Top

Published in:

01-09-2016 | Original Scientific Report

Intraoperative Near-infrared Imaging for Parathyroid Gland Identification by Auto-fluorescence: A Feasibility Study

Authors: Frederic De Leeuw, Ingrid Breuskin, Muriel Abbaci, Odile Casiraghi, Haïtham Mirghani, Aïcha Ben Lakhdar, Corinne Laplace-Builhé, Dana Hartl

Published in: World Journal of Surgery | Issue 9/2016

Abstract

Background

Parathyroid glands (PGs) can be particularly hard to distinguish from surrounding tissue and thus can be damaged or removed during thyroidectomy. Postoperative hypoparathyroidism is the most common complication after thyroidectomy. Very recently, it has been found that the parathyroid tissue shows near-infrared (NIR) auto-fluorescence which could be used for intraoperative detection, without any use of contrast agents. The work described here presents a histological validation ex vivo of the NIR imaging procedure and evaluates intraoperative PG detection by NIR auto-fluorescence using for the first time to our knowledge a commercially available clinical NIR imaging device.

Methods

Ex vivo study on resected operative specimens combined with a prospective in vivo study of consecutive patients who underwent total or partial thyroid, or parathyroid surgery at a comprehensive cancer center. During surgery, any tissue suspected to be a potential PG by the surgeon was imaged with the Fluobeam 800 ^® system. NIR imaging was compared to conventional histology (ex vivo) and/or visual identification by the surgeon (in vivo).

Results

We have validated NIR auto-fluorescence with an ex vivo study including 28 specimens. Sensitivity and specificity were 94.1 and 80 %, respectively. Intraoperative NIR imaging was performed in 35 patients and 81 parathyroids were identified. In 80/81 cases, the fluorescence signal was subjectively obvious on real-time visualization. We determined that PG fluorescence is 2.93 ± 1.59 times greater than thyroid fluorescence in vivo.

Conclusions

Real-time NIR imaging based on parathyroid auto-fluorescence is fast, safe, and non-invasive and shows very encouraging results, for intraoperative parathyroid identification.

Binder-Foucard F, Bossard N, Delafosse P et al (2014) Cancer incidence and mortality in France over the 1980–2012 period: solid tumors. Rev Epidemiol Sante Publique 62:95–108. doi:10.1016/j.respe.2013.11.073 CrossRefPubMed

Shaha AR (2004) Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope 114:393–402. doi:10.1097/00005537-200403000-00001 CrossRefPubMed

Kim TY, Kim WG, Kim WB, Shong YK (2014) Current status and future perspectives in differentiated thyroid cancer. Endocrinol Metab (Seoul) 29:217–225. doi:10.3803/EnM.2014.29.3.217 CrossRef

Hartl DM, Brasnu DF, Shah JP et al (2013) Is open surgery for head and neck cancers truly declining? Eur Arch Otorhinolaryngol 270:2793–2802. doi:10.1007/s00405-012-2322-y CrossRefPubMed

Christou N, Mathonnet M (2013) Complications after total thyroidectomy. J Visc Surg 150:249–256. doi:10.1016/j.jviscsurg.2013.04.003 CrossRefPubMed

Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A (2015) Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg 102:359–367. doi:10.1002/bjs.9676 CrossRefPubMed

Mittendorf EA, McHenry CR (2004) Complications and sequelae of thyroidectomy and an analysis of surgeon experience and outcome. Surg Technol Int 12:152–157PubMed

Vahrmeijer AL, Hutteman M, van der Vorst JR et al (2013) Image-guided cancer surgery using near-infrared fluorescence. Nat Rev Clin Oncol 10:507–518CrossRefPubMedPubMedCentral

Hadjipanayis CG, Jiang H, Roberts DW, Yang L (2011) Current and future clinical applications for optical imaging of cancer: from intraoperative surgical guidance to cancer screening. Semin Oncol 38:109–118. doi:10.1053/j.seminoncol.2010.11.008 CrossRefPubMedPubMedCentral

10.

Paras C, Keller M, White L et al (2011) Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt 16:67012–67014CrossRef

11.

McWade MA, Paras C, White LM et al (2013) A novel optical approach to intraoperative detection of parathyroid glands. Surgery 154:1371–1377. doi:10.1016/j.surg.2013.06.046 CrossRefPubMedPubMedCentral

12.

