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Karcioglu AS, Hartl D, Shonka DC, Slough CM, Stack BC, Tolley N, Abdelhamid Ahmed AH, Randolph GW. Autofluorescence of Parathyroid Glands: A Review of Methods of Parathyroid Gland Identification and Parathyroid Vascular Assessment. Otolaryngol Clin North Am 2024; 57:139-154. [PMID: 37634981 DOI: 10.1016/j.otc.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Postoperative hypoparathyroidism may cause significant patient morbidity and even mortality. Emerging technologies centered on autofluorescent properties of parathyroid glands when exposed to near-infrared light hold promise to improve surgical parathyroid gland identification and preservation. Two systems (probe-based and camera-based) are commercially available currently; however, neither system alone provides indication of vascular viability or postoperative parathyroid gland function. The administration of indocyanine green, when combined with near-infrared fluorescence imaging, enables subjective assessment of parathyroid gland perfusion. Additional technologies to assess parathyroid gland perfusion are being developed. The impact of these nascent technologies on relevant clinical outcomes is an area of active investigation.
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Affiliation(s)
- Amanda Silver Karcioglu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, 9669 North Kenton Avenue, Suite 206, Skokie, IL 60076, USA.
| | - Dana Hartl
- Department of Surgery, Thyroid Surgery Unit, Gustave Roussy Cancer Campus and University Paris-Saclay, 114 rue Edouard Vaillant, Villejuif, Paris 94805, France
| | - David C Shonka
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, PO Box 800713, Charlottesville, VA 22903, USA
| | - Cristian M Slough
- Department of Otolaryngology-Head and Neck Surgery, Hawke's Bay Fallen Soldiers' Memorial Hospital, Te Whatu Ora Health New Zealand, 251 Orchard Road, Frimley, Hastings 4120, New Zealand
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Hawke's Bay Fallen Soldiers' Memorial Hospital, Te Whatu Ora Health New Zealand, 251 Orchard Road, Frimley, Hastings 4120, New Zealand; Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, PO Box 19662, Springfield, IL 62794-9662, USA
| | - Neil Tolley
- Department Otolaryngology-Head & Neck Surgery, St Mary's Hospital, Imperial College NHS Healthcare Trust, Praed Street, Paddington, London W2 1NY, UK
| | - Amr H Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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2
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Mulder MB, Duh QY. Magic Pen?-An Innovative Adjunct for Intraoperative Identification of Parathyroid Glands. JAMA Surg 2023; 158:1059-1060. [PMID: 37531121 DOI: 10.1001/jamasurg.2023.3257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Michelle B Mulder
- Section of Endocrine Surgery, Department of Surgery, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Quan-Yang Duh
- Section of Endocrine Surgery, Department of Surgery, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
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3
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Rao SS, Rao H, Moinuddin Z, Rozario AP, Augustine T. Preservation of parathyroid glands during thyroid and neck surgery. Front Endocrinol (Lausanne) 2023; 14:1173950. [PMID: 37324265 PMCID: PMC10266226 DOI: 10.3389/fendo.2023.1173950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/13/2023] [Indexed: 06/17/2023] Open
Abstract
The parathyroid glands are situated in close proximity to the thyroid gland. They have an important endocrine function maintaining calcium and phosphate homeostasis in the body by the secretion of parathormone (PTH), which is responsible for this function. The parathyroid glands are commonly damaged during thyroid surgeries. This could lead to transient or permanent hypoparathyroidism in 30% of cases. Preservation of the parathyroid glands, is an important and integral part of thyroidectomy and other surgical interventions in the neck. The main principle underlying this is a thorough understanding of parathyroid anatomy in relation to the thyroid gland and other important structures in the area. There can also be significant variation in the anatomical location of the glands. Various techniques and methods have been described for parathyroid preservation. They include intraoperative identification utilizing indocyanine green (ICG) fluorescence, carbon nanoparticles, loupes, and microscopes. The techniques of surgery (meticulous capsular dissection), expertise, central compartment neck dissection, preoperative vitamin D deficiency, extent and type of thyroidectomy are the risk factors associated with damaged thyroids, inadvertent parathyroidectomy and subsequent hypoparathyroidism. Parathyroid Autotransplantation is a treatment option for inadvertent parathyroidectomy. Ultimately, the best way to assure normal parathyroid function is to preserve them in situ intraoperatively undamaged.
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Affiliation(s)
- Smitha S. Rao
- Department of Endocrine and Breast Surgery, Oncology, K.S. Hegde Medical Academy, Nitte University, Mangalore, India
| | - Himagirish Rao
- Department of Endocrine and General Surgery, St. John's National Academy of Health Sciences, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Zia Moinuddin
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Anthony P. Rozario
- Department of Endocrine and General Surgery, St. John's National Academy of Health Sciences, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Titus Augustine
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Tampu IE, Eklund A, Johansson K, Gimm O, Haj-Hosseini N. Diseased thyroid tissue classification in OCT images using deep learning: Towards surgical decision support. JOURNAL OF BIOPHOTONICS 2023; 16:e202200227. [PMID: 36203247 DOI: 10.1002/jbio.202200227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Intraoperative guidance tools for thyroid surgery based on optical coherence tomography (OCT) could aid distinguish between normal and diseased tissue. However, OCT images are difficult to interpret, thus, real-time automatic analysis could support the clinical decision-making. In this study, several deep learning models were investigated for thyroid disease classification on 2D and 3D OCT data obtained from ex vivo specimens of 22 patients undergoing surgery and diagnosed with several thyroid pathologies. Additionally, two open-access datasets were used to evaluate the custom models. On the thyroid dataset, the best performance was achieved by the 3D vision transformer model with a Matthew's correlation coefficient (MCC) of 0.79 (accuracy = 0.90) for the normal-versus-abnormal classification. On the open-access datasets, the custom models achieved the best performance (MCC > 0.88, accuracy > 0.96). Results obtained for the normal-versus-abnormal classification suggest OCT, complemented with deep learning-based analysis, as a tool for real-time automatic diseased tissue identification in thyroid surgery.
