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Two Techniques to Create Hypoparathyroid Mice: Parathyroidectomy Using GFP Glands and Diphtheria-Toxin-Mediated Parathyroid Ablation
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Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but
Aimee DiMarco1,2, Ravi Chotalia1, Ruth Bloxham1
1Department of Endocrine Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
World Journal of Surgery
|February 10, 2019
Summary
Near-infrared autofluorescence (AF) of parathyroid glands correlates with serum calcium, PTH, and cell type. However, current technology requires refinement for routine clinical use in parathyroid surgery.
Area of Science:
- Endocrine Surgery
- Surgical Technology
- Medical Imaging
Background:
- Parathyroid gland identification failure impacts hyperparathyroidism cure rates (2-5%).
- Near-infrared (NIR) autofluorescence (AF) is explored as an intraoperative tool for parathyroid surgery.
- Understanding AF characteristics is crucial for its clinical application.
Purpose of the Study:
- To investigate clinical factors correlating with parathyroid gland AF.
- To evaluate the clinical utility of NIR AF in parathyroid surgery.
Main Methods:
- NIR imaging was employed during parathyroidectomy for primary and renal hyperparathyroidism.
- Surgeons graded parathyroid gland AF intraoperatively.
- Correlations were assessed between AF and pre-operative calcium, PTH, SestaMIBI, gland weight, and histology.
Main Results:
- 257 out of 284 glands (90.5%) were visualized using NIR.
- AF intensity showed correlation with pre-operative serum calcium and PTH levels.
- Increased AF was observed in glands with a predominance of oxyphil cells in renal hyperparathyroidism cases.
Conclusions:
- Parathyroid gland autofluorescence intensity is linked to serum calcium, PTH, and histological composition.
- Further technological advancements are needed for routine clinical adoption, including improved visualization and signal consistency.
- Current NIR AF technology's clinical utility is not yet justified for widespread use.
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