Auris, nasus, larynx · 2025
The impact of detecting and autotransplanting parathyroid gland with near-infrared imaging during total laryngectomy with total thyroidectomy.
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Takahashi Takeshi, Otaki Kohei, Ohshima Shusuke, Takahashi Yuto, Tanaka Ryoko, Saijo Kohei, Omata Jo, Yokoyama Yusuke, Shodo Ryusuke, Ueki Yushi, Yamazaki Keisuke, Matsuyama Hiroshi, Horii Arata
Аннотация
OBJECTIVE: Persistent postoperative hypoparathyroidism (hypoPT) after total thyroidectomy (TT) is a serious complication necessitating lifelong treatment. HypoPT would be more serious when combined with total laryngectomy (TL), since in situ preservation nor autotransplantation of parathyroid glands (PGs) is not always attempted. This study examined the accuracy of identifying PGs using near-infrared fluorescence imaging (NIFI) and assessed the oncological safety and impact of PG autotransplantation on hypoPT in TL+TT.
METHODS: This prospective study was conducted between June 2020 and November 2023 at three hospitals in Niigata, Japan. Twelve patients who underwent TL+TT were included. Specimens were evaluated for autofluorescence (AF) using NIFI ex vivo followed by histological examination. Levels of albumin-corrected calcium and intact parathyroid hormone (PTH) were monitored postoperatively.
RESULTS: Twenty-nine AF-positive tissues were identified as possible PGs using NIFI. Histological examination revealed that 27 were PGs and 2 were adipose tissues: 0-5 (median=2) PGs were autotransplanted per patient. All 272 tissues isolated as lymph nodes by the surgeon's visual inspection were negative for AF, none of which were PGs by histological examinations. Therefore, NIFI exhibited 100 % sensitivity and 99 % specificity for PG identification. The rate of persistent postoperative hypoPT was 33 % (4/12). After a median follow-up of 42 months (range 16-54 months), no tumor recurrence was observed in the sites of parathyroid autotransplantation.
CONCLUSION: This study demonstrated the high accuracy of NIFI in identifying PGs during TL+TT. PG autotransplantation with NIFI assistance emerged as a viable technique for mitigating postoperative hypoPT in TL+TT procedures.
METHODS: This prospective study was conducted between June 2020 and November 2023 at three hospitals in Niigata, Japan. Twelve patients who underwent TL+TT were included. Specimens were evaluated for autofluorescence (AF) using NIFI ex vivo followed by histological examination. Levels of albumin-corrected calcium and intact parathyroid hormone (PTH) were monitored postoperatively.
RESULTS: Twenty-nine AF-positive tissues were identified as possible PGs using NIFI. Histological examination revealed that 27 were PGs and 2 were adipose tissues: 0-5 (median=2) PGs were autotransplanted per patient. All 272 tissues isolated as lymph nodes by the surgeon's visual inspection were negative for AF, none of which were PGs by histological examinations. Therefore, NIFI exhibited 100 % sensitivity and 99 % specificity for PG identification. The rate of persistent postoperative hypoPT was 33 % (4/12). After a median follow-up of 42 months (range 16-54 months), no tumor recurrence was observed in the sites of parathyroid autotransplantation.
CONCLUSION: This study demonstrated the high accuracy of NIFI in identifying PGs during TL+TT. PG autotransplantation with NIFI assistance emerged as a viable technique for mitigating postoperative hypoPT in TL+TT procedures.