Intraoperative Probe-Based Confocal Endomicroscopy to Histologically Differentiate Thyroid From Parathyroid Tissue...

Area of Science:

• Endocrine Surgery
• Surgical Pathology
• Medical Imaging

Background:

• Frozen section is standard for distinguishing thyroid from parathyroid tissue during neck surgery.
• Frozen section is time-consuming, costly, and requires tissue removal before analysis.
• This study explores probe-based confocal laser endomicroscopy (pCLE) for intraoperative histological confirmation.

Purpose of the Study:

• To demonstrate the histological rendering of normal and pathological tissues using pCLE.
• To assess pCLE's utility in differentiating thyroid and parathyroid tissues in real-time.
• To evaluate pCLE as a tool to guide surgical resection decisions.

Main Methods:

• Prospective, single-institution, nonrandomized observational study.
• Real-time in vivo fluorescence microscopy using a CystoFlex UHD probe after fluorescein sodium injection.
• Comparison of pCLE videos with visual inspection and final histology.

Main Results:

• Eleven patients with hyperparathyroidism and thyroid conditions were included.
• 104 videos of various neck tissues were recorded and analyzed.
• pCLE demonstrated 89.3% sensitivity and 90% specificity in differentiating thyroid and parathyroid tissue compared to histology.

Conclusions:

• Intraoperative pCLE can reliably differentiate thyroid, parathyroid, and lymph node tissues.
• pCLE provides non-traumatic, real-time histological assessment before tissue resection.
• This pilot study suggests pCLE's potential to enhance surgical decision-making in endocrine neck surgery.