Research progress of clinical application of near-infrared autofluorescence detection technology in parathyroid glands and studies of autofluorescent substances_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Mo ¹ , NI Jingshu ² , DONG Meili ² , ZHANG Yang ² ,  WANG Yikun ²

1. Medical Pathology Center, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230000, P. R. China;
2. Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, P. R. China;

Corresponding author：

WANG Yikun, Email: wyk@aiofm.ac.cn

Keywords：

parathyroid gland; near-infrared fluorescence; fluorescent substance

DOI：

10.7507/1007-9424.202410073

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the clinical application of near-infrared autofluorescence (NIRAF) detection technology in the parathyroid glands and the research progress on the autofluorescent substances. Method The literature on the researches of clinical application of NIRAF detection technology in parathyroid glands and the fluorescent substances at home and abroad in recent years was summarized. Results Most current studies indicated that the NIRAF detection technology could effectively assist surgeons in identifying parathyroid tissue, improve the accuracy of intraoperative parathyroid identification, and reduce postoperative complications such as hypocalcemia. However, a small number of studies had found that the use of NIRAF detection technology during surgery does not benefit the reduction of postoperative complications in thyroid surgery patients, especially in those with secondary hyperparathyroidism. Current research on autofluorescent substances in the parathyroid glands was relatively scarce, with proteins such as the calcium-sensing receptor and vitamin D receptor being considered potential sources of fluorescence emitted by the parathyroid glands under near-infrared light excitation. Conclusions Based on the reviewed literature, NIRAF detection technology for the parathyroid glands has shown significant effectiveness in intraoperative identification of parathyroid tissue and reduction of postoperative complications. However, there are still limitations, such as insufficient accuracy in patients with hyperparathyroidism and lack of convenience in use, which restrict its clinical application. Therefore, future research should focus on identifying the endogenous fluorescent substances in the parathyroid glands and their luminescence mechanisms. This will allow for targeted improvements in fluorescence detection technology, further enhancing the accuracy and convenience of intraoperative parathyroid detection, ultimately benefiting patients more significantly.