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Affiliation(s)
- Iulian Emil Tampu
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Anders Eklund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Division of Statistics & Machine Learning, Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Kenth Johansson
- Department of Surgery, Västervik Hospital, Västervik, Sweden
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Oliver Gimm
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Neda Haj-Hosseini
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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Pan H, Yang Z, Hou F, Zhao J, Yu Y, Liang Y. Classification of neck tissues in OCT images by using convolutional neural network. Lasers Med Sci 2022; 38:21. [PMID: 36564643 DOI: 10.1007/s10103-022-03665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 11/12/2022] [Indexed: 12/25/2022]
Abstract
Identification and classification of surrounding neck tissues are very important in thyroid surgery. The advantages of optical coherence tomography (OCT), high resolution, non-invasion, and non-destruction make it have great potential in identifying different neck tissues during thyroidectomy. We studied the automatic classification for neck tissues in OCT images based on convolutional neural network in this paper. OCT images of five kinds of neck tissues were collected firstly by our home-made swept source (SS-OCT) system, and a dataset was built for neural network training. Three image classification neural networks: LeNet, VGGNet, and ResNet, were used to train and test the dataset. The impact of transfer learning on the classification of neck tissue OCT images was also studied. Through the comparison of accuracy, it was found that ResNet has the best classification accuracy among the three networks. In addition, transfer learning did not significantly improve the accuracy, but it can somewhat accelerate the convergence of the network and shorten the network training time.
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Affiliation(s)
- Hongming Pan
- Institute of Modern Optics, Nankai University, Tianjin Key Laboratory of Micro-Scale Optical Information Science and Technology, Tianjin, 300350, China
| | - Zihan Yang
- Institute of Modern Optics, Nankai University, Tianjin Key Laboratory of Micro-Scale Optical Information Science and Technology, Tianjin, 300350, China
| | - Fang Hou
- Institute of Modern Optics, Nankai University, Tianjin Key Laboratory of Micro-Scale Optical Information Science and Technology, Tianjin, 300350, China
| | - Jingzhu Zhao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Yang Yu
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Yanmei Liang
- Institute of Modern Optics, Nankai University, Tianjin Key Laboratory of Micro-Scale Optical Information Science and Technology, Tianjin, 300350, China.
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Shao C, Li Z, Zhang C, Zhang W, He R, Xu J, Cai Y. Optical diagnostic imaging and therapy for thyroid cancer. Mater Today Bio 2022; 17:100441. [PMID: 36388462 PMCID: PMC9640994 DOI: 10.1016/j.mtbio.2022.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022] Open
Abstract
Thyroid cancer, as one of the most common endocrine cancers, has seen a surge in incidence in recent years. This is most likely due to the lack of specificity and accuracy of its traditional diagnostic modalities, leading to the overdiagnosis of thyroid nodules. Although there are several treatment options available, they are limited to surgery and 131I radiation therapy that come with significant side effects and hence cannot meet the treatment needs of anaplastic thyroid carcinoma with very high malignancy. Optical imaging that utilizes optical absorption, refraction and scattering properties, not only observes the structure and function of cells, tissues, organs, or even the whole organism to assist in diagnosis, but can also be used to perform optical therapy to achieve targeted non-invasive and precise treatment of thyroid cancer. These applications of screening, diagnosis, and treatment, lend to optical imaging's promising potential within the realm of thyroid cancer surgical navigation. Over the past decade, research on optical imaging in the diagnosis and treatment of thyroid cancer has been growing year by year, but no comprehensive review on this topic has been published. Here, we review key advances in the application of optical imaging in the diagnosis and treatment of thyroid cancer and discuss the challenges and potential for clinical translation of this technology.
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Key Words
- 131I-BSA@CuS, 131I-labeled BSA-modified CuS nanoparticles
- 5-ALA, 5-Aminolevulinic acid
- ASIR, age-standardized rates of cancer incidence
- ATC, anaplastic thyroid carcinoma
- Au@MSNs, photo-triggered Gold nanodots capped mesoporous silica nanoparticles
- AuNCs@BSA-I, innovative iodinated gold nanoclusters
- BRAF, V-Raf murine sarcoma viral oncogene homolog B
- CBDCA, Carboplatin
- CDFI, color doppler flow imaging ultrasound
- CLND, central compartmentalized node dissection
- CPDA-131I NPs, the 131I-radiolabeled cerebroid polydopamine nano-particles
- CT, Computed Tomography
- DOT, Diffuse Optical Tomography
- DTC, differentiated thyroid cancer
- ECDT, enhanced chemodynamical therapy
- EGF, epidermal growth factor
- EGFR, epidermal growth factor receptor
- ESMO, European Society of Medical Oncology
- FDA, U.S. Food and Drug Administration
- FI, fluorescence imaging
- FNAB, fine-needle aspiration biopsy
- FNAs, fine needle aspirations
- FTC, follicular thyroid carcinoma
- GC, germinal center
- HAOA, Hyaluronic Acid and Oleic Acid
- HYP, hypericin
- ICG, indocyanine green
- IJV, internal jugular vein
- IR825@B-PPNs, Polymeric NPs with bevacizumab and IR825 conjugated on the surface
- L-A PTA, laparoscopic photothermal ablation
- MDR, multidrug resistance
- MTC, medullary thyroid carcinoma
- Multimodal therapy
- NIR, near-infrared
- NIR-FI, near-infrared fluorescence imaging
- NIR-PIT, near-infrared photoimmunotherapy
- NIRF, near-infrared fluorescence
- NMRI, Nuclear Magnetic Resonance Imaging
- OCT, Optical Coherence Tomography
- OI, optical imaging
- OS, overall survival
- Optical imaging
- Optical imaging-guided surgery
- PAI, Photoacoustic Imaging
- PDT, photodynamic therapy
- PET, Positron Emission Tomography
- PGs, parathyroid glands
- PLP, porphyrin-HDL nanoparticle
- PTA, photothermal reagents
- PTC, papillary thyroid carcinoma
- PTT, photothermal therapy
- Pd-MOF, porphyrin–palladium metal–organic framework
- Phototherapy
- RIT, radioactive iodine therapy
- ROS, reactive oxygen species
- SEC, Selenocysteine
- SV, subclavian vein
- SiRNA, interfering RNA
- TC, thyroid cancer
- TD, Thoracic Duct
- TF, tissue factor
- Thyroid cancer
- mETE, microscopic extrathyroidal extension
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Affiliation(s)
- Chengying Shao
- Otolaryngology& Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang 310014, China
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Zhenfang Li
- School of Basic Medical Sciences and Forensic Medicine, Hangzhou Medical College, Hangzhou 310012, China
| | - Chengchi Zhang
- Zhejiang University of Technology, Hangzhou, 310023, China
| | - Wanchen Zhang
