Autofluorescence pattern of parathyroid adenomas

Demarchi, M.; Karenovicŝ, Wolfram; Bédat, Benoît; Vito, Claudio De; Triponez, Frédéric

doi:10.1093/bjsopen/zraa047

Cited by 32 publications

(29 citation statements)

References 30 publications

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“…To date, the research on the NIRAF characteristics of pathologic PGs has reported somewhat inconsistent findings. However, a number of studies have reported that pathologic PGs demonstrate lower AF compared to normal PGs 1,7,14,23,24 . This may be due to differences in the concentration of the fluorophore, which has not yet been identified, present in pathologic versus normal PGs.…”

Section: Discussionmentioning

confidence: 98%

“…Finding and recognizing parathyroid glands (PGs) is a fundamental skill required for positive outcomes in both thyroid and parathyroid surgery. For thyroidectomy, this is the first step in preserving these glands, necessary to avoid postoperative hypoparathyroidism and hypocalcemia 1,2 . In parathyroidectomy, identifying the PGs is compulsory for surgical success.…”

Section: Introductionmentioning

confidence: 99%

“…Near‐infrared imaging (NIRI) is currently being utilized in a number of ways to assess PGs. PGs possess a particularly intense intrinsic fluorescent nature that when stimulated with the proper wavelength of light can be seen with no augmentation or injected agent 1,2 . Although the fluorophore responsible for this autofluorescent (AF) quality has not yet been identified, near‐infrared autofluorescence (NIRAF) has been shown to be effective at identifying PGs in the setting of both thyroid and parathyroid surgeries 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…For visualization of the vascularity of PGs, indocyanine green (ICG) is the preferred injection agent. In addition to allowing for evaluation of the perfusion of the PGs, ICG‐enhanced NIRI can aid in their recognition 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…The PTeye device (Medtronic, Minneapolis, MN) is the only probe‐based system currently available. Rather than an image on a screen showing varying degrees of brightness, the PTeye provides an absolute measure of the degree of AF of tissue (detection level) and a relative measurement of AF compared to the AF of the thyroid gland (detection ratio [DR]) 1,2 . Tissue demonstrating a ratio of 1.2 or greater has been shown with a high degree of sensitivity and specificity to represent parathyroid tissue 6 …”

Section: Introductionmentioning

confidence: 99%

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Parathyroid Gland Autofluorescence Characteristics in Patients With Primary Hyperparathyroidism

et al. 2021

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Objective Near‐infrared imaging for intraoperative parathyroid gland (PG) detection has recently commanded significant attention. The PTeye (Medtronic, Minneapolis, MN) is a probe‐based system for near‐infrared autofluorescent evaluation of PGs. This study was designed to evaluate the capabilities of the PTeye in the setting of surgery for primary hyperparathyroidism. Study Design Prospective, Cohort study. Methods This single‐institution, prospective cohort study included all patients undergoing parathyroidectomy for primary hyperparathyroidism with presumed single gland disease from June 2020 to December 2020. Absolute intensity and intensity ratios, with the thyroid as the control tissue, were obtained for the adenoma, ipsilateral normal PG, and adjacent tissue. The ability of the PTeye to function when not in direct contact with tissue was measured. Results Twenty‐two patients were included. The median intensity ratio for the in situ adenomas was 4.38 (interquartile range [IQR]: 2.03–5.87), ipsilateral normal PGs 6.17 (IQR: 3.83–7.67), strap muscle 0.47 (IQR: 0.30–0.60), and fat 0.20 (IQR: 0.17–0.47). All normal PGs and 21/22 adenomas demonstrated autofluorescence above the detection threshold. The PTeye functioned at a maximum distance of separation of 10 mm through saline medium and 6 mm through clear solid medium. Conclusion This study confirms the PTeye's ability to recognize PGs with a high degree of precision. The device was found to function properly even with the probe not in direct contact with the tissue. Although adenomatous PGs appear to demonstrate altered autofluorescent properties from normal PGs, additional research is required to determine if these differences are clinically useful. Level of Evidence 3 Laryngoscope, 132:715–721, 2022

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Parathyroid Gland Autofluorescence Characteristics in Patients With Primary Hyperparathyroidism

et al. 2021

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Near-Infrared Autofluorescence Signatures of Single- vs Multigland Disease in Primary Hyperparathyroidism

