Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d9847889e167">Background</h5> <p id="P1">Inability to accurately identify parathyroid glands during cervical endocrine surgery hinders patients from achieving post-operative normocalcemia. An intrinsic near-infrared fluorescence method was developed for real-time parathyroid identification with high accuracy. This study assesses the clinical utility of this approach. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d9847889e172">Methods</h5> <p id="P2">Autofluorescence measurements were obtained from 137 patients (264 parathyroid glands) undergoing parathyroidectomy and/or thyroidectomy. Measurements were correlated to disease state, calcium levels, parathyroid hormone (PTH), vitamin D levels, age, sex, ethnicity and body-mass index (BMI). Statistical analysis identified which factors significantly affect parathyroid detection. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d9847889e177">Results</h5> <p id="P3">High parathyroid fluorescence was consistently detected and showed wide variability across patients. Near-infrared fluorescence was used to correctly identify 256/264 (97%) of glands. The technique showed high accuracy over a wide variety of disease states, though patients with secondary hyperparathyroidism demonstrated confounding results. Analysis revealed BMI (P&lt;0.01), disease state (P&lt;0.01), vitamin D (P&lt;0.05), and calcium levels (P&lt;0.05) account significantly for variability in signal intensity. Age, gender, PTH, and ethnicity had no effect. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d9847889e182">Conclusions</h5> <p id="P4">This intrinsic fluorescence-based intraoperative technique can accurately detect nearly all parathyroid glands in real-time. Its discrimination capacity is largely unlimited by patient variables, but several factors affect signal intensity. These results demonstrate potential clinical utility of optical guidance for parathyroid detection. </p> </div>