- Otolaryngology& Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang 310014, China
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Ru He
- School of Basic Medical Sciences and Forensic Medicine, Hangzhou Medical College, Hangzhou 310012, China
| | - Jiajie Xu
- Otolaryngology& Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang 310014, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou 310014, China
| | - Yu Cai
- Clinical Research Institute, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
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Demarchi MS, Karenovics W, Bédat B, Triponez F. Near-infrared fluorescent imaging techniques for the detection and preservation of parathyroid glands during endocrine surgery. Innov Surg Sci 2022; 7:87-98. [PMID: 36561508 PMCID: PMC9742281 DOI: 10.1515/iss-2021-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives In over 30% of all thyroid surgeries, complications arise from transient and definitive hypoparathyroidism, underscoring the need for real-time identification and preservation of parathyroid glands (PGs). Here, we evaluate the promising intraoperative optical technologies available for the identification, preservation, and functional assessment of PGs to enhance endocrine surgery. Methods We performed a review of the literature to identify published studies on fluorescence imaging in thyroid and parathyroid surgery. Results Fluorescence imaging is a well-demonstrated approach for both in vivo and in vitro localization of specific cells or tissues, and is gaining popularity as a technique to detect PGs during endocrine surgery. Autofluorescence (AF) imaging and indocyanine green (ICG) angiography are two emerging optical techniques to improve outcomes in thyroid and parathyroid surgeries. Near-infrared-guided technology has significantly contributed to the localization of PGs, through the detection of glandular AF. Perfusion through the PGs can be visualized with ICG, which can also reveal the blood supply after dissection. Conclusions Near infrared AF and ICG angiography, providing a valuable spatial and anatomical information, can decrease the incidence of complications in thyroid surgery.
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Affiliation(s)
- Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Benoît Bédat
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Wang Q, Xiangli W, Chen X, Zhang J, Teng G, Cui X, Idrees BS, Wei K. Primary study of identification of parathyroid gland based on laser-induced breakdown spectroscopy. BIOMEDICAL OPTICS EXPRESS 2021; 12:1999-2014. [PMID: 33996212 PMCID: PMC8086479 DOI: 10.1364/boe.417738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 06/01/2023]
Abstract
The identification and preservation of parathyroid glands (PGs) is a major issue in thyroidectomy. The PG is particularly difficult to distinguish from the surrounding tissues. Accidental damage or removal of the PG may result in temporary or permanent postoperative hypoparathyroidism and hypocalcemia. In this study, a novel method for identification of the PG was proposed based on laser-induced breakdown spectroscopy (LIBS) for the first time. LIBS spectra were collected from the smear samples of PG and non-parathyroid gland (NPG) tissues (thyroid and neck lymph node) of rabbits. The emission lines (related to K, Na, Ca, N, O, CN, C2, etc.) observed in LIBS spectra were ranked and selected based on the important weight calculated by random forest (RF). Three machine learning algorithms were used as classifiers to distinguish PGs from NPGs. The artificial neural network classifier provided the best classification performance. The results demonstrated that LIBS can be adopted to discriminate between smear samples of PG and NPG, and it has a potential in intra-operative identification of PGs.
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Affiliation(s)
- Qianqian Wang
- School of Optics and Photonics, Beijing Institute of Technology, 100081 Beijing, China
- Key Laboratory of Photonic Information Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, 100081 Beijing, China
| | - Wenting Xiangli
- School of Optics and Photonics, Beijing Institute of Technology, 100081 Beijing, China
- Key Laboratory of Photonic Information Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, 100081 Beijing, China
| | - Xiaohong Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Beijing 100730, China
| | - Jinghong Zhang
- Department of General Surgery, Beijing Tongren Hospital, Beijing 100730, China
| | - Geer Teng
- School of Optics and Photonics, Beijing Institute of Technology, 100081 Beijing, China
- Key Laboratory of Photonic Information Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, 100081 Beijing, China
| | - Xutai Cui
- School of Optics and Photonics, Beijing Institute of Technology, 100081 Beijing, China
- Key Laboratory of Photonic Information Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, 100081 Beijing, China
| | - Bushra Sana Idrees
- School of Optics and Photonics, Beijing Institute of Technology, 100081 Beijing, China
- Key Laboratory of Photonic Information Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, 100081 Beijing, China
| | - Kai Wei
- School of Optics and Photonics, Beijing Institute of Technology, 100081 Beijing, China
- Key Laboratory of Photonic Information Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, 100081 Beijing, China
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Micko A, Placzek F, Fonollà R, Winklehner M, Sentosa R, Krause A, Vila G, Höftberger R, Andreana M, Drexler W, Leitgeb RA, Unterhuber A, Wolfsberger S. Diagnosis of Pituitary Adenoma Biopsies by Ultrahigh Resolution Optical Coherence Tomography Using Neuronal Networks. Front Endocrinol (Lausanne) 2021; 12:730100. [PMID: 34733239 PMCID: PMC8560084 DOI: 10.3389/fendo.2021.730100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Despite advancements of intraoperative visualization, the difficulty to visually distinguish adenoma from adjacent pituitary gland due to textural similarities may lead to incomplete adenoma resection or impairment of pituitary function. The aim of this study was to investigate optical coherence tomography (OCT) imaging in combination with a convolutional neural network (CNN) for objectively identify pituitary adenoma tissue in an ex vivo setting. METHODS A prospective study was conducted to train and test a CNN algorithm to identify pituitary adenoma tissue in OCT images of adenoma and adjacent pituitary gland samples. From each sample, 500 slices of adjacent cross-sectional OCT images were used for CNN classification. RESULTS OCT data acquisition was feasible in 19/20 (95%) patients. The 16.000 OCT slices of 16/19 of cases were employed for creating a trained CNN algorithm (70% for training, 15% for validating the classifier). Thereafter, the classifier was tested on the paired samples of three patients (3.000 slices). The CNN correctly predicted adenoma in the 3 adenoma samples (98%, 100% and 84% respectively), and correctly predicted gland and transition zone in the 3 samples from the adjacent pituitary gland. CONCLUSION Trained convolutional neural network computing has the potential for fast and objective identification of pituitary adenoma tissue in OCT images with high sensitivity ex vivo. However, further investigation with larger number of samples is required.