Akgun,

Berber

2024

JAMA Otolaryngol Head Neck Surg

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ImportanceThe success of parathyroidectomy depends on accurate intraoperative localization and identification of all diseased glands in parathyroid exploration based on surgeon expertise to prevent persistent hyperparathyroidism. Near-infrared autofluorescence (NIRAF) imaging has recently emerged as a promising adjunctive intraoperative tool for localizing parathyroid glands; however, its potential utility in the assessment of parathyroid glands has yet to be established.ObjectiveTo analyze the differences in NIRAF signatures of parathyroid glands in single vs multiple glands in primary hyperparathyroidism (pHPT).Design, Setting, and ParticipantsThis prospective diagnostic study analyzed in vivo NIRAF images of parathyroid glands obtained during parathyroidectomies between November 18, 2019, and December 31, 2023, at a single tertiary referral center. Pixel intensities of the images were measured using third-party software. Patients who underwent parathyroidectomy for sporadic pHPT using a second-generation NIRAF imaging device were included. Patients with multiple endocrine neoplasm disorders were excluded. In vivo NIRAF images obtained during the procedures were analyzed.ExposureNear-infrared autofluorescence imaging during parathyroidectomy.Main Outcomes and MeasuresThe primary outcomes were the autofluorescence intensity and heterogeneity of single adenomas and multigland disease (ie, double adenomas and 3- or 4-gland hyperplasia) in sporadic pHPT. Normalized autofluorescence intensity was calculated by dividing the mean pixel intensity of the parathyroid gland by the background tissue. A heterogeneity index was calculated by dividing the standard deviation by the mean pixel intensity of the gland. The secondary outcome was the visibility of each parathyroid gland on NIRAF imaging before it became apparent to the naked eye during exploration.ResultsA total of 1287 in vivo NIRAF images obtained from 377 patients (median [IQR] age, 66 [56-73] years; 299 female [79.3%]) were analyzed. Of all patients, 230 (61.0%) had a single adenoma, 91 (24.1%) had double adenomas, and 56 (14.9%) had 3- or 4-gland hyperplasia. A mean (SD) of 3.4 (1.1) parathyroid glands were identified in the procedures. A comparison of 581 diseased glands (45.1%) and 706 normal glands (54.9%) showed a lower median normalized autofluorescence intensity of 2.09 (95% CI, 1.07-4.01) vs 2.66 (95% CI, 1.43-4.20; effect size = 0.36) and higher heterogeneity index of 0.18 (95% CI, 0.07-0.41) vs 0.11 (95% CI, 0.01-0.27; effect size = 0.45), respectively. Of diseased glands, single adenomas (233 [40.1%]) vs double adenomas (187 [32.2%]) and 3- or 4-gland hyperplasia (161 [27.7%]) had a lower median autofluorescence intensity of 1.92 (95% CI, 1.02-4.44) vs 2.22 (95% CI, 1.10-3.97; effect size = 0.21), respectively. On receiver operating characteristic analysis, the optimal autofluorescence intensity threshold to differentiate between single adenomas vs multigland disease was 2.14, with a sensitivity of 64.4%, specificity of 58.1%, and area under the curve of 0.626.Conclusions and RelevanceThese findings suggest that parathyroid glands in single- vs multigland disease may exhibit different autofluorescence characteristics. Although the effect size was modest, the differences identified should be kept in mind when assessing the parathyroid glands during surgical exploration.

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The utility of parathyroid autofluorescence as an adjunct in thyroid and parathyroid surgery 2023

Pace‐Asciak,

Russell,

Solorzano

et al. 2023

Head & Neck

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Thyroid and parathyroid surgery requires careful dissection around the vascular pedicle of the parathyroid glands to avoid excessive manipulation of the tissues. If the blood supply to the parathyroid glands is disrupted, or the glands are inadvertently removed, temporary and/or permanent hypocalcemia can occur, requiring post‐operative exogenous calcium and vitamin D analogues to maintain stable levels. This can have a significant impact on the quality of life of patients, particularly if it results in permanent hypocalcemia. For over a decade, parathyroid tissue has been noted to have unique intrinsic properties known as “fluorophores,” which fluoresce when excited by an external light source. As a result, parathyroid autofluorescence has emerged as an intra‐operative technique to help with identification of parathyroid glands and to supplement direct visualization during thyroidectomy and parathyroidectomy. Due to the growing body of literature surrounding Near Infrared Autofluorescence (NIRAF), we sought to review the value of using autofluorescence technology for parathyroid detection during thyroid and parathyroid surgery. A literature review of parathyroid autofluorescence was performed using PubMED. Based on the reviewed literature and expert surgeons' opinions who have used this technology, recommendations were made. We discuss the current available technologies (image vs. probe approach) as well as their limitations. We also capture the opinions and recommendations of international high‐volume endocrine surgeons and whether this technology is of value as an intraoperative adjunct. The utility and value of this technology seems promising and needs to be further defined in different scenarios involving surgeon experience and different patient populations and conditions.

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Autofluorescence pattern of parathyroid adenomas

Cited by 32 publications

References 30 publications

Parathyroid Gland Autofluorescence Characteristics in Patients With Primary Hyperparathyroidism

Parathyroid Gland Autofluorescence Characteristics in Patients With Primary Hyperparathyroidism

Near-Infrared Autofluorescence Signatures of Single- vs Multigland Disease in Primary Hyperparathyroidism

The utility of parathyroid autofluorescence as an adjunct in thyroid and parathyroid surgery 2023

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