title: Intraoperative Near-infrared Imaging for Parathyroid Gland Identification by Auto-fluorescence: A Feasibility Study.
abstract: Parathyroid glands (PGs) can be particularly hard to distinguish from surrounding tissue and thus can be damaged or removed during thyroidectomy. Postoperative hypoparathyroidism is the most common complication after thyroidectomy. Very recently, it has been found that the parathyroid tissue shows near-infrared (NIR) auto-fluorescence which could be used for intraoperative detection, without any use of contrast agents. The work described here presents a histological validation ex vivo of the NIR imaging procedure and evaluates intraoperative PG detection by NIR auto-fluorescence using for the first time to our knowledge a commercially available clinical NIR imaging device.
  
  
  
  Ex vivo study on resected operative specimens combined with a prospective in vivo study of consecutive patients who underwent total or partial thyroid, or parathyroid surgery at a comprehensive cancer center. During surgery, any tissue suspected to be a potential PG by the surgeon was imaged with the Fluobeam 800 (®) system. NIR imaging was compared to conventional histology (ex vivo) and/or visual identification by the surgeon (in vivo).
  
  
  
  We have validated NIR auto-fluorescence with an ex vivo study including 28 specimens. Sensitivity and specificity were 94.1 and 80 %, respectively. Intraoperative NIR imaging was performed in 35 patients and 81 parathyroids were identified. In 80/81 cases, the fluorescence signal was subjectively obvious on real-time visualization. We determined that PG fluorescence is 2.93 ± 1.59 times greater than thyroid fluorescence in vivo.
  
  
  
  Real-time NIR imaging based on parathyroid auto-fluorescence is fast, safe, and non-invasive and shows very encouraging results, for intraoperative parathyroid identification.
authors.affiliation: Plateforme d'Imagerie et Cytométrie, UMS AMMICa, Gustave Roussy, Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805, Villejuif, France. Frederic.DELEEUW@gustaveroussy.fr.|UMR CNRS 8081- IR4M, Université Paris-Sud, Université Paris-Saclay, 91401, Orsay, France. Frederic.DELEEUW@gustaveroussy.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: De Leeuw
authors.affiliation: Département de Chirurgie ORL, Unité Thyroïde, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Breuskin
authors.affiliation: Plateforme d'Imagerie et Cytométrie, UMS AMMICa, Gustave Roussy, Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805, Villejuif, France.|UMR CNRS 8081- IR4M, Université Paris-Sud, Université Paris-Saclay, 91401, Orsay, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Abbaci
authors.affiliation: Département de Pathologie, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Casiraghi
authors.affiliation: Département de Chirurgie ORL, Unité Thyroïde, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France.
authors.forename: Haïtham
authors.initials: H
authors.lastname: Mirghani
authors.affiliation: Département de Pathologie, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France.
authors.forename: Aïcha
authors.initials: A
authors.lastname: Ben Lakhdar
authors.affiliation: Plateforme d'Imagerie et Cytométrie, UMS AMMICa, Gustave Roussy, Université Paris-Saclay, 114, rue Édouard-Vaillant, 94805, Villejuif, France.|UMR CNRS 8081- IR4M, Université Paris-Sud, Université Paris-Saclay, 91401, Orsay, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Laplace-Builhé
authors.affiliation: Département de Chirurgie ORL, Unité Thyroïde, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France.
authors.forename: Dana
authors.initials: D
authors.lastname: Hartl
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013965:Thyroidectomy / Q000009:adverse effects