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Affiliation(s)
- Alexander Micko
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Fabian Placzek
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Roger Fonollà
- Department of Electrical Engineering, Video Coding and Architectures, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Michael Winklehner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ryan Sentosa
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Arno Krause
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Greisa Vila
- Division of Endocrinology and Metabolism of the Department of Internal Medicine III, Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Marco Andreana
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Rainer A. Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Christian Doppler Laboratory Innovative Optical Imaging and its Translation for “Innovative Optical Imaging and its Translation into Medicine” (OPTRAMED), Medical University of Vienna, Vienna, Austria
| | - Angelika Unterhuber
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Stefan Wolfsberger,
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Placzek F, Micko A, Sentosa R, Fonollà R, Winklehner M, Hosmann A, Andreana M, Höftberger R, Drexler W, Leitgeb RA, Wolfsberger S, Unterhuber A. Towards ultrahigh resolution OCT based endoscopical pituitary gland and adenoma screening: a performance parameter evaluation. BIOMEDICAL OPTICS EXPRESS 2020; 11:7003-7018. [PMID: 33408976 PMCID: PMC7747926 DOI: 10.1364/boe.409987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 05/06/2023]
Abstract
Ultrahigh resolution optical coherence tomography (UHR-OCT) for differentiating pituitary gland versus adenoma tissue has been investigated for the first time, indicating more than 80% accuracy. For biomarker identification, OCT images of paraffin embedded tissue are correlated to histopathological slices. The identified biomarkers are verified on fresh biopsies. Additionally, an approach, based on resolution modified UHR-OCT ex vivo data, investigating optical performance parameters for the realization in an in vivo endoscope is presented and evaluated. The identified morphological features-cell groups with reticulin framework-detectable with UHR-OCT showcase a promising differentiation ability, encouraging endoscopic OCT probe development for in vivo application.
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Affiliation(s)
- Fabian Placzek
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4L, 1090 Vienna, Austria
- These authors contributed equally to this work
| | - Alexander Micko
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- These authors contributed equally to this work
| | - Ryan Sentosa
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4L, 1090 Vienna, Austria
| | - Roger Fonollà
- Department of Electrical Engineering, Video Coding and Architectures, Eindhoven University of Technology, 5612 AZ Eindhoven, Noord-Brabant, The Netherlands
| | - Michael Winklehner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Marco Andreana
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4L, 1090 Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4L, 1090 Vienna, Austria
| | - Rainer A. Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4L, 1090 Vienna, Austria
- Christian Doppler Laboratory OPTRAMED, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Angelika Unterhuber
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 4L, 1090 Vienna, Austria
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11
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Monib S, Mohamed A, Abdelaziz MI. Methylene Blue Spray for Identification of Parathyroid Glands During Thyroidectomy. Cureus 2020; 12:e11569. [PMID: 33364096 PMCID: PMC7749813 DOI: 10.7759/cureus.11569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hypocalcaemia is a common delayed complication after thyroidectomy. Several studies have identified risk factors and possible ways to prevent post-thyroidectomy hypocalcemia. The purpose of our study is to evaluate the effectiveness of an intraoperative methylene blue spray to identify parathyroid glands during thyroidectomy. Materials and methods: We have conducted a prospective non-randomised cohort study with 50 patients who underwent hemithyroidectomy or total thyroidectomy between January 2019 and January 2020. During thyroidectomy, 1 ml (10 mg) of 1% methylene blue was sprayed over the parathyroid glands, the inferior thyroid artery, and the recurrent laryngeal nerve. Results: Our study included 50 patients with ages ranging from 18 to 80 years old (43.0±9.7). We were able to identify the parathyroid glands with the intraoperative methylene blue spray in 82% of cases, with no significant postoperative complications. Conclusion: Our study concludes that the methylene blue spray is a safe, feasible, and effective technique to identify parathyroid glands.
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Affiliation(s)
- Sherif Monib
- Breast Surgery, West Hertfordshire Hospitals NHS Trust, St Albans and Watford General Hospitals, London, GBR
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12
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Multimodal imaging with integrated auto-fluorescence and optical coherence tomography for identification of neck tissues. Lasers Med Sci 2020; 36:1023-1029. [PMID: 32895854 DOI: 10.1007/s10103-020-03139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
We report a multimodal optical system by combining OCT with autofluorescence imaging for identifying neck tissues, which can use the advantages of large field of view and high sensitivity for identifying parathyroid glands of fluorescence imaging, and high-resolution structural imaging of OCT to confirm them and identify lymph nodes and metastatic lymph nodes at the same time. It is proven that this multimodal optical system can be used to identify different neck tissues effectively and efficiently. We think that integrated auto-fluorescence and OCT imaging have the great potential in the application of navigation and assistant diagnosis of thyroid surgery.
