Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands

Demarchi, M.; Karenovicŝ, Wolfram; Bédat, Benoît; Triponez, Frédéric

doi:10.3390/jcm9030830

Cited by 50 publications

(52 citation statements)

References 41 publications

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“…4 ). Adipose tissue was noted in two instances, one with white and the other with brown adipose tissue ( Figs 9 and 10 ), which is a well known cause of false-positive NIRAF findings in non-parathyroid tissues 12 , 14 , 19 . One specimen showed mild oncocytic (oxyphilic) foci of the parathyroid adenoma, and in another the mark was wrongly placed on the adenomatous part of the specimen.…”

Section: Resultsmentioning

confidence: 99%

Autofluorescence pattern of parathyroid adenomas

et al. 2021

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Background Primary hyperparathyroidism (pHPT) is a common endocrine pathology, and it is due to a single parathyroid adenoma in 80–85 per cent of patients. Near-infrared autofluorescence (NIRAF) has recently been used in endocrine surgery to help in the identification of parathyroid tissue, although there is currently no consensus on whether this technique can differentiate between normal and abnormal parathyroid glands. The aim of this study was to describe the autofluorescence pattern of parathyroid adenoma in pHPT. Methods Between January and June 2019, patients with pHPT who underwent surgical treatment for parathyroid adenoma were enrolled. Parathyroid autofluorescence was measured. Results Twenty-three patients with histologically confirmed parathyroid adenomas were included. Parathyroid adenomas showed a heterogeneous fluorescence pattern, and a well defined autofluorescent ‘cap’ region was observed in 17 of 23 specimens. This region was on average 28 per cent more fluorescent than the rest of the adenoma, and corresponded to a rim of normal histological parathyroid tissue (sensitivity and specificity 88 and 67 per cent respectively). After resection, all patients were treated successfully, with normal postoperative values of calcium and parathyroid hormone documented. Conclusion Parathyroid adenomas show a heterogeneous autofluorescence pattern. Using NIRAF imaging, the majority of specimens showed a well defined autofluorescent portion corresponding to a rim of normal parathyroid tissue. Further studies should be conducted to validate these findings.

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Section: Resultsmentioning

confidence: 99%

Autofluorescence pattern of parathyroid adenomas

et al. 2021

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“…[35][36][37] ICG has been trialed in various off-label studies for intraoperative analysis of tissue viability during bowel anastomosis or plastic surgery reconstructions, biliary surgery, parathyroid identification, tumor identification, and lymphography and sentinel node identification in various malignancies. [37][38][39][40] A number of studies assessing the potential of ICG to aid in sentinel lymph node mapping through the use of fluorescence imaging have now been published, including a critical mass of high-quality prospective studies. [21][22][23][24][25][26][27][28][29][30] Previous meta-analyses comparing the sentinel node detection rates between ICG and BD and RI 38,41,42 were limited by source data reporting the identification rate per patient (i.e.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery

et al. 2020

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Introduction Conventional methods for axillary sentinel lymph node biopsy (SLNB) are fraught with complications such as allergic reactions, skin tattooing, radiation, and limitations on infrastructure. A novel technique has been developed for lymphatic mapping utilizing fluorescence imaging. This meta-analysis aims to compare the gold standard blue dye and radioisotope (BD-RI) technique with fluorescence-guided SLNB using indocyanine green (ICG). Methods This study was registered with PROSPERO (CRD42019129224). The MEDLINE, EMBASE, Scopus, and Web of Science databases were searched using the Medical Subject Heading (MESH) terms ‘Surgery’ AND ‘Lymph node’ AND ‘Near infrared fluorescence’ AND ‘Indocyanine green’. Studies containing raw data on the sentinel node identification rate in breast cancer surgery were included. A heterogeneity test (using Cochran’s Q) determined the use of fixed- or random-effects models for pooled odds ratios (OR). Results Overall, 1748 studies were screened, of which 10 met the inclusion criteria for meta-analysis. ICG was equivalent to radioisotope (RI) at sentinel node identification (OR 2.58, 95% confidence interval [CI] 0.35–19.08, p < 0.05) but superior to blue dye (BD) (OR 9.07, 95% CI 6.73–12.23, p < 0.05). Furthermore, ICG was superior to the gold standard BD-RI technique (OR 4.22, 95% CI 2.17–8.20, p < 0.001). Conclusion Fluorescence imaging for axillary sentinel node identification with ICG is equivalent to the single technique using RI, and superior to the dual technique (RI-BD) and single technique with BD. Hospitals using RI and/or BD could consider changing their practice to ICG given the comparable efficacy and improved safety profile, as well as the lesser burden on hospital infrastructure.

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“…In this regard, the controversy is similar to that for nerve monitoring. Recently, NIFI has been combined with indocyanine green angiography 30 . Whether, this modification would provide benefits in regard to the preservation of parathyroid vasculature is unknown at this time.…”

Section: Discussionmentioning

confidence: 99%

The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy

Kim

Erten

Kahramangil

et al. 2020

Journal of Surgical Oncology

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Background Compared with conventional thyroidectomy, hypocalcemia rate was reported to be lower after total thyroidectomy (TT) utilizing near infrared fluorescence imaging (NIFI). The aim of this study is to evaluate the impact of NIFI on postoperative parathyroid function after TT. Methods This was a retrospective institutional review board‐approved study comparing 100 patients who underwent TT with NIFI guidance and 200 patients without, by the same surgeon. Clinical parameters were compared using χ2 and t test. Results Average number of parathyroid glands identified intraoperatively was similar between two groups. However, rate of incidental parathyroidectomy was higher in conventional (14%) versus NIFI group (6%) (P = .039), despite similar (4% vs 6%, respectively) autotransplantation rates (P = .562). Incidences of transient (6.5% vs 5.0%) and permanent (0.5% vs 0%) hypocalcemia were not statistically different between conventional and NIFI groups (P = NS). Conclusion The use of NIFI during thyroidectomy may decrease the rate of incidental parathyroidectomy by increasing the ability of the surgeon to recognize parathyroid glands with fluorescent contrast distinction. Nevertheless, in contrary to recent reports in literature, postoperative hypocalcemia rate was not altered compared with conventional technique, suggesting that preservation of parathyroid vasculature, rather than an augmented ability to detect the glands, may dominantly affect postoperative function.

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Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands

Cited by 50 publications

References 41 publications

Autofluorescence pattern of parathyroid adenomas

Autofluorescence pattern of parathyroid adenomas

Meta-analysis Comparing Fluorescence Imaging with Radioisotope and Blue Dye-Guided Sentinel Node Identification for Breast Cancer Surgery

The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy

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