Abstract
Background. Successful surgical management of primary hyperparathyroidism requires the ability
to identify and distinguish normal from abnormal parathyroid tissue. Microscopic pathologic
confirmation often helps with the diagnoses and decisions regarding the extent of
parathyroid resection. Confocal reflectance microscopy (CRM) is an optical method
of noninvasively imaging tissue without fixation, sectioning, and staining as in standard
histopathology. The goal of this study was to determine if CRM imaging could be used
to distinguish normal from diseased parathyroid tissue intraoperatively. Methods. In this study, 44 parathyroid glands from 21 patients undergoing operations for primary
hyperparathyroidism were imaged immediately after excision. CRM images were compared
with conventional hematoxylin-and-eosin stained sections obtained from the same gland.
The percentage area occupied by fat cells was calculated in images of both normal
and diseased glands. Results. Characteristic microscopic features of parathyroid glands were distinguishable by
CRM and correlated well with histopathology. The stromal fat content of normal and
diseased glands could easily be determined. The percentage area occupied by fat cells
differed significantly (P <.00001) in normal glands (average, 23.0% ± 10.9%) and adenomatous glands (average,
0.4% ± 0.7%). Conclusions. CRM imaging rapidly revealed microscopic features that reliably differentiated normal
and diseased parathyroid glands. The success of this preliminary ex vivo study promotes
interest in further development of an in situ probe for in vivo clinical diagnostic
use. (Surgery 2000;128:1088-1101.)
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Article info
Footnotes
*Supported in part by Lucid Inc, Henrietta, NY.
**Reprint requests: Randall D. Gaz, MD, Director of Endocrine Surgery, Massachusetts General Hospital, Ambulatory Care Center, Room 716, 15 Parkman St, Boston, MA 02114.
★Surgery 2000;128:1088-1101.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