McWade M, Paras C, White LM et al (2014) Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging. J Clin Endocrinol Metab 99:4574–4580. doi:10.1210/jc.2014-2503 CrossRefPubMedPubMedCentral

13.

Lorente-Poch L, Sancho JJ, Munoz-Nova JL et al (2015) Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg 4:82–90. doi:10.3978/j.issn.2227-684X.2014.12.04 PubMedPubMedCentral

14.

Guimaraes AV, Brandao LG, Dedivitis RA (2010) Contact endoscopy for identifying the parathyroid glands during thyroidectomy. Acta Otorhinolaryngol Ital 30:20–26PubMedPubMedCentral

15.

Suh YJ, Choi JY, Chai YJ et al (2014) Indocyanine green as a near-infrared fluorescent agent for identifying parathyroid glands during thyroid surgery in dogs. Surg Endosc. doi:10.1007/s00464-014-3971-2

16.

Takeuchi S, Shimizu K, Shimizu K Jr et al (2014) Identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid during endocrine neck surgery. J Nippon Med Sch 81:84–93CrossRefPubMed

17.

Antakia R, Gayet P, Guillermet S et al (2014) Near infrared fluorescence imaging of rabbit thyroid and parathyroid glands. J Surg Res 192:480–486. doi:10.1016/j.jss.2014.05.061 CrossRefPubMed

18.

Hyun H, Park MH, Owens EA et al (2015) Structure-inherent targeting of near-infrared fluorophores for parathyroid and thyroid gland imaging. Nat Med 21:192–197. doi:10.1038/nm.3728 CrossRefPubMedPubMedCentral

19.

Chakedis JM, Maser C, Brumund KT, Bouvet M (2015) Indocyanine green fluorescence-guided redo parathyroidectomy. BMJ Case Rep. doi:10.1136/bcr-2015-211778 PubMed

20.

McWade MA, Sanders ME, Broome JT et al (2015) Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery. doi:10.1016/j.surg.2015.06.047 PubMed

21.

Stavrakis AI, Ituarte PH, Ko CY, Yeh MW (2007) Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 142:887–899. doi:10.1016/j.surg.2007.09.003 CrossRefPubMed

22.

Mondal SB, Gao S, Zhu N et al (2014) Real-time fluorescence image-guided oncologic surgery. Adv Cancer Res 124:171–211. doi:10.1016/B978-0-12-411638-2.00005-7 CrossRefPubMedPubMedCentral

23.

Zhu B, Sevick-Muraca EM (2015) A review of performance of near-infrared fluorescence imaging devices used in clinical studies. Br J Radiol 88:20140547. doi:10.1259/bjr.20140547 CrossRefPubMed

24.

de Boer E, Harlaar NJ, Taruttis A et al (2015) Optical innovations in surgery. Br J Surg 102:e56–e72. doi:10.1002/bjs.9713 CrossRefPubMed

Title: Intraoperative Near-infrared Imaging for Parathyroid Gland Identification by Auto-fluorescence: A Feasibility Study
Authors: Frederic De Leeuw
Ingrid Breuskin
Muriel Abbaci
Odile Casiraghi
Haïtham Mirghani
Aïcha Ben Lakhdar
Corinne Laplace-Builhé
Dana Hartl
Publication date: 01-09-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 9/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3571-5

2024 ASCO Annual Meeting

Springer Medicine

Intraoperative Near-infrared Imaging for Parathyroid Gland Identification by Auto-fluorescence: A Feasibility Study

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2016

High Probability of an Underlying Colorectal Cancer Among Patients Treated for Acute Diverticulitis. A Population-Based Cohort Follow-Up Study

Access to Safe Obstetric Surgical Care in Low-Income Countries

The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

Prospective Validation of Optimal Drain Management “The 3 × 3 Rule” after Liver Resection

In Response to Letter to the Editor: Resanovic A, Resanovic V, Zdravkovic D, Toskovic B, Djordjevic M (2016) Bile Duct Injuries Indeed are a Rare, But Much Feared Complication

Orthopedic Activity in Field Hospitals Following Earthquakes in Nepal and Haiti