A novel optical approach to intraoperative detection of parathyroid glands.
A novel optical approach to intraoperative detection of parathyroid glands.
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DOI：
10.1016/j.surg.2013.06.046
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发表时间：
2013-12
期刊：
影响因子：
3.8
通讯作者：
Broome, James T.
中科院分区：
文献类型：
--
作者：
McWade, Melanie A.;Paras, Constantine;White, Lisa M.;Phay, John E.;Mahadevan-Jansen, Anita;Broome, James T.
无意中切除甲状旁腺是内分泌手术中的一个挑战。迫切需要一种能够在手术过程中提供灵敏、实时甲状旁腺检测的诊断工具。我们开发了一种术中技术，利用近红外 (NIR) 荧光对甲状旁腺进行体内实时检测，无论其病理状态如何。术中测量了 45 名接受甲状旁腺切除术和甲状腺切除术的患者的近红外荧光。在手术过程中，使用基于探针的便携式荧光系统在 785 nm 激发下测量甲状旁腺和周围颈部组织的光谱。通过与组织学或外科医生的视觉识别进行比较来评估准确性。近红外荧光检测 100% 的患者有甲状旁腺。甲状旁腺荧光比甲状腺强（1.2-18倍），荧光峰值在822 nm。周围组织未显示自发荧光。疾病状态并不影响区分甲状旁腺的能力，但可能会导致信号变异。无论组织病理如何，近红外荧光光谱都可以在术中检测甲状旁腺。该信号可能是由甲状旁腺中存在的钙敏感受体引起的。信号强度和一致性表明该方法的简单性和有效性。它的实施可以限制手术时间、降低成本并提高手术成功率。
Inadvertent removal of parathyroid glands is a challenge in endocrine operations. There is a critical need for a diagnostic tool that provides sensitive, real-time parathyroid detection during procedures. We have developed an intraoperative technique using near-infrared (NIR) fluorescence for in vivo, real-time detection of the parathyroid regardless of its pathologic state. NIR fluorescence was measured intraoperatively from 45 patients undergoing parathyroidectomy and thyroidectomy. Spectra were measured from the parathyroid and surrounding neck tissues during the operation with the use of a portable, probe-based fluorescence system at 785-nm excitation. Accuracy was evaluated by comparison with histology or visual recognition by the surgeon. NIR fluorescence detected the parathyroid in 100% of patients. Parathyroid fluorescence was stronger (1.2–18 times) than that of the thyroid with peak fluorescence at 822 nm. Surrounding tissues showed no auto-fluorescence. Disease state did not affect the ability to discriminate parathyroid glands but may account for signal variability. NIR fluorescence spectroscopy can detect intraoperatively the parathyroid regardless of tissue pathology. The signal may be caused by calcium-sensing receptors present in the parathyroid. The signal strength and consistency indicates the simplicity and effectiveness of this method. Its implementation may limit operative time, decrease costs, and improve operative success rates.
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