Near-Infrared Fluorescence Imaging in the Identification of Parathyroid Glands in Thyroidectomy
Near-Infrared Fluorescence Imaging in the Identification of Parathyroid Glands in Thyroidectomy
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近红外荧光成像在甲状腺切除术中甲状旁腺的识别
DOI：
10.1002/lary.29163
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发表时间：
2021
期刊：
影响因子：
2.6
通讯作者：
Takeshi Takahashi et al
中科院分区：
文献类型：
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作者：
Kuroki Masashi;Shibata Hirofumi;Iinuma Ryota;Okuda Hiroshi;Ohashi Toshimitsu;Ogawa Takenori;Horikawa Yukio;Takeshi Takahashi et al
目的/假设评估近红外荧光成像（NIFI）在组织学证实的PG/非PG标本中识别甲状旁腺（PG）的能力，并与外科医生的视觉敏锐度进行比较，并确定NIFI在检测甲状腺切除术标本中偶然切除的PG时的灵敏度，与外科医生的视觉检查相比。研究设计前瞻性研究。36例各种甲状腺疾病患者入组。通过有经验的外科医生的目视检查识别可能的PG（n = 28）和淋巴结（n = 32）。使用NIFI，从甲状腺切除术标本中进一步鉴定出15个PG。对于这75个样本，记录了外科医生的判断（PG与非PG）。在检查每个标本的NIFI自体荧光后进行组织学评估。结果在识别PG方面，外科医生的视觉检查和NIFI之间的敏感性、特异性、阳性预测值和阴性预测值均无显著差异，其值分别为100%/97.1%、85.0%/87.5%、85.4%/87.2%和100%/97.2%，分别NIFI检测甲状腺切除术标本PG的敏感性（82.9%）显著高于外科医生目视检查（61.0%）。假阴性标本包含出血/充血和/或封装厚的组织，而假阳性标本包含电凝tissues.ConclusionsNIFI显示结果相媲美的经验丰富的外科医生的目视检查，在识别PG。这可能有利于新手外科医生。对于经验丰富的外科医生来说，NIFI可能有助于在甲状腺切除术标本中定位偶然切除的PG，以进行自体移植。预防腺体内出血和充血，小心去除厚囊，以及无电凝的无血手术对于减少假阳性和假阴性结果非常重要。喉镜，131：1188-1193，2021
Objectives/HypothesisTo assess the ability of near‐infrared fluorescence imaging (NIFI) to identify parathyroid glands (PGs) among histologically proven PG/non‐PG specimens compared with a surgeon's visual acumen, and to determine NIFI sensitivity in detecting incidentally resected PGs from thyroidectomy specimens, compared to the surgeon's visual inspection.Study DesignProspective study.MethodsWith mean age of 61 years, 36 patients with various thyroid diseases were enrolled. Possible PGs (n = 28) and lymph nodes (n = 32) were identified by the experienced surgeon's visual inspection. Using NIFI, 15 PGs were further identified from thyroidectomy specimens. For these 75 specimens, the surgeon's judgments (PG vs. non‐PG) were recorded. Histological evaluation was performed after examining the NIFI auto‐fluorescence of each specimen.ResultsThere were no significant differences in sensitivity, specificity, positive predictive value, and negative predictive value between the surgeon's visual inspection and NIFI in identifying PGs, with values of 100%/97.1%, 85.0%/87.5%, 85.4%/87.2%, and 100%/97.2%, respectively. The sensitivity of NIFI (82.9%) for detection of PGs from thyroidectomy specimens was significantly higher than that of the surgeon's visual inspection (61.0%). False negative specimens contained bleeding/congestion and/or encapsulation by thick tissues, whereas false positive specimens contained electrocoagulated tissues.ConclusionsNIFI showed results comparable to the experienced surgeon's visual inspection in identifying PGs. This could benefit novice surgeons. NIFI may be useful for experienced surgeons to locate incidentally resected PGs within thyroidectomy specimens for auto‐transplantation. Prevention of intra‐gland bleeding and congestion, careful removal of thick capsules, and bloodless surgeries without electrocoagulation are important for reducing false positive and false negative results.Laryngoscope, 131:1188–1193, 2021