Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection.
Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection.
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DOI：
10.1016/j.surg.2015.06.047
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发表时间：
2016-01
期刊：
影响因子：
3.8
通讯作者：
Mahadevan-Jansen A
中科院分区：
文献类型：
--
作者：
McWade MA;Sanders ME;Broome JT;Solórzano CC;Mahadevan-Jansen A
在颈部内分泌手术中无法准确识别甲状旁腺阻碍了患者实现术后正常血钙。建立了一种用于甲状旁腺高精度实时识别的本征近红外荧光方法。这项研究评估了这种方法的临床实用性。对137例接受甲状旁腺切除术和/或甲状腺切除术的患者(264个甲状旁腺)进行了自体荧光测量。测量结果与疾病状态、钙水平、甲状旁腺激素(PTH)、维生素D水平、年龄、性别、种族和体重指数(BMI)相关。统计分析确定了哪些因素对甲状旁腺检测有显著影响。持续检测到甲状旁腺高荧光，并在不同患者之间表现出广泛的变异性。使用近红外荧光技术正确识别了256/264(97%)的腺体。尽管继发性甲状旁腺功能亢进的患者表现出令人困惑的结果，但该技术在各种疾病状态下显示出高准确度。分析表明，体重指数(P<；0.01)、疾病状态(P<；0.01)、维生素D(P<；0.05)和钙水平(P<；0.05)显著影响信号强度的变化。年龄、性别、甲状旁腺素和种族没有影响。这种基于固有荧光的术中技术可以实时准确地检测几乎所有的甲状旁腺。它的分辨能力在很大程度上不受患者变量的限制，但有几个因素会影响信号强度。这些结果显示了光学导引检测甲状旁腺的潜在临床应用价值。
Inability to accurately identify parathyroid glands during cervical endocrine surgery hinders patients from achieving post-operative normocalcemia. An intrinsic near-infrared fluorescence method was developed for real-time parathyroid identification with high accuracy. This study assesses the clinical utility of this approach. Autofluorescence measurements were obtained from 137 patients (264 parathyroid glands) undergoing parathyroidectomy and/or thyroidectomy. Measurements were correlated to disease state, calcium levels, parathyroid hormone (PTH), vitamin D levels, age, sex, ethnicity and body-mass index (BMI). Statistical analysis identified which factors significantly affect parathyroid detection. High parathyroid fluorescence was consistently detected and showed wide variability across patients. Near-infrared fluorescence was used to correctly identify 256/264 (97%) of glands. The technique showed high accuracy over a wide variety of disease states, though patients with secondary hyperparathyroidism demonstrated confounding results. Analysis revealed BMI (P<0.01), disease state (P<0.01), vitamin D (P<0.05), and calcium levels (P<0.05) account significantly for variability in signal intensity. Age, gender, PTH, and ethnicity had no effect. This intrinsic fluorescence-based intraoperative technique can accurately detect nearly all parathyroid glands in real-time. Its discrimination capacity is largely unlimited by patient variables, but several factors affect signal intensity. These results demonstrate potential clinical utility of optical guidance for parathyroid detection.