title: A novel, noninvasive imaging technique for intraoperative assessment of parathyroid glands: confocal reflectance microscopy.
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.
authors: Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Boston, MA, USA.
authors: W M
authors: WM
authors: White
authors: G J
authors: GJ
authors: Tearney
authors: B Z
authors: BZ
authors: Pilch
authors: R L
authors: RL
authors: Fabian
authors: R R
authors: RR
authors: Anderson
authors: R D
authors: RD
authors: Gaz
mesh_terms: D000236:Adenoma / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000473:pathology / Q000601:surgery*; D006965:Hyperplasia; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010280:Parathyroid Glands / Q000473:pathology*; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000473:pathology
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium