Probe-Based System Effective in Recognizing Parathyroid Glands During Surgery for Primary Hyperparathyroidism

by Linda Kossoff •

What are the capabilities of the probe-based PTeye system for near-infrared autofluorescent (NIRAF) evaluation of parathyroid glands (PGs) in surgery for primary hyperparathyroidism?

BOTTOM LINE

This study confirms that the probe-based PTeye system can recognize PGs with a high degree of precision.

BACKGROUND: Intraoperative recognition of PGs is challenging but required for successful thyroid and parathyroid surgery. Although NIRAF can be effective at identifying PGs in these surgeries, near-infrared imaging (NIRI) not reliant on autofluorescence has also been investigated. Camera-based devices are often used for NIRAF or NIRI detection, but a probe-based system was recently developed.

STUDY DESIGN: Prospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Henry Ford Hospital, Detroit, Mich.

SYNOPSIS: Researchers recruited patients undergoing parathyroidectomy for primary hyperparathyroidism with presumed single gland disease at a single institution from June 2020 to December 2020. Twenty-two patients were included. The probe-based PTeye system was used intraoperatively to obtain absolute intensity and intensity ratios for the adenoma, ipsilateral normal PG, and adjacent tissue. After the adenoma was identified and assessed, it was excised. The ipsolateral, normal PG was found and interrogated with the probe. The median intensity ratio for the in situ adenomas was 4.38 (interquartile range [IQR]: 2.03-5.87), ipsilateral normal PGs 6.17 (IQR: 3.83-7.67), strap muscle 0.47 (IQR: 0.30-0.60), and fat 0.20 (IQR: 0.17-0.47). All normal PGs and 21 of 22 adenomas demonstrated autofluorescence above the detection threshold for parathyroid tissue. These findings and those of previous studies suggest that surgeons can consider employing the PTeye rather than frozen section biopsy or tissue aspiration to confirm the presence of parathyroid tissue. Limitations included the fact that adenomas tend to be heterogeneous and so the AF feature is hard to quantify. Precise capabilities and limitations of these devices and approaches must be delineated.

CITATION: Law RH, Larrabee KA, Van Harn M, Singer MC. Parathyroid gland autofluorescence characteristics in patients with primary hyperparathyroidism. Laryngoscope. 2022;132:715-721