Material and methods. In experiments on rabbits and in clinical studies evaluation the lymphatic system with the use of the instrument complex FLUM-808 was analysed. Results. For visualization of the lymphatic vessels of the skin, the intradermal administration of ICG, dissolved in 20 % albumin in the order of 0.02 mg/ml, is optimal. Peritumoral injection of ICG allows visualizing sentinel lymph nodes in patients with lung cancer. Conclusions. The developed NIR fluorescence diagnostic system FLUM-808 allows to real time visualization of lymphatic vessels and lymph nodes.

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