Autofluorescence imaging of parathyroid glands: An assessment of potential indications
Autofluorescence imaging of parathyroid glands: An assessment of potential indications
复制标题
DOI：
10.1016/j.surg.2019.04.072
复制
发表时间：
2020-01-01
期刊：
影响因子：
3.8
通讯作者：
Berber, Eren
中科院分区：
文献类型：
--
作者：
Kose, Emin;Rudin, Anatoliy, V;Berber, Eren
背景：本研究的目的是通过将自身荧光特征与病理标本相关联，确定近红外荧光成像检测甲状旁腺的准确性，以及近红外荧光成像在甲状腺和甲状旁腺手术中的潜在适应症。方法：这是一项机构审查委员会批准的，对接受甲状腺切除术和甲状旁腺切除术的患者进行近红外荧光成像的前瞻性研究。每个送到病理学处的标本都用近红外荧光成像检查，并根据其自身荧光特征预测是甲状旁腺组织还是非甲状旁腺组织，然后与病理结果相关联。结果：自体荧光被证明存在于98%的甲状旁腺，23%的人在外科医生进行视觉识别之前，根据自体荧光特征用红外线正确识别。有550个标本用自身荧光成像，然后送到病理室。对于这些样本，预测甲状旁腺组织的敏感性、特异性和阳性和阴性预测值分别为98.5%、97.2%、95.1%和99.1%。在5%的全甲状腺切除术标本中，偶然切除的甲状旁腺被自身荧光识别，导致其随后的再植。在甲状旁腺疾病和术前定位阴性的患者中，21%的异常腺体在外科医生肉眼识别之前被自身荧光识别出来。结论：虽然红外自身荧光对手术标本中甲状旁腺组织存在的确认能力很高，但在外科医生视觉识别前原位发现甲状旁腺的能力较低。在将该技术纳入内分泌外科实践时，应牢记这些优点和局限性。一旦外科医生发现了甲状旁腺，或者发现了类似甲状旁腺的组织，自体荧光标记就可以非常准确地确定甲状旁腺组织。(C) 2019 Elsevier Inc.版权所有。
Background: The aim of this study was to determine both the accuracy of near infrared fluorescence imaging to detect parathyroid glands and the potential indications of near infrared fluorescence imaging in thyroid and parathyroid surgery by correlating the autofluorescence signature with the pathologic specimen.Methods: This was an institutional review board-approved, prospective study of patients undergoing thyroidectomy and parathyroidectomy with near infrared fluorescence imaging. Each specimen sent to pathology was inspected with near infrared fluorescence imaging and predicted to be either parathyroid or non-parathyroid tissue by its autofluorescence signature and then correlated with the pathologic findings.Results: Autofluorescence was demonstrated to be present in 98% of the parathyroid glands, with 23% identified correctly with infrared based on the autofluorescence signature before visual identification by the surgeon. There were 550 specimens that were imaged with autofluorescence and then sent to pathology. For these samples, sensitivity, specificity, and positive and negative predictive values to predict parathyroid tissue were 98.5%, 97.2%, 95.1%, and 99.1%. In 5% of the total thyroidectomy specimens, incidentally resected parathyroid glands were identified with autofluorescence, leading to their subsequent reimplantation. In patients with parathyroid disease and negative preoperative localization, 21% of abnormal glands were recognized with autofluorescence before visual identification by the surgeon.Conclusion: Although the ability of infrared autofluorescence to confirm the presence of parathyroid tissue within surgical specimens was high, its power to find parathyroid glands in situ before visual recognition by surgeons was low. These advantages and limitations should be kept in mind when incorporating this technology into an endocrine surgical practice. Once a parathyroid seems to have been identified by the surgeon or tissue that looks like a parathyroid gland is identified, the autofluorescence signature is a very accurate assurance of parathyroid tissue. (C) 2019 Elsevier Inc. All rights reserved.