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Discovery of parathyroid fluorescence may reduce endocrine surgery risks
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High amounts of autofluorescence exhibited by the parathyroid glands may eventually aid surgeons in locating parathyroid tissue more precisely during removal and other procedures, researchers said.
To develop a better optical method for differentiating the parathyroid from surrounding tissue regardless of disease state, Anita Mahadevan-Jansen, PhD, and colleagues at Vanderbilt University employed a technique derived from near-infrared autofluorescence to measure the fluorescence of the thyroid and parathyroid. Their study included 21 patients aged 18 to 99 years undergoing thyroidectomy or parathyroidectomy. According to results, autofluorescence of the parathyroid was exceptionally high — exceeding 800 nm — and allowed the researchers to clearly pinpoint its location among the surrounding tissue.
“We have discovered that the parathyroid glands are two to 10 times more fluorescent in the near-infrared than any other tissues found in the neck,” Mahadevan-Jansen, professor of biomedical engineering, said in a press release. “We have taken measurements with more than 50 patients now and we have found this effect 100% of the time, even when the tissue is diseased. That is amazing. You almost never get 100% results in biological studies.”
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The researchers examined fluorescence by exciting the tissue with a 785-nm diode laser (Innovative Photonic Solutions) that applied 80 mW to an area with a 400-mcm diameter and collecting data on clinical spectra in the excited area via a 2000-FL fluorescence spectrometer (Ocean Optics). A fiber optic probe was then used to obtain measurements.
Near-infrared fluorescence spectroscopy can quickly and accurately detect parathyroid tissue at a relatively low cost, although certain problems exist with the first-generation device, the researchers said.
According to researcher John E. Phay, MD, the tool is “a bit burdensome because [the physician] has to dim the lights” to measure fluorescence. To address this problem, the researchers plan to add a filter to block out visible light and a camera that includes the fluorescence of all throat tissue on a single display in future versions.
“We still haven’t figured out the source of the fluorescence, but that doesn’t stand in the way of using this effect to improve the effectiveness of parathyroid surgeries and reduce the damage done to the parathyroid in other endocrine surgeries,” Mahadevan-Jansen said.
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