PMID- 31369053
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220422
IS  - 2168-619X (Electronic)
IS  - 2168-6181 (Print)
IS  - 2168-6181 (Linking)
VI  - 145
IP  - 10
DP  - 2019 Oct 1
TI  - Intraoperative Autofluorescence Parathyroid Identification in Patients With 
      Multiple Endocrine Neoplasia Type 1.
PG  - 897-902
LID - 10.1001/jamaoto.2019.1987 [doi]
AB  - IMPORTANCE: Intrinsic near-infrared (NIR) autofluorescence of the parathyroid 
      gland enables intraoperative gland identification without the need for contrast 
      agent injection. However, whether real-time autofluorescence imaging is useful in 
      patients with multiple endocrine neoplasia type 1 (MEN1) and primary 
      hyperparathyroidism is unknown. OBJECTIVE: To compare quantified intraoperative 
      parathyroid autofluorescence imaging results for patients with MEN1-associated vs 
      those with non-MEN1 sporadic primary hyperparathyroidism. DESIGN, SETTING, AND 
      PARTICIPANTS: A retrospective analysis of prospectively collected data on a 
      cohort of 71 consecutive patients undergoing surgery for primary 
      hyperparathyroidism by 2 experienced endocrine surgeons between June 1, 2017, and 
      July 31, 2018, was conducted. Intraoperative imaging was performed with a 
      handheld NIR autofluorescence device and images were captured for analysis. Post 
      hoc blinded imaging analysis was conducted with Image J software to quantify 
      representative areas of greatest autofluorescence from the parathyroid, thyroid, 
      and adjacent soft tissue. MAIN OUTCOMES AND MEASURES: Primary end points were 
      parathyroid autofluorescence and background thyroid and soft tissue 
      autofluorescence, reported as median values with interquartile ranges. Rates of 
      false-negative (lack of significant parathyroid gland autofluorescence compared 
      with background autofluorescence, defined as parathyroid 
      autofluorescence-background autofluorescence ratio <1.10) and false-positive 
      autofluorescence (aberrant autofluorescence of nonparathyroid tissue confirmed by 
      pathologic testing) were analyzed. RESULTS: Of the 71 consecutive patients with 
      primary hyperparathyroidism who underwent parathyroidectomy during the study 
      period, 6 patients had genetically or clinically diagnosed MEN1 and 65 had 
      sporadic non-MEN1 hyperparathyroidism. Most patients were women (MEN1: 4 [67%]; 
      non-MEN1: 51 [78%]). Median (interquartile range) age was 49.0 (38.0-53.8) years 
      in the MEN1 cohort and 61.0 (54.0-67.0) years in the non-MEN1 cohort. No 
      clinically significant differences in serum preoperative parathyroid hormone 
      level or parathyroid gland size or weight on pathologic examination were observed 
      between the 2 cohorts. The median absolute value of in situ parathyroid 
      autofluorescence was significantly lower in the MEN1 cohort than the non-MEN1 
      cohort (54.4 vs 74.3; Hedges g = -1.03; 95% CI, -1.89 to -0.17), as was the ratio 
      of parathyroid to background autofluorescence (1.08 vs 1.59; g = -1.59; 95% CI, 
      -2.23 to -0.96). Three patients (50%) with MEN1 had false-negative nonfluorescent 
      parathyroid adenomas vs 6 patients (9%) without MEN1. Nonparathyroid fibroadipose 
      tissue of patients with MEN1 exhibited greater background autofluorescence, 
      leading to high false-positive rates (5 of 6 patients [83%]) vs only 3 of 65 (5%) 
      false-positive autofluorescence nonparathyroid specimens among patients without 
      MEN1. CONCLUSIONS AND RELEVANCE: Intraoperative identification of parathyroid 
      glands using their autofluorescence by real-time NIR imaging appears to have 
      utility in patients with primary hyperparathyroidism. In this initial cohort of 
      patients with MEN1, decreased parathyroid autofluorescence and increased 
      background autofluorescence of nonparathyroid tissue may be associated with high 
      rates of false-negative and false-positive fluorescence, potentially limiting the 
      utility of this adjunct in this specific subset of patients.
FAU - Squires, Malcolm H
AU  - Squires MH
AD  - Division of Surgical Oncology, Department of Surgery, The Ohio State University 
      Wexner Medical Center, Columbus.
FAU - Shirley, Lawrence A
AU  - Shirley LA
AD  - Division of Surgical Oncology, Department of Surgery, The Ohio State University 
      Wexner Medical Center, Columbus.
FAU - Shen, Chengli
AU  - Shen C
AD  - Division of Surgical Oncology, Department of Surgery, The Ohio State University 
      Wexner Medical Center, Columbus.
FAU - Jarvis, Rachel
AU  - Jarvis R
AD  - Division of Surgical Oncology, Department of Surgery, The Ohio State University 
      Wexner Medical Center, Columbus.
FAU - Phay, John E
AU  - Phay JE
AD  - Division of Surgical Oncology, Department of Surgery, The Ohio State University 
      Wexner Medical Center, Columbus.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - JAMA Otolaryngol Head Neck Surg
JT  - JAMA otolaryngology-- head & neck surgery
JID - 101589542
SB  - IM
PMC - PMC6681562
COIS- Conflict of Interest Disclosures: Dr Phay reported a licensing agreement from AI 
      BIomed outside the scope of the submitted work and had a patent to 
      Intra-operative Use of Fluorescence Spectroscopy and Applications of Same 
      licensed. No other disclosures were reported.
EDAT- 2019/08/02 06:00
MHDA- 2019/08/02 06:01
PMCR- 2020/08/01
CRDT- 2019/08/02 06:00
PHST- 2019/08/02 06:00 [pubmed]
PHST- 2019/08/02 06:01 [medline]
PHST- 2019/08/02 06:00 [entrez]
PHST- 2020/08/01 00:00 [pmc-release]
AID - 2740684 [pii]
AID - ooi190045 [pii]
AID - 10.1001/jamaoto.2019.1987 [doi]
PST - ppublish
SO  - JAMA Otolaryngol Head Neck Surg. 2019 Oct 1;145(10):897-902. doi: 
      10.1001/jamaoto.2019.1987.