Abstract
Background
Intraoperative parathyroid gland identification can be challenging. Parathyroid glands
have an intrinsic autofluorescence when excited by wavelengths in the near-infrared
region. Studies using near-infrared cameras to detect parathyroid gland near-infrared
autofluorescence have suggested improved identification. The pathologic parathyroid
glands in primary hyperparathyroidism have variable near-infrared autofluorescence
intensity, but how this correlates with different characteristics of hyperparathyroidism
is unknown. Our objective was to correlate the fluorescent intensity of excited glands
with clinical variables to enhance a surgeon’s ability to identify parathyroid glands.
Methods
The data on patients undergoing surgery for primary hyperparathyroidism were collected.
The images were collected intraoperatively with a handheld near-infrared device and
analyzed. The data consisted of the ratio of mean parathyroid gland near-infrared
autofluorescence over background (white gauze) near-infrared autofluorescence. The
variables assessed for correlation with autofluorescence intensity were gland volume
and weight, preoperative serum calcium and parathyroid hormone, age, body mass index,
and sex. The images were quantified by Image J software (National Institutes of Health,
Bethesda, MD). The lasso regression was analyzed by R version 4.1.3 to calculate adjusted
P values (R Foundation for Statistical Computing, Vienna, Austria).
Results
From 2017 to 2021, 131 patients with primary hyperparathyroidism underwent parathyroidectomies
of 151 parathyroid glands. The mean near-infrared autofluorescence intensity of parathyroid
glands had a negative correlation with weight with lighter glands fluorescing more
(P = .019) and a positive correlation with age with glands from older patients fluorescing
more (P = .013). There were no significant correlations with preoperative serum calcium and
parathyroid hormone, body mass index, and sex (P > .05).
Conclusion
In patients with primary hyperparathyroidism, we found that autofluorescence intensity
correlated with parathyroid gland weight and patient age. This suggested that near-infrared
camera use may be particularly helpful in identifying smaller adenomas and in older
patients.
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Article info
Publication history
Published online: August 15, 2022
Accepted:
June 16,
2022
Footnotes
The work was accepted and presented at the annual 2022 American Surgical Congress under the auspices of the Society of University Surgeons (SUS) in Orlando, FL, February 3, 2022.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