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13
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Emil Tampu I, Maintz M, Koller D, Johansson K, Gimm O, Capitanio A, Eklund A, Haj-Hosseini N. Optical coherence tomography for thyroid pathology: 3D analysis of tissue microstructure. BIOMEDICAL OPTICS EXPRESS 2020; 11:4130-4149. [PMID: 32923033 PMCID: PMC7449746 DOI: 10.1364/boe.394296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
To investigate the potential of optical coherence tomography (OCT) to distinguish between normal and pathologic thyroid tissue, 3D OCT images were acquired on ex vivo thyroid samples from adult subjects (n=22) diagnosed with a variety of pathologies. The follicular structure was analyzed in terms of count, size, density and sphericity. Results showed that OCT images highly agreed with the corresponding histopatology and the calculated parameters were representative of the follicular structure variation. The analysis of OCT volumes provides quantitative information that could make automatic classification possible. Thus, OCT can be beneficial for intraoperative surgical guidance or in the pathology assessment routine.
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Affiliation(s)
- Iulian Emil Tampu
- Department of Biomedical Engineering, Linköping University, Linköping 581 85, Sweden
| | - Michaela Maintz
- Department of Biomedical Engineering, Linköping University, Linköping 581 85, Sweden
| | - Daniela Koller
- Department of Biomedical Engineering, Linköping University, Linköping 581 85, Sweden
| | - Kenth Johansson
- Department of Surgery, Västervik Hospital and Örebro University Hospital, Västervik and Örebro, Sweden
| | - Oliver Gimm
- Department of Surgery, and Department of Biomedical and Clinical Sciences, Linköping University Hospital and Linköping University, Linköping 581 85, Sweden
| | - Arrigo Capitanio
- Department of Clinical Pathology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping 581 85, Sweden
| | - Anders Eklund
- Department of Biomedical Engineering, Linköping University, Linköping 581 85, Sweden
- Division of Statistics & Machine Learning, Department of Computer and Information Science, Linköping University, Linköping 581 83, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping 581 85, Sweden
| | - Neda Haj-Hosseini
- Department of Biomedical Engineering, Linköping University, Linköping 581 85, Sweden
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14
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Zaffino P, Moccia S, De Momi E, Spadea MF. A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future. Ann Biomed Eng 2020; 48:2171-2191. [PMID: 32601951 DOI: 10.1007/s10439-020-02553-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.
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Affiliation(s)
- Paolo Zaffino
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
| | - Sara Moccia
- Department of Information Engineering (DII), Universitá Politecnica delle Marche, via Brecce Bianche, 12, 60131, Ancona, AN, Italy.
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, MI, Italy
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
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15
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Intraoperative Adjunct Methods for Localization in Primary Hyperparathyroidism. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 53:84-95. [PMID: 32377064 PMCID: PMC7199831 DOI: 10.14744/semb.2019.37542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/16/2022]
Abstract
Primary hyperparathyroidism (pHPT) is a frequently seen endocrine disease, and its main treatment is surgery. In the majority of pHPT, the disease involves only a single gland, and the majority of the pathological glands can be determined by preoperative localization methods.In addition to preoperative localization studies in parathyroidectomy, the use of adjunct methods to improve intraoperative localization in order to increase success of surgery is becoming widespread. These methods include different approaches, mainly intraoperative parathyroid hormone (PTH) measurement, followed by intraoperative gamma probe application, intraoperative ultrasonography, parathyroid imaging with methylene blue, and frozen section examination. Recently, especially promising new imaging methods have been described in the literature with various optical technologies to increase the localization of the parathyroid glands and to evaluate their viability. These methods include parathyroid imaging with autofluorescence, indocyanine green imaging with autofluorescence, autofluorescence imaging with methylene blue, autofluorescence imaging with 5-aminolevulinic acid, optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging, and Raman spectroscopy. Currently, minimally invasive parathyroidectomy has become the standard treatment for selected pHPT patients with the aid of preoperative imaging and intraoperative auxiliary methods . The aim of the present study was to evaluate the routinely used new promising intraoperative adjunct methods in pHPT.
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16
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Rubinstein M, Hu AC, Chung PS, Kim JH, Osann KE, Schalch P, Armstrong WB, Wong BJF. Intraoperative use of optical coherence tomography to differentiate normal and diseased thyroid and parathyroid tissues from lymph node and fat. Lasers Med Sci 2020; 36:269-278. [PMID: 32337680 DOI: 10.1007/s10103-020-03024-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study is twofold: (1) to determine the feasibility of optical coherence tomography (OCT) to differentiate normal and diseased tissue of the neck region intraoperatively and (2) to evaluate how accurately a cohort of test subjects can identify various tissue types when shown a sample set of OCT images. In this in vivo, prospective, single institutional study, an OCT imaging system (Niris, Imalux, Cleveland, OH) was used to image parathyroid, thyroid, lymph node, and fat tissue in 76 patients during neck surgery. Biopsies were performed for comparison of OCT images with histology in select cases (n = 20). Finally, a group of either surgeons or scientists familiar with OCT (n = 17) were shown a sample of OCT images and asked to identify the tissue. A total of 437 OCT images were analyzed, and characteristic features of each tissue type were identified. OCT demonstrated distinct differences in structural architecture and signal intensity that allows differentiation between thyroid and parathyroid tissues, lymph nodes, and fat. OCT images were also compared with histology with good correlation. There was no difference in correctly identifying OCT-imaged tissue type between surgeons and scientists. This study is the first in vivo OCT imaging study to evaluate both normal and diseased tissues that may be encountered during neck surgery. OCT has the potential to become a valuable intraoperative tool to differentiate diseased and normal thyroid tissue intraoperatively to obtain an "optical biopsy" in real time without fixation, staining, or tissue resection.
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Affiliation(s)
- Marc Rubinstein
- Departement of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, CA, USA
- Beckman Laser Institute and Medical Clinic, University of California Irvine, 1002 Health Sciences Rd, Irvine, CA, 92617, USA
| | - Allison C Hu
- Departement of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, CA, USA
- Beckman Laser Institute and Medical Clinic, University of California Irvine, 1002 Health Sciences Rd, Irvine, CA, 92617, USA
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Phil-Sang Chung
- Beckman Laser Institute Korea, Dankook University, Cheonan, South Korea
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Dankook University, Cheonan, South Korea
| | - Jason H Kim
- Departement of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, CA, USA
| | - Kathryn E Osann
- Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Paul Schalch
- Departement of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, CA, USA
| | - William B Armstrong
- Departement of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, CA, USA
| | - Brian J F Wong
- Departement of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, CA, USA.