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1. 何林烨, 王艺超, 李志辉. 2022年中国甲状腺癌流行情况分析: 基于《中国肿瘤登记年报》2005–2018年数据. 中国普外基础与临床杂志, 2024, 31(7): 790-795.
2. Bergenfelz A, Nordenström E, Almquist M. Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy. Surgery, 2020, 167(1): 124-128.
3. lin dX, Zhuo XB, Lin Y, et al. Enhancing parathyroid preservation in papillary thyroid carcinoma surgery using nano-carbon suspension. Sci Rep, 2024, 14(1): 24680. doi: 10.1038/s41598-024-76126-1.
4. Uludag M, Cetinoglu I, Unlu MT, et al. The role of frozen section examination in thyroid surgery. Sisli Etfal Hastan Tip Bul, 2023, 57(4): 441-450.
5. McEntee PD, Greevy JE, Triponez F, et al. Parathyroid gland identification and angiography classification using simple machine learning methods. BJS Open, 2024, 8(5): zrae122. doi: 10.1093/bjsopen/zrae122.
6. Das K, Stone N, Kendall C, et al. Raman spectroscopy of parathyroid tissue pathology. Lasers Med Sci, 2006, 21(4): 192-197.
7. Paras C, Keller M, White L, et al. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011, 16(6): 067012. doi: 10.1117/1.3583571.
8. Safia A, Abd Elhadi U, Massoud S, et al. The impact of using near-infrared autofluorescence on parathyroid gland parameters and clinical outcomes during total thyroidectomy: a meta-analytic study of randomized controlled trials. Int J Surg, 2024, 110(6): 3827-3838.
9. Pace-Asciak P, Russell J, Solorzano C, et al. The utility of parathyroid autofluorescence as an adjunct in thyroid and parathyroid surgery 2023. Head Neck, 2023, 45(12): 3157-3167.
10. Nagururu NV, Ali KM, Seo S, et al. Handheld autofluorescence imaging system for intraoperative parathyroid detection. VideoEndocrinology, 2023, 10(1): 9-10.
11. 姚春晖, 张洋, 刘斌, 等. 基于近红外自体荧光技术的甲状旁腺快速识别系统. 激光与光电子学进展, 2023, 60(6): 330-336.
12. 王云生, 薛金, 王兴越, 等. 红外荧光显像在甲状腺癌根治手术中对甲状旁腺保护的应用价值. 现代肿瘤医学, 2023, 24: 011.
13. 柳桢, 殷德涛, 王涛, 等. 近红外荧光系统对甲状腺术中甲状旁腺识别临床应用研究. 中国实用外科杂志, 2020, 40(2): 230-234.
14. Liu J, Wang X, Wang R, et al. Near-infrared auto-fluorescence spectroscopy combining with Fisher’s linear discriminant analysis improves intraoperative real-time identification of normal parathyroid in thyroidectomy. BMC Surg, 2020, 20(1): 4. doi: 10.1186/s12893-019-0670-x.
15. Chen W, Ma X, Shao P, et al. Autofluorescence detection and co-axial projection for intraoperative localization of parathyroid gland. Biomed Eng Online, 2022, 21(1): 37. doi: 10.1186/s12938-022-01004-8.
16. Aoyama M, Takizawa H, Yamamoto K, et al. Effects of excitation light intensity on parathyroid autofluorescence with a novel near-infrared fluorescence imaging system: two surgical case reports. Gland Surg, 2020, 9(5): 1584-1589.
17. Takahashi T, Yamazaki K, Ota H, et al. Near-infrared fluorescence imaging in the identification of parathyroid glands in thyroidectomy. Laryngoscope, 2021, 131(5): 1188-1193.
18. Liu Z, Ma RS, Jia JL, et al. Evaluation of autofluorescence in identifying parathyroid glands by measuring parathyroid hormone in fine-needle biopsy washings. Front Endocrinol (Lausanne), 2022, 12: 819503. doi: 10.3389/fendo.2021.819503.
19. 余亮, 陈先恒, 李海涛. 自体荧光联合示踪用盐酸米托蒽醌注射液在甲状腺术中识别甲状旁腺的临床应用. 中国现代普通外科进展, 2024, 27(7): 549-553.
20. 迟昊, 李昆临, 杨明宇, 等. 甲状腺手术中荧光显像技术保护甲状旁腺的应用进展. 中国普通外科杂志, 2023, 32(11): 1778-1786.
21. Karcioglu AS, Hartl D, Shonka DC, et al. Autofluorescence of parathyroid glands: A review of methods of parathyroid gland identification and parathyroid vascular assessment. Otolaryngol Clin North Am, 2024, 57(1): 139-154.
22. 殷廷杰, 潘彬, 殷素鹏, 等. 探针式近红外甲状旁腺自体荧光探测技术用于腔镜甲状腺全切除术中甲状旁腺识别及功能保护的研究. 中国普外基础与临床杂志, 2024, 31(11): 1341-1346.
23. Chen W, Zhang R, Yang R, et al. Converting a probe-based fluorescence system into an easy-to-use adjunct for the detection of parathyroid glands accidentally resected intraoperatively. Langenbecks Arch Surg, 2023, 408(1): 262. doi: 10.1007/s00423-023-02985-3.
24. Solórzano CC, Thomas G, Baregamian N, et al. Detecting the near infrared autofluorescence of the human parathyroid: Hype or opportunity?. Ann Surg, 2020, 272(6): 973-985.
25. Kiernan CM, Thomas G, Baregamian N, et al. Initial clinical experiences using the intraoperative probe-based parathyroid autofluorescence identification system-PTeye™ during thyroid and parathyroid procedures. J Surg Oncol, 2021, 124(3): 271-281.
26. Wang B, Zhu CR, Liu H, et al. The ability of near-infrared autofluorescence to protect parathyroid gland function during thyroid surgery: a meta-analysis. Front Endocrinol (Lausanne), 2021, 12: 714691. doi: 10.3389/fendo.2021.714691.
27. Benmiloud F, Godiris-Petit G, Gras R, et al. Association of autofluorescence-based detection of the parathyroid glands during total thyroidectomy with postoperative hypocalcemia risk: Results of the PARAFLUO multicenter randomized clinical trial. JAMA Surg, 2020, 155(2): 106-112.
28. Sehnem L, Noureldine SI, Avci S, et al. A multicenter evaluation of near-infrared autofluorescence imaging of parathyroid glands in thyroid and parathyroid surgery. Surgery, 2023, 173(1): 132-137.
29. Guerlain J, Breuskin I, Abbaci M, et al. Intraoperative parathyroid gland identification using autofluorescence imaging in thyroid cancer surgery with central neck dissection: Impact on post-operative hypocalcemia. Cancers (Basel), 2023, 16(1): 182. doi: 10.3390/cancers16010182.
30. Yasuda T, Kuba K, Yoneyama E, et al. Utility of intraoperative intrinsic near-infrared imaging for primary hyperparathyroidism in multiple endocrine neoplasia type 1. Cureus, 2024, 16(3): e55706. doi: 10.7759/cureus.55706.
31. Silver Karcioglu AL, Triponez F, Solórzano CC, et al. Emerging imaging technologies for parathyroid gland identification and vascular assessment in thyroid surgery: A review from the American Head and Neck Society Endocrine Surgery Section. JAMA Otolaryngol Head Neck Surg, 2023, 149(3): 253-260.
32. 郭飞跃. 近红外自体荧光技术用于甲状腺术中甲状旁腺显影的Meta分析. 石家庄: 河北医科大学, 2022.
33. Lykke E, Christensen A, Juhl K, et al. Effect of near infrared autofluorescence guided total thyroidectomy on postoperative hypoparathyroidism: a randomized clinical trial. Eur Arch Otorhinolaryngol, 2023, 280(5): 2593-2603.
34. DiMarco A, Chotalia R, Bloxham R, et al. Does fluoroscopy prevent inadvertent parathyroidectomy in thyroid surgery?. Ann R Coll Surg Engl, 2019, 101(7): 508-513.
35. McWade MA, Paras C, White LM, et al. A novel optical approach to intraoperative detection of parathyroid glands. Surgery, 2013, 154(6): 1371-1377.
36. Ladurner R, Al Arabi N, Guendogar U, et al. Near-infrared autofluorescence imaging to detect parathyroid glands in thyroid surgery. Ann R Coll Surg Engl, 2018, 100(1): 33-36.
37. Rodriguez M, Nemeth E, Martin D. The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol, 2005, 288(2): F253-F264. doi: 10.1152/ajprenal.00302.2004.
38. 陈曦, 许叶, 王埮. 钙敏感受体在神经系统疾病中的研究进展. 中国现代医生, 2024, 62(4): 103-106.
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