Detecting the Near Infrared Autofluorescence of the Human Parathyroid: Hype or Opportunity?
Detecting the Near Infrared Autofluorescence of the Human Parathyroid: Hype or Opportunity?
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DOI：
10.1097/sla.0000000000003700
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发表时间：
2020-12
影响因子：
9
通讯作者：
Mahadevan-Jansen A
中科院分区：
文献类型：
--
作者：
Solórzano CC;Thomas G;Baregamian N;Mahadevan-Jansen A
最近，美国食品药品监督管理局批准了两种基于近红外自体荧光（NIRAF）的设备用于无标签识别甲状旁腺（PG），因此，教育外科界了解这一新兴技术的现实范围变得至关重要。在此，我们对利用NIRAF的研究进行了综述，并对该技术用于术中PG检测进行了关键评价。未能可视化PG可能导致健康PG的意外损伤/切除或无法定位患病PG，从而导致术后并发症。PG具有NIRAF的发现为术中实时高准确性识别PG提供了新的途径。使用以下关键术语：在各种搜索引擎（如PubMed和Google Scholar）中搜索“甲状旁腺，近红外，自体荧光”，我们确定了与NIRAF作为PG识别技术的本综述相关的各种出版物。如果文章仅关注造影剂，作为NIRAF的评论/概述或不是用英语撰写，则将其排除。迄今为止，研究已经调查了NIRAF检测用于（i）术中识别PG组织，（ii）解剖前或解剖后定位PG，（iii）区分健康与患病PG，以及（iv）最大限度减少甲状腺全切除术后术后低钙血症的潜力。由于基于NIRAF的PG鉴定是非侵入性的和无标记的，因此这种方法的普及程度大大增加。由于能够进行NIRAF检测的各种技术目前存在局限性，我们预计将继续开发更新的器械迭代，以增强这些模式的当前优点，从而帮助外科医生识别和保留PG。然而，更具体和长期的结果研究与这些模式是必不可少的，以确定这种技术对患者的结果和实际的成本效益的影响。
With the recent approval of two near infrared autofluorescence (NIRAF)-based devices for label-free identification of parathyroid glands (PG) by the Food and Drug Administration, it becomes crucial to educate the surgical community on the realistic scope of this emerging technology. Here, we have compiled a review of studies that utilize NIRAF and present a critical appraisal of this technique for intraoperative PG detection. Failure to visualize PGs could lead to accidental damage/excision of healthy PGs or inability to localize diseased PGs, resulting in postsurgical complications. The discovery that PGs have NIRAF led to new avenues for intraoperatively identifying PGs with high accuracy in real-time. Using the following key terms: ‘parathyroid, near infrared, autofluorescence’ in various search engines such as PubMed and Google Scholar, we identified various publications relevant to this review of NIRAF as a technique for PG identification. Articles were excluded if they focused solely on contrast agents, served as commentaries/overviews on NIRAF or were not written in English. To date, studies have investigated the potential of NIRAF detection for (i) identifying PG tissues intraoperatively, (ii) locating PGs prior to or after dissection, (iii) distinguishing healthy from diseased PGs and (iv) minimizing post-operative hypocalcemia after total thyroidectomy. Since NIRAF-based identification of PG is non-invasive and label-free, the popularity of this approach has considerably surged. As the present limitations of various technologies capable of NIRAF detection are identified, we anticipate that newer device iterations will continue to be developed enhancing the current merits of these modalities to aid surgeons in identifying and preserving PGs. However, more concrete and long-term outcome studies with these modalities are essential to determine the impact of this technique on patient outcome and actual cost-benefits.