Sung Won Kim1, Hyoung Shin Lee1, Yeh-Chan Ahn2, Chan Woo Park3, Seok Won Jeon3, Chang Hoi Kim3, Jae Beom Ko3, Chulho Oak4, Yikeun Kim2, Kang Dae Lee5. 1. Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Kosin University, Busan, South Korea; Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, South Korea. 2. Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, South Korea; Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, Busan, South Korea. 3. Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Kosin University, Busan, South Korea. 4. Department of Internal Medicine, College of Medicine, Kosin University, Busan, South Korea; Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, South Korea. 5. Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Kosin University, Busan, South Korea; Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, South Korea. Electronic address: kdlee59@gmail.com.
Abstract
BACKGROUND: Studies to date have shown that near-infrared autofluorescence imaging (NIR) can detect the parathyroid gland during thyroidectomy. However, there are no reports that NIR imaging can identify the parathyroid gland when it's covered with fibrofatty tissue before identification by a surgeon's naked eye. In this study, we investigated the feasibility of parathyroid gland mapping to facilitate early identification of the parathyroid gland during thyroidectomy. STUDY DESIGN: Seventy parathyroid glands from 38 patients who underwent thyroidectomy for papillary thyroid cancer were included in this prospective study. Near-infrared with infrared illumination (NIR-IR) imaging using a 780-nm light-emitting diode was conducted at the predicted locations of the superior or inferior parathyroid glands. Parathyroid mapping was conducted in 3 stages. Stages P1, P2, and P3 were defined as imaging before identification of the gland by direct visualization, imaging after identification, and imaging in the removed specimen, respectively. RESULTS: Sixty-four parathyroid glands (92.8%) could be localized in stage P1 before surgical dissection and exposure of the gland. Five parathyroid glands that were not detected at stage P1 were identified in stages P2 (4 cases, 5.8%) and P3 (1 case, 1.4%). One parathyroid gland was not identified in either the NIR imaging or the pathologic examination. The sensitivity, specificity, and accuracy of parathyroid gland mapping in stages P1, P2, and P3 were all 100%. CONCLUSIONS: Parathyroid gland mapping using our NIR-IR imaging technique was feasible, with an excellent accuracy rate. This technique may be helpful for early identification of parathyroid glands during thyroidectomy.
BACKGROUND: Studies to date have shown that near-infrared autofluorescence imaging (NIR) can detect the parathyroid gland during thyroidectomy. However, there are no reports that NIR imaging can identify the parathyroid gland when it's covered with fibrofatty tissue before identification by a surgeon's naked eye. In this study, we investigated the feasibility of parathyroid gland mapping to facilitate early identification of the parathyroid gland during thyroidectomy. STUDY DESIGN: Seventy parathyroid glands from 38 patients who underwent thyroidectomy for papillary thyroid cancer were included in this prospective study. Near-infrared with infrared illumination (NIR-IR) imaging using a 780-nm light-emitting diode was conducted at the predicted locations of the superior or inferior parathyroid glands. Parathyroid mapping was conducted in 3 stages. Stages P1, P2, and P3 were defined as imaging before identification of the gland by direct visualization, imaging after identification, and imaging in the removed specimen, respectively. RESULTS: Sixty-four parathyroid glands (92.8%) could be localized in stage P1 before surgical dissection and exposure of the gland. Five parathyroid glands that were not detected at stage P1 were identified in stages P2 (4 cases, 5.8%) and P3 (1 case, 1.4%). One parathyroid gland was not identified in either the NIR imaging or the pathologic examination. The sensitivity, specificity, and accuracy of parathyroid gland mapping in stages P1, P2, and P3 were all 100%. CONCLUSIONS: Parathyroid gland mapping using our NIR-IR imaging technique was feasible, with an excellent accuracy rate. This technique may be helpful for early identification of parathyroid glands during thyroidectomy.
Authors: Melanie A McWade; Giju Thomas; John Q Nguyen; Melinda E Sanders; Carmen C Solórzano; Anita Mahadevan-Jansen Journal: J Am Coll Surg Date: 2019-02-13 Impact factor: 6.113