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. 2019 Sep 25:2019:4687951.
doi: 10.1155/2019/4687951. eCollection 2019.

Intraoperative Near-Infrared Autofluorescence and Indocyanine Green Imaging to Identify Parathyroid Glands: A Comparison

Max Lerchenberger  1 , Norah Al Arabi  1 , Julia K S Gallwas  2 , Herbert Stepp  3 , Klaus K J Hallfeldt  1 , Roland Ladurner  1
Affiliations

Intraoperative Near-Infrared Autofluorescence and Indocyanine Green Imaging to Identify Parathyroid Glands: A Comparison

Max Lerchenberger et al. Int J Endocrinol. .

Abstract

Objective: To investigate the feasibility of near-infrared autofluorescence (AF) and indocyanine green (ICG) fluorescence to identify parathyroid glands intraoperatively.

Methods: Fluorescence imaging was carried out during open parathyroid and thyroid surgery. After visual identification, parathyroid glands were exposed to near-infrared (NIR) light with a wavelength between 690 and 770 nm. The camera of the Storz® NIR/ICG endoscopic system used detects NIR light as a blue signal. Therefore, parathyroid AF was expected to be displayed in the blue color channel in contrast to the surrounding tissue. Following AF imaging, a bolus of 5 mg ICG was applied intravenously. ICG fluorescence was detected using the same NIR/ICG imaging system. Well-vascularized parathyroid glands were expected to show a strong fluorescence in contrast to surrounding lymphatic and adipose tissue.

Results: We investigated 78 parathyroid glands from 50 patients. 64 parathyroid glands (82%) displayed AF showing the typical bluish violet color. 63 parathyroid glands (81%) showed a strong and persistent fluorescence after application of ICG. The sensitivity of identifying a parathyroid gland by AF was 82% (64 true positive and 14 false negative results), while ICG imaging showed a sensitivity of 81% (63 true positive and 15 false negative results). The Fisher exact test revealed no significant difference between both groups at p < 0.05. Neither lymph nodes nor adipose tissue revealed substantial AF or ICG fluorescence.

Conclusion: AF and ICG fluorescence reveal a high degree of sensitivity in identifying parathyroid glands. Further, ICG imaging facilitates the assessment of parathyroid perfusion. However, in the current setting both techniques are not suitable as screening tools to identify parathyroid glands at an early stage of the operation.

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Conflict of interest statement

Karl Storz® GmbH provided a laparoscopic system with a special light source and camera free of charge to R. Ladurner and K. Hallfeldt. Karl Storz® GmbH had no role in the design of the study, in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results. N. Al Arabi, M. Lerchenberger, J. Gallwas and H. Stepp have no conflicts of interest or financial ties to disclose.

Figures

Figure 1
Figure 1
Parathyroid gland. (a) Autofluorescence image that displays the typical bluish violet color of the gland. (b) The parathyroid gland in normal white light. (c) 2 min after i.v. application of 5 mg ICG. The gland shows hardly any ICG fluorescence, and it can be assumed that it is devascularized.
Figure 2
Figure 2
Parathyroid gland exposed to normal white light (a) and near-infrared light 2 min after i.v. application of 5 mg ICG (b). The gland displays a strong fluorescence indicating a good vascularity. The surrounding structures, especially the thyroid, are less fluorescent.
See this image and copyright information in PMC

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