- Beckman Laser Institute and Medical Clinic, University of California Irvine, 1002 Health Sciences Rd, Irvine, CA, 92617, USA.
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA.
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17
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Yang N, Boudoux C, De Montigny E, Maniakas A, Gologan O, Madore WJ, Khullar S, Guertin L, Christopoulos A, Bissada E, Ayad T. Rapid head and neck tissue identification in thyroid and parathyroid surgery using optical coherence tomography. Head Neck 2019; 41:4171-4180. [PMID: 31571306 DOI: 10.1002/hed.25972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/25/2019] [Accepted: 09/06/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) is a noninvasive imaging modality that may reproduce the microarchitecture of tissues in real-time. This study examines whether OCT can render distinct images of thyroid, parathyroid glands, adipose tissue, and lymph nodes in both healthy and pathological states. METHODS Twenty-seven patients undergoing thyroidectomy, parathyroidectomy, and/or neck dissection for thyroid cancer were recruited prospectively for imaging prior to histopathological analysis. RESULTS Based on 122 imaged specimens, qualitative OCT descriptions were derived for healthy thyroid, parathyroid gland, adipose tissue, and lymph node. The frequencies at which distinguishing features were present for each tissue type were 88%, 83%, 100%, and 82%. OCT appearance of pathological specimens were also described. CONCLUSIONS Healthy neck tissues have distinct OCT appearances, which could facilitate parathyroid identification during thyroidectomies. However, images of parathyroid adenomas could be confused with those of lymph nodes, and benign and malignant thyroid nodules could not be differentiated.
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Affiliation(s)
- Nathan Yang
- Centre Hospitalier de l'Université de Montréal, Department of Otolaryngology-Head & Neck Surgery, Montreal, Quebec, Canada
| | - Caroline Boudoux
- Department of Engineering Physics, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Etienne De Montigny
- Department of Engineering Physics, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Anastasios Maniakas
- Centre Hospitalier de l'Université de Montréal, Department of Otolaryngology-Head & Neck Surgery, Montreal, Quebec, Canada
| | - Olga Gologan
- Department of Anatomical Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Wendy-Julie Madore
- Department of Engineering Physics, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Sharmila Khullar
- Department of Anatomical Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Louis Guertin
- Centre Hospitalier de l'Université de Montréal, Department of Otolaryngology-Head & Neck Surgery, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Centre Hospitalier de l'Université de Montréal, Department of Otolaryngology-Head & Neck Surgery, Montreal, Quebec, Canada
| | - Eric Bissada
- Centre Hospitalier de l'Université de Montréal, Department of Otolaryngology-Head & Neck Surgery, Montreal, Quebec, Canada
| | - Tareck Ayad
- Centre Hospitalier de l'Université de Montréal, Department of Otolaryngology-Head & Neck Surgery, Montreal, Quebec, Canada
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18
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Piromchai P, Juengtrakool T, Laohasiriwong S, Kasemsiri P, Ungarereevittaya P. The sensitivity and specificity of methylene blue spray to identify the parathyroid gland during thyroidectomy. PeerJ 2019; 7:e6376. [PMID: 30697498 PMCID: PMC6347963 DOI: 10.7717/peerj.6376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/02/2019] [Indexed: 11/20/2022] Open
Abstract
Background Hypocalcemia is a common complication of thyroidectomy resulting from an injury to the parathyroid gland. Methylene blue, which is a medication and dye that has been used for more than a century, is safe and readily available. The previous study has found that methylene blue spray on the surgical field is absorbed by the parathyroid gland faster than in the perithyroidal area. This study was aimed to evaluate the diagnostic value of methylene blue spray to identify the parathyroid gland during thyroid lobectomy. Methods Patients who underwent thyroid lobectomy were recruited. After the recurrent laryngeal nerve was identified, methylene blue was sprayed onto the thyroid bed. After 5 min, the thyroid bed was inspected for areas in which the blue color had been rapidly absorbed. Biopsies were conducted for histopathology at both the stained area and the area in which the color had faded. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results A total of 47 patients participated in this study. The sensitivity of methylene blue spray to identify the parathyroid gland during thyroid lobectomy was 92.31% (95% CI [63.97–99.81]) and specificity was 56.79% (95% CI [45.31–67.76]). The PPV was 25.53% (95% CI [20.34–31.53]) and NPV was 97.87% (95% CI [87.39–99.67]). There were no patients with post-operative hypocalcemia, allergic reactions to the methylene blue, or methylene blue toxicity. Conclusion The methylene blue spray could serve as a screening tool for identification of the parathyroid gland.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thipphailin Juengtrakool
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supawan Laohasiriwong
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pornthep Kasemsiri
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Piti Ungarereevittaya
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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19
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Lerchenberger M, Al Arabi N, Gallwas JKS, Stepp H, Hallfeldt KKJ, Ladurner R. Intraoperative Near-Infrared Autofluorescence and Indocyanine Green Imaging to Identify Parathyroid Glands: A Comparison. Int J Endocrinol 2019; 2019:4687951. [PMID: 31662746 PMCID: PMC6778890 DOI: 10.1155/2019/4687951] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/11/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the feasibility of near-infrared autofluorescence (AF) and indocyanine green (ICG) fluorescence to identify parathyroid glands intraoperatively. METHODS Fluorescence imaging was carried out during open parathyroid and thyroid surgery. After visual identification, parathyroid glands were exposed to near-infrared (NIR) light with a wavelength between 690 and 770 nm. The camera of the Storz® NIR/ICG endoscopic system used detects NIR light as a blue signal. Therefore, parathyroid AF was expected to be displayed in the blue color channel in contrast to the surrounding tissue. Following AF imaging, a bolus of 5 mg ICG was applied intravenously. ICG fluorescence was detected using the same NIR/ICG imaging system. Well-vascularized parathyroid glands were expected to show a strong fluorescence in contrast to surrounding lymphatic and adipose tissue. RESULTS We investigated 78 parathyroid glands from 50 patients. 64 parathyroid glands (82%) displayed AF showing the typical bluish violet color. 63 parathyroid glands (81%) showed a strong and persistent fluorescence after application of ICG. The sensitivity of identifying a parathyroid gland by AF was 82% (64 true positive and 14 false negative results), while ICG imaging showed a sensitivity of 81% (63 true positive and 15 false negative results). The Fisher exact test revealed no significant difference between both groups at p < 0.05. Neither lymph nodes nor adipose tissue revealed substantial AF or ICG fluorescence. CONCLUSION AF and ICG fluorescence reveal a high degree of sensitivity in identifying parathyroid glands. Further, ICG imaging facilitates the assessment of parathyroid perfusion. However, in the current setting both techniques are not suitable as screening tools to identify parathyroid glands at an early stage of the operation.
