title: The utility of indocyanine green near infrared fluorescent imaging in the identification of parathyroid glands during surgery for primary hyperparathyroidism.
abstract: OBJECTIVE
  Intraoperative adjuncts for the localization of parathyroid glands in parathyroid surgery are limited. The aim of this study is to assess the usefulness of indocyanine green (ICG) near-infrared (NIR) fluorescent imaging in patients undergoing surgery for primary hyperparathyroidism (PHPT).
  
  
  METHODS
  ICG imaging was performed in 33 patients undergoing parathyroidectomy (PTX). Thyroid and parathyroid ICG uptake were assessed and independently verified on a grading scale. Clinical variables were recorded and analyzed for factors associated with ICG uptake.
  
  
  RESULTS
  Of 112 glands identified by naked eye, 104 (92.9%) demonstrated ICG uptake. Concomitant ICG fluorescence was identified in the thyroid in all patients. There was a trend toward increased ICG fluorescence in patients <60 years of age (P = 0.05). A higher degree of fluorescence was seen in patients presenting with pre-operative calcium values >11 mg/dl (P = 0.04) and in those parathyroids larger than 10 mm (P < 0.01). All patients had biochemically proven cure. No patients who underwent subtotal PTX (n = 6) developed postoperative hypoparathyroidism.
  
  
  CONCLUSIONS
  ICG can reliably localize parathyroid glands during PTX and additionally allow for assessment of parathyroid perfusion in patients undergoing subtotal resection. Concomitant fluorescence of the thyroid gland limits ICG's usefulness in directing the course of PTX. J. Surg. Oncol. 2016;113:771-774. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Nisar
authors.initials: N
authors.lastname: Zaidi
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Emre
authors.initials: E
authors.lastname: Bucak
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alexis
authors.initials: A
authors.lastname: Okoh
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hakan
authors.initials: H
authors.lastname: Yigitbas
authors.affiliation: Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D000328:Adult; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D013961:Thyroid Gland / Q000000981:diagnostic imaging; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: fluorescence-guided surgery; hyperparathyroidism; indocyanine green; near-infrared fluorescence; parathyroidectomy