Publications

Exploration par autofluorescence des glandes parathyroïdiennes

Heterogeneous and low-intensity parathyroid autofluorescence: Patterns suggesting hyperfunction at parathyroid exploration
Emin Kose, MD 1, Bora Kahramangil, MD 1, Husnu Aydin, MD 1, Mustafa Donmez,MD 1, Eren Berber, MD 2 

1 Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH.  2  Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH.
BACKGROUND:
Although parathyroid glands have been found to exhibit autofluorescence with near-infrared fluorescence imaging, it is unknown if autofluorescence characteristics vary between hyperfunctioning and normofunctioning glands. The hypothesis was that pattern of autofluorescence exhibited by hyper- functioning versus normofunctioning parathyroid glands would be different.

METHODS:
This is an Institutional Review Board–approved, prospective clinical study. Patients underwent bilateral neck exploration for primary hyperparathyroidism, during which autofluorescence from each gland was assessed with near-infrared fluorescence imaging. Pattern and intensity of autofluorescence between hyperfunctioning and normofunctioning parathyroid glands were compared.

RESULTS:
Overall, 199 parathyroid glands were identified in 50 patients (single gland disease, n = 31; multigland disease, n = 19). Autofluorescence was detected from 96% ( n = 192) of parathyroid glands, all of which exhibited a higher intensity autofluorescence than the background tissues. Parathyroid gland location was revealed by near-infrared fluorescence imaging before dissection in 26% ( n = 52). A total of 77 glands that were large or firm were excised and 122 were preserved because of normal appearance. Hyperfunctioning parathyroid glands had a lower mean normalized autofluorescence intensity than normofunctioning parathyroid glands (1.8, and 2.6, respectively, P < .001). Moreover, hyperfunctioning parathyroid glands more often exhibited a heterogeneous pattern of autofluorescence (75% and 5%, respectively, P < .001). On multivariate analysis, only parathyroid gland hyperfunction correlated with normalized autofluorescence intensity. On receiver operative characteristic curve, optimal cutoffof nor- malized autofluorescence intensity to differentiate hyperfunctioning from normofunctioning parathyroid glands was 2.0.

CONCLUSION:
Our results indicate that hyperfunctioning and normofunctioning parathyroid glands exhibit different patterns of autofluorescence in hyperparathyroidism. Given these findings, autofluorescence pat- tern could be implemented as another adjunctive parameter for gland assessment during parathyroid exploration.
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