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Affiliation(s)
- Max Lerchenberger
- Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany
| | - Norah Al Arabi
- Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany
| | - Julia K. S. Gallwas
- Department of Obstetrics and Gynecology, Ludwig Maximilians University Munich, Maistr. 11, 80337 Munich, Germany
| | - Herbert Stepp
- Laser-Research Laboratory, LIFE-Center and Department of Urology, Ludwig Maximilians University Munich, Grosshadern Medical Campus, Feodor-Lynen-Str. 19, 81377 Munich, Germany
| | - Klaus K. J. Hallfeldt
- Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany
| | - Roland Ladurner
- Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany
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20
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Ignat M, Lindner V, Vix M, Marescaux J, Mutter D. Intraoperative Probe-Based Confocal Endomicroscopy to Histologically Differentiate Thyroid From Parathyroid Tissue Before Resection. Surg Innov 2018; 26:141-148. [PMID: 30466375 DOI: 10.1177/1553350618814078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frozen section is the standard method to histologically distinguish parathyroid tissue from thyroid tissue during endocrine neck surgery. Frozen section can be time-consuming and costly. Its drawback is that it is to be performed only after the removal of a suspected pathological tissue. This study demonstrates the use of probe-based confocal laser endomicroscopy (pCLE) to confirm histology prior to tissue resection. DESIGN A prospective, single-institution, nonrandomized study was conducted. No sample size calculation was performed for this observational trial. The primary objective was the description of histological rendering of normal and pathological tissues through pCLE. Real-time in vivo fluorescence microscopy imaging was performed with the CystoFlex UHD probe after intravenous injection of 2.5 mL of 10% fluorescein sodium. RESULTS Eleven patients with hyperparathyroidism and thyroid conditions were included. A total of 104 videos showing thyroid, parathyroid, adipose tissue, muscle, laryngeal nerve, and lymph nodes were recorded. Videos were compared with visual information and pathological samples (when sampling was indicated). Thyroid tissue could be identified based on the presence of colloid follicles (intensely fluorescent area surrounded by a small ridge of low-fluorescence epithelial cells) including the pathognomonic aspect of resorption vacuole. Parathyroid tissue could be identified based on a regular, "diamond-shaped" capillary network encompassing parathyroid chief cells. Blinded reinterpretation of pCLE videos demonstrated an 89.3% sensitivity and a 90% specificity as compared with histology in tissue recognition. CONCLUSION This pilot study describes representative renderings of intraoperative pCLE to nontraumatically differentiate thyroid, parathyroid, and lymph nodes before surgical removal.
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Affiliation(s)
- Mihaela Ignat
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Michel Vix
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Didier Mutter
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
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21
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Abbaci M, De Leeuw F, Breuskin I, Casiraghi O, Lakhdar AB, Ghanem W, Laplace-Builhé C, Hartl D. Parathyroid gland management using optical technologies during thyroidectomy or parathyroidectomy: A systematic review. Oral Oncol 2018; 87:186-196. [PMID: 30527238 DOI: 10.1016/j.oraloncology.2018.11.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023]
Abstract
New optical technologies enhancing localization or assessing viability of parathyroid glands (PG) during endocrine surgery have been reported in clinical studies. These technologies could become complementary to the surgeon's eyes and may improve surgical outcomes in thyroidectomy and parathyroidectomy. Here, we conducted a systematic review focusing on PG identification and functional assessment using optical methods to enhance surgery. A systematic literature review was performed using MEDLINE and Embase database. Two authors selected studies and extracted data; qualitative analysis was performed to summarize the characteristics of reported optical tools for thyroidectomy or parathyroidectomy. Identification and vascularisation of PG during surgery were evaluated. Clinical and biochemical outcomes were appraised when reported. Studies relating to parathyroidectomy or thyroidectomy combined with autofluorescence, fluorescent methylene blue, 5-aminolevulinic acid, indocyanine green (ICG), optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging and Raman spectroscopy were identified with MEDLINE and Embase. We included a total of 47 relevant articles with a total of 1615 patients enrolled. Each optical technique is described and appreciated related to its surgical purpose. Autofluorescence and ICG imaging of PG are the most widely reported optical technologies for identification and assessment of vascularisation of PG. Results are mainly based on observational studies and argue for the feasibility of both techniques in endocrine surgery but prospective randomized studies have not been performed. In vivo applications are still limited for the other methods and further investigations correlating these techniques with post-operative parathormone measurements are still needed before considering these technologies in clinical practice.
