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World Journal of Surgery

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Open Access 01-06-2019 | Hyperparathyroidism | Original Scientific Report

Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but Routine Clinical Use is Not Justified

Authors: Aimee DiMarco, Ravi Chotalia, Ruth Bloxham, Charlotte McIntyre, Neil Tolley, F. Fausto Palazzo

Published in: World Journal of Surgery | Issue 6/2019

Abstract

Background

The inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2–5%. The poorly understood characteristic of parathyroid tissue to manifest autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery.

Methods

Consecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition.

Results

Ninety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially ‘visualisable’ glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF.

Conclusion

Autofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.

Croce AC, Bottiroli G (2014) Autofluorescence spectroscopy and imaging: a tool for biomedical research and diagnosis. Eur J Histochem 58(4):2461CrossRefPubMedPubMedCentral

Meerwaldt R, Lutgers HL, Links TP, Graaff R, Baynes JW, Gans ROB et al (2007) Skin autofluorescence is a strong predictor of cardiac mortality in diabetes. Diabetes Care 30(1):107–112CrossRefPubMed

Tanaka K, Tani Y, Asai J, Nemoto F, Kusano Y, Suzuki H et al (2005) Skin autofluorescence is associated with severity of vascular complications in Japanese patients with Type 2 diabetes. Diabet Med 16(12):3687–3693

Keller MD, Majumder SK, Kelley MC, Meszoely IM, Boulos FI, Olivares GM et al (2010) Autofluorescence and diffuse reflectance spectroscopy and spectral imaging for breast surgical margin analysis. Lasers Surg Med 42(1):15–23CrossRefPubMed

Won Y, Hong SH, Yu HY, Kwon YH, Yun SJ, Lee SC et al (2007) Photodetection of basal cell carcinoma using methyl 5-aminolaevulinate-induced protoporphyrin IX based on fluorescence image analysis. Clin Exp Dermatol 32(4):423–429CrossRefPubMed

Kuwayama K, Miyauchi S, Tateoka R, Abe H, Kamo N (2002) Fluorescein uptake by a monocarboxylic acid transporter in human intestinal Caco-2 cells. Biochem Pharmacol 63(1):81–88CrossRefPubMed

Ris F, Hompes R, Cunningham C, Lindsey I, Guy R, Jones O et al (2014) Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery. Surg Endosc Other Interv Tech 28(7):2221–2226CrossRef

Vahrmeijer AL, Hutteman M, Van Der Vorst JR, Van De Velde CJH, Frangioni JV (2013) Image-guided cancer surgery using near-infrared fluorescence. Nat Rev Clin Oncol 10(9):507–518CrossRefPubMedPubMedCentral

Paras C, Keller M, White L, Phay J, Mahadevan-Jansen A (2011) Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt 16(6):67012CrossRef

10.

McWade MA, Paras C, White LM, Phay JE, Mahadevan-Jansen A, Broome JT (2013) A novel optical approach to intraoperative detection of parathyroid glands. Surgery (United States) 154(6):1371–1377

11.

Ladurner R, Al Arabi N, Guendogar U, Hallfeldt K, Stepp H, Gallwas J (2018) Near-infrared autofluorescence imaging to detect parathyroid glands in thyroid surgery. Ann R Coll Surg Engl 100(1):33–36CrossRefPubMed

12.

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

13.

Stavrakis AI, Ituarte PHG, Ko CY, Yeh MW (2007) Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 142(6):887–899CrossRefPubMed

14.

Vidal Fortuny J, Belfontali V, Sadowski SM, Karenovics W, Guigard S, Triponez F (2016) Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery. Br J Surg 103(5):537–543CrossRefPubMedPubMedCentral

15.

Vidal Fortuny J, Karenovics W, Triponez F, Sadowski SM (2016) Intra-operative indocyanine green angiography of the parathyroid gland. World J Surg. https://doi.org/10.1007/s00268-016-3493-2 CrossRefPubMedPubMedCentral

16.

Christensen SE, Nissen PH, Vestergaard P, Heickendorff L, Brixen K, Mosekilde L (2008) Discriminative power of three indices of renal calcium excretion for the distinction between familial hypocalciuric hypercalcaemia and primary hyperparathyroidism: a follow-up study on methods. Clin Endocrinol (Oxf) 69(5):713–720CrossRef

17.

Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C et al (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the fourth international workshop. J Clin Endocrinol Metab 99(10):3561–3569CrossRefPubMedPubMedCentral

18.

Wheeler DC, Winkelmayer WC (2017) KDIGO 2017 clinical practice guideline for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 7(1):1–59CrossRef

19.

Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin GL, Udelsman R et al (2003) Comparison of intraoperative iPTH assay (QPTH) criteria in guiding PTx: which criterion is the most accurate? Surgery 134:973–981CrossRefPubMed

20.

McWade MA, Paras C, White LM, Phay JE, Solórzano CC, Broome JT et al (2014) Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging. J Clin Endocrinol Metab 99(12):4574–4580CrossRefPubMedPubMedCentral

21.

McWade MA, Sanders ME, Broome JT, Solórzano CC, Mahadevan-Jansen A (2016) Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery (United States) 159:193–202

22.

Gogusev J, Duchambon P, Hory B, Giovannini M, Goureau Y, Sarfati E et al (1997) Depressed expression of calcium receptor in parathyroid gland tissue of patients with hyperparathyroidism. Kidney Int 51(1):328–336CrossRefPubMed

23.

Shinden Y, Nakajo A, Arima H, Tanoue K, Hirata M, Kijima Y et al (2017) Intraoperative identification of the parathyroid gland with a fluorescence detection system. World J Surg 41(6):1506–1512. https://doi.org/10.1007/s00268-017-3903-0 CrossRefPubMed

Title: Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but Routine Clinical Use is Not Justified
Authors: Aimee DiMarco
Ravi Chotalia
Ruth Bloxham
Charlotte McIntyre
Neil Tolley
F. Fausto Palazzo
Publication date: 01-06-2019
Publisher: Springer International Publishing
Keywords: Hyperparathyroidism
Parathyroidectomy
Parathyroidectomy
Published in: World Journal of Surgery / Issue 6/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-04929-9

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Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but Routine Clinical Use is Not Justified

Abstract

Background

Methods

Results

Conclusion

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Abstract

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