BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: A Mahadevan-Jansen; M F Mitchell; N Ramanujam; A Malpica; S Thomsen; U Utzinger; R Richards-Kortum Journal: Photochem Photobiol Date: 1998-07 Impact factor: 3.421
Authors: N Ramanujam; M F Mitchell; A Mahadevan-Jansen; S L Thomsen; G Staerkel; A Malpica; T Wright; N Atkinson; R Richards-Kortum Journal: Photochem Photobiol Date: 1996-10 Impact factor: 3.421
Authors: Steven A Toms; Wei-Chiang Lin; Robert J Weil; Mahlon D Johnson; E Duco Jansen; Anita Mahadevan-Jansen Journal: Neurosurgery Date: 2005-10 Impact factor: 4.654
Authors: Matthew D Keller; Shovan K Majumder; Mark C Kelley; Ingrid M Meszoely; Fouad I Boulos; Graciela M Olivares; Anita Mahadevan-Jansen Journal: Lasers Surg Med Date: 2010-01 Impact factor: 4.025
Authors: George J Hunter; Dawid Schellingerhout; Thinh H Vu; Nancy D Perrier; Leena M Hamberg Journal: Radiology Date: 2012-07-12 Impact factor: 11.105
Authors: Jorge Falco; Fernando Dip; Pablo Quadri; Martin de la Fuente; Marcos Prunello; Raúl J Rosenthal Journal: Surg Endosc Date: 2017-03-31 Impact factor: 4.584
Authors: Melanie A McWade; Constantine Paras; Lisa M White; John E Phay; Carmen C Solórzano; James T Broome; Anita Mahadevan-Jansen Journal: J Clin Endocrinol Metab Date: 2014-12 Impact factor: 5.958
Authors: Aimee DiMarco; Ravi Chotalia; Ruth Bloxham; Charlotte McIntyre; Neil Tolley; F Fausto Palazzo Journal: World J Surg Date: 2019-06 Impact factor: 3.352