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. 2021 Jan 8;5(1):zraa047.
doi: 10.1093/bjsopen/zraa047.

Autofluorescence pattern of parathyroid adenomas

M S Demarchi  1 , W Karenovics  1 , B Bédat  1 , C De Vito  2 , F Triponez  1
Affiliations

Autofluorescence pattern of parathyroid adenomas

M S Demarchi et al. BJS Open. .

Abstract
in English, Spanish

Background: Primary hyperparathyroidism (pHPT) is a common endocrine pathology, and it is due to a single parathyroid adenoma in 80-85 per cent of patients. Near-infrared autofluorescence (NIRAF) has recently been used in endocrine surgery to help in the identification of parathyroid tissue, although there is currently no consensus on whether this technique can differentiate between normal and abnormal parathyroid glands. The aim of this study was to describe the autofluorescence pattern of parathyroid adenoma in pHPT.

Methods: Between January and June 2019, patients with pHPT who underwent surgical treatment for parathyroid adenoma were enrolled. Parathyroid autofluorescence was measured.

Results: Twenty-three patients with histologically confirmed parathyroid adenomas were included. Parathyroid adenomas showed a heterogeneous fluorescence pattern, and a well defined autofluorescent 'cap' region was observed in 17 of 23 specimens. This region was on average 28 per cent more fluorescent than the rest of the adenoma, and corresponded to a rim of normal histological parathyroid tissue (sensitivity and specificity 88 and 67 per cent respectively). After resection, all patients were treated successfully, with normal postoperative values of calcium and parathyroid hormone documented.

Conclusion: Parathyroid adenomas show a heterogeneous autofluorescence pattern. Using NIRAF imaging, the majority of specimens showed a well defined autofluorescent portion corresponding to a rim of normal parathyroid tissue. Further studies should be conducted to validate these findings.

Antecedentes: El hiperparatiroidismo primario (primary hyperparathyroidism, pHPT) es una patología endocrina frecuente y su causa es un adenoma paratiroideo único en el 80-85% de los pacientes. La autofluorescencia casi infrarroja (near-infrared auto-fluorescence, NIRAF) ha sido utilizada recientemente en la cirugía endocrina para ayudar en la identificación del tejido paratiroideo, aunque no hay en la actualidad consenso sobre si esta técnica puede diferenciar a las glándulas paratiroideas normales de las anormales. El objetivo de este estudio fue describir el patrón de autofluorescencia del adenoma de paratiroides en el pHPT.

Métodos: Entre enero 2019 y junio 2019, se reclutaron pacientes con pHPT sometidos a tratamiento quirúrgico por adenoma de paratiroides; la autofluorescencia paratiroidea se midió, se describió, y los resultados se analizaron.

Resultados: Se incluyeron 23 pacientes con adenomas de paratiroides confirmados por histología. Los adenomas paratiroideos mostraron un patrón de fluorescencia heterogéneo, y se observó una región capsular bien definida de autofluorescencia en 17 de 23 especímenes. Esta región era por término medio un 28% más fluorescente en comparación con el resto del adenoma y correspondía con el borde de tejido paratiroideo histológicamente normal (sensibilidad y especificidad del 88,2% y 66,7%, respectivamente). Tras la resección, todos los pacientes fueron tratados satisfactoriamente, con valores postoperatorios normales documentados de calcio y PTH.

Conclusiones: Los adenomas de paratiroides muestran un patrón de fluorescencia heterogéneo. Con el uso de NIRAF, la mayoría de los especímenes presentaban una porción de autofluorescencia bien definida correspondiendo al borde de tejido paratiroideo normal. Se deben realizar más estudios para validar estos hallazgos.

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Figures

Fig. 1
Fig. 1
Intraoperative images captured with Fluobeam LX® device Near-infrared autofluorescence image of a parathyroid adenoma and b two normal parathyroid glands.
Fig. 2
Fig. 2
Near-infrared autofluorescence images captured after resection of parathyroid adenomas a,b Images show the heterogeneous dim autofluorescence pattern of two adenomas; the brighter and more intense autofluorescence signal of a cap is highlighted by arrows. In both images, a 1 × 1-cm-square is indicated on a surgical ruler (in colour, the marking is purple on a white ruler). To calculate the fluorescence score (see text), the values were normalized based on the mean fluorescence intensity of the 1 × 1-cm square to overcome differences in image exposure.
Fig. 3
Fig. 3
Near-infrared autofluorescence image captured after resection of a parathyroid adenoma Image shows the heterogeneous autofluorescence pattern of the adenoma and absence of the cap. A 1 × 1-cm square is indicated on a surgical ruler (in colour, the marking is purple on a white ruler) at the top of the image.
Fig. 4
Fig. 4
Near-infrared autofluorescence image, operative specimen, and histology of parathyroid adenoma a Near-infrared autofluorescence (NIRAF) image showing cap of parathyroid adenoma; b surgical specimen showing cap marked with surgical ink; and c histological analysis showing a conserved rim of normal parathyroid tissue (green ink) corresponding to the marked area in b (haematoxylin and eosin stain; original magnification c ×20).
Fig. 5
Fig. 5
Zones of fluorescence intensity Zones of fluorescence intensity detected with ImageJ software are outlined in yellow: a no zone marked; b most intense part of resected specimen (cap); c dimmest part of resected specimen; and d whole adenoma. A 1 × 1-cm-square is indicated on a surgical ruler (in colour, the marking is purple on a white ruler).
Fig. 6
Fig. 6
Near-infrared autofluorescence image of two different adenomas resected in the same patient The specimen on the right has a cap, whereas that on the left has no clear cap but a well defined region of higher autofluorescence intensity.
Fig. 7
Fig. 7
Near-infrared autofluorescence image of parathyroid adenoma with no clear cap or well defined region of higher intensity marked during surgery
Fig. 8
Fig. 8
Fold of mean near-infrared autofluorescence differences between the most intense and dimmest parts of the resected specimen Median (bold line), mean (cross), i.q.r. (box), and range (error bars) excluding outlier (circle) are shown.
Fig. 9
Fig. 9
Parathyroid adenoma with brown adipose tissue Brown adipose tissue is marked with green ink (haematoxylin and eosin stain; original magnification a ×20, b ×200).
Fig. 10
Fig. 10
Near-infrared false-positive autofluorescence image of a parathyroid adenoma, which was confirmed as adipose tissue on anatomopathological analysis
See this image and copyright information in PMC

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