Surgery · 2026
Autofluorescence can aid in differentiating normal from pathologic parathyroid glands during parathyroidectomy.
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Larrabee Katherine A, Jassal Japnam, Springer Kylie, Singer Michael C
Аннотация
BACKGROUND: Several studies suggest that during parathyroidectomy near-infrared autofluorescence may be able to help differentiate hyperfunctional from normal parathyroid glands. However, to date, no clear metric for employing autofluorescence in this manner in real-time during surgery has been described. This study investigated whether a specific measure of autofluorescence heterogeneity can aid discrimination of pathologic from normal parathyroid glands.
METHODS: In patients undergoing curative parathyroidectomy for classic or normohormonal primary hyperparathyroidism, a near-infrared autofluorescence device interrogated all identified parathyroid glands. Minimum and maximum autofluorescence values were obtained for each gland to calculate 2 measures of heterogeneity: variability (maximum minus minimum) and autofluorescence index (maximum/minimum ratio). Receiving operating characteristic analysis was performed to try to identify an autofluorescence index threshold to differentiate normal from pathologic glands.
RESULTS: The study included 72 patients. Cure was achieved by treating 57 single adenomas, 5 double adenomas, and 10 cases of 4-gland hyperplasia. Pathologic glands demonstrated significantly higher autofluorescence variability and autofluorescence index. In cases of single adenomas, a gland with autofluorescence index ≥2.4 was statistically more likely to be pathologic (area under the curve = 0.90). In 4-gland hyperplasia, glands with autofluorescence index ≥2.5 were more likely to be pathologic (area under the curve = 0.86). Autofluorescence index and gland weight were not correlated.
CONCLUSION: Autofluorescence index provides a quantitative, intraoperative measure of parathyroid gland heterogeneity that can help differentiate hyperfunctional from normal parathyroid glands in real time. An autofluorescence index ≥2.5 strongly suggests that a parathyroid gland is adenomatous or hyperplastic. Surgeons may use this information in any case in which distinguishing between normal and hyperfunctional glands is challenging.
METHODS: In patients undergoing curative parathyroidectomy for classic or normohormonal primary hyperparathyroidism, a near-infrared autofluorescence device interrogated all identified parathyroid glands. Minimum and maximum autofluorescence values were obtained for each gland to calculate 2 measures of heterogeneity: variability (maximum minus minimum) and autofluorescence index (maximum/minimum ratio). Receiving operating characteristic analysis was performed to try to identify an autofluorescence index threshold to differentiate normal from pathologic glands.
RESULTS: The study included 72 patients. Cure was achieved by treating 57 single adenomas, 5 double adenomas, and 10 cases of 4-gland hyperplasia. Pathologic glands demonstrated significantly higher autofluorescence variability and autofluorescence index. In cases of single adenomas, a gland with autofluorescence index ≥2.4 was statistically more likely to be pathologic (area under the curve = 0.90). In 4-gland hyperplasia, glands with autofluorescence index ≥2.5 were more likely to be pathologic (area under the curve = 0.86). Autofluorescence index and gland weight were not correlated.
CONCLUSION: Autofluorescence index provides a quantitative, intraoperative measure of parathyroid gland heterogeneity that can help differentiate hyperfunctional from normal parathyroid glands in real time. An autofluorescence index ≥2.5 strongly suggests that a parathyroid gland is adenomatous or hyperplastic. Surgeons may use this information in any case in which distinguishing between normal and hyperfunctional glands is challenging.