Dynamic Optical Contrast Imaging Aids Parathyroid Gland Localization in Ex Vivo Specimens

by Linda Kossoff •

How effective is the dynamic optical contrast imaging (DOCI) technique as a tool in specifically differentiating parathyroid tissue and adjacent structures, facilitating efficient and reliable tissue differentiation?

BOTTOM LINE

The DOCI technique reliably facilitates specific parathyroid gland localization and constitutes important groundwork for in vivo precision endocrine surgery.

BACKGROUND: Surgical excision of lesions is the standard of care for primary hyperthyroidism, but intraoperative parathyroid localization remains a significant challenge. Currently, surgeons rely on preoperative cross-sectional imaging to identify the general location of the offending gland. Limited options exist for optical imaging methods that provide real-time feedback on tissue identity.

STUDY DESIGN: Prospective study.

SETTING: Department of Head and Neck Surgery, University of California Los Angeles, Calif.

SYNOPSIS: Following their previous work demonstrating the ability of the DOCI technique to localize the parathyroid gland reliably in ex vivo tissues, researchers set about demonstrating the increased efficiency of DOCI to support in vivo intraoperative use and the feasibility of DOCI-based tissue segmentation. They used both animal (swine) and human tissue in the study. Fresh porcine thyroid, fat, and thymus were resected and immediately imaged using a DOCI setup. Human specimens were obtained from 12 patients (eight female, ages 18-79) who were diagnosed with primary hyperparathyroidism and undergoing surgical management to remove a single adenoma. Upon excision, these specimens were also imaged using DOCI. Results showed significant DOCI contrast between parathyroid glands and adjacent tissue of all types in both animal and human experiments. Regarding segmentation, linear discriminant classifier for tissue type prediction based on DOCI also matched the underlying histology. Authors conclude that the DOCI system has the potential to help surgeons precisely distinguish and dissect thyroid and parathyroid glands from surrounding neck tissues and structures through wide-field visual contrast concordant with histopathological results.

CITATION: Hu Y, Han AY, Huang S, et al. A tool to locate parathyroid glands using dynamic optical contrast imaging. Laryngoscope. 2021;131:2391-2397.