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Revista argentina de endocrinología y metabolismo
versión On-line ISSN 1851-3034
Resumen
DIP, Fernando et al. Autofluorescence: an innovative method in the intraoperative identification of parathyroid adenomas. Rev. argent. endocrinol. metab. [online]. 2018, vol.55, n.1, pp.40-49. ISSN 1851-3034.
Introduction
The treatment of primary hyperparathyroidism consists on the resection of the abnormal parathyroid gland (PG). Identification of PGs is challenging even for expert surgeons. Currently, there are no effective and harmless methods for intraoperative identification of PGs. The aim of this study is to report our experience with the identification of PGs using autofluorescence.
Materials and methods
Patients with diagnosis of primary hyperparathyroidism were included in the study. Patients were preoperatively worked up with labs [parathyroid hormone (PTH), serum calcium], neck ultrasound (US) and Technetium (99mTc) sestamibi. The parathyroid gland Intraoperative fluorescent visualization (PG-IFV) method was used during the surgery to identify PGs. The fluorescent intensity ratio of normal PGs and parathyroid adenomas (PA) was analyzed and correlated to different variables. All patients underwent a post-resection rapid PTH analysis and frozen section.
Results
Fifty-nine patients were included in the study. The US accurately predicted the location of the PA in 68% of the cases, while 99mTc sestamibi was accurate in 75% of the cases. The most frequently reported localization of the adenoma was right inferior (29%). PG-IFV facilitated the visualization of the PGs in 100% of the cases, with a 27% increase in the visualization of the PGs when compared to white light. The postoperative PTH decreased 76.4% and the calcium 1.8 mg/dl. The fluorescent intensity ratio of the PAs was significantly higher than normal PGs (44.4 vs 27.2, p <0.001). There was positive correlation between the PTH and the fluorescent intensity ratio of the PAs [Spearman’s correlation coefficient (SCC) = 0.448; p = 0.045]. The solid histoarchitectural pattern of the PAs presented a negative correlation with fluorescent intensity ratio (SCC = -0.4709, p = 0.03).
Conclusion
The use of PG-IFV is an effective method for intraoperative identification of normal and abnormal PGs. The fluorescent intensity ratio of abnormal PGs was significantly higher than normal PGs.
Palabras clave : Parathyroid adenoma; Primary hyperparathyroidism; Autofluorescence.