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Affiliation(s)
- Muriel Abbaci
- Gustave Roussy, Université Paris-Saclay, Plate-forme Imagerie et Cytométrie, UMS 23/3655, Villejuif F-94805, France; IR4M-UMR 8081, Université Paris-Saclay, Université Paris Sud, CNRS, Orsay F-91401, France.
| | - Frederic De Leeuw
- Gustave Roussy, Université Paris-Saclay, Plate-forme Imagerie et Cytométrie, UMS 23/3655, Villejuif F-94805, France
| | - Ingrid Breuskin
- Gustave Roussy, Université Paris-Saclay, Départements de Cancérologie et de Chirurgie Cervico-Faciale, Villejuif F-94805, France
| | - Odile Casiraghi
- Gustave Roussy, Université Paris-Saclay, Département de Biologie et Pathologie Médicale, Villejuif F-94805, France
| | - Aïcha Ben Lakhdar
- Gustave Roussy, Université Paris-Saclay, Département de Biologie et Pathologie Médicale, Villejuif F-94805, France
| | - Wahib Ghanem
- Gustave Roussy, Université Paris-Saclay, Départements de Cancérologie et de Chirurgie Cervico-Faciale, Villejuif F-94805, France
| | - Corinne Laplace-Builhé
- Gustave Roussy, Université Paris-Saclay, Plate-forme Imagerie et Cytométrie, UMS 23/3655, Villejuif F-94805, France; IR4M-UMR 8081, Université Paris-Saclay, Université Paris Sud, CNRS, Orsay F-91401, France
| | - Dana Hartl
- Gustave Roussy, Université Paris-Saclay, Départements de Cancérologie et de Chirurgie Cervico-Faciale, Villejuif F-94805, France
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22
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Thomas G, McWade MA, Paras C, Mannoh EA, Sanders ME, White LM, Broome JT, Phay JE, Baregamian N, Solórzano CC, Mahadevan-Jansen A. Developing a Clinical Prototype to Guide Surgeons for Intraoperative Label-Free Identification of Parathyroid Glands in Real Time. Thyroid 2018; 28:1517-1531. [PMID: 30084742 PMCID: PMC6247985 DOI: 10.1089/thy.2017.0716] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients undergoing thyroidectomy may have inadvertent damage or removal of the parathyroid gland(s) due to difficulty in real-time parathyroid identification. Near-infrared autofluorescence (NIRAF) has been demonstrated as a label-free modality for intraoperative parathyroid identification with high accuracy. This study presents the translation of that approach into a user-friendly clinical prototype for rapid intraoperative guidance in parathyroid identification. METHODS A laboratory (lab)-built spectroscopy system that measures NIRAF in tissue was evaluated for identifying parathyroid glands in vivo across 162 patients undergoing thyroidectomy and/or parathyroidectomy. Based on these results, a clinical prototype called PTeye was designed with a user-friendly interface and subsequently investigated in 35 patients. The performance of the lab-built system and the clinical prototype were concurrently compared side by side by a single user with 20 patients in each group. The influence of (i) intrapatient and interpatient variability of NIRAF in thyroid and parathyroid glands and (ii) thyroid and parathyroid pathology on intraoperative parathyroid identification were investigated. The effect of blood on NIRAF intensity of parathyroid and thyroid was tested ex vivo with the PTeye system to assess if a hemorrhagic surgical field would affect parathyroid identification. Accuracy of both systems were determined by correlating the acquired data with either visual confirmation by a surgeon for unexcised parathyroid glands or histology reports for excised parathyroid glands. RESULTS The overall accuracy of the lab-built system in guiding parathyroid identification was 92.5%, while the PTeye system achieved an accuracy of 96.1%. Unlike the lab-built system, the PTeye could guide parathyroid identification even as the operating room lights remained on and required only 25% of the laser power used by the lab-built setup. Parathyroid glands had elevated NIRAF intensity compared to thyroid and other neck tissues, regardless of thyroid or parathyroid pathology. Blood did not seem to affect tissue NIRAF measurements obtained with both systems. CONCLUSION In this study, the clinical prototype PTeye demonstrated high accuracy for label-free intraoperative parathyroid identification. The intuitive interface of the PTeye that can guide in identifying parathyroid tissue in the presence of ambient room lights suggests that it is a reliable and easy-to-use tool for surgical personnel.
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Affiliation(s)
- Giju Thomas
- Vanderbilt Biophotonics Center, Vanderbilt University Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University Nashville, Tennessee
| | - Melanie A. McWade
- Vanderbilt Biophotonics Center, Vanderbilt University Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University Nashville, Tennessee
| | - Constantine Paras
- Vanderbilt Biophotonics Center, Vanderbilt University Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University Nashville, Tennessee
| | - Emmanuel A. Mannoh
- Vanderbilt Biophotonics Center, Vanderbilt University Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University Nashville, Tennessee
| | | | - Lisa M. White
- Murfreesboro Surgical Center, Murfreesboro, Tennessee
| | | | - John E. Phay
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center and The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Naira Baregamian
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Nashville, Tennessee
| | - Carmen C. Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Nashville, Tennessee
| | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center, Vanderbilt University Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University Nashville, Tennessee
- Address correspondence to: Anita Mahadevan-Jansen, PhD, Department of Biomedical Engineering, Vanderbilt University, Station B, Box 351631, Nashville, TN 37235
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Intraoperative optical coherence tomography of the human thyroid: Feasibility for surgical assessment. Transl Res 2018; 195:13-24. [PMID: 29287166 PMCID: PMC5899010 DOI: 10.1016/j.trsl.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/20/2017] [Accepted: 12/02/2017] [Indexed: 01/06/2023]
Abstract
Thyroid nodules assessed with ultrasound and fine-needle aspiration biopsy are diagnosed as "suspicious" or "indeterminate" in 15%-20% of the cases. Typically, total thyroidectomy is performed in such cases; however, only 25%-50% are found to be cancerous upon final histopathologic analysis. Here we demonstrate optical coherence tomography (OCT) imaging of the human thyroid as a potential intraoperative imaging tool for providing tissue assessment in real time during surgical procedures. Fresh excised tissue specimens from 28 patients undergoing thyroid surgery were imaged in the laboratory using a benchtop OCT system. Three-dimensional OCT images showed different microstructural features in normal, benign, and malignant thyroid tissues. A similar portable OCT system was then designed and constructed for use in the operating room, and intraoperative imaging of excised thyroid tissue from 6 patients was performed during the surgical procedure. The results demonstrate the potential of OCT to provide real-time imaging guidance during thyroid surgeries.
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Englhard AS, Betz T, Volgger V, Lankenau E, Ledderose GJ, Stepp H, Homann C, Betz CS. Intraoperative assessment of laryngeal pathologies with optical coherence tomography integrated into a surgical microscope. Lasers Surg Med 2017; 49:490-497. [PMID: 28231390 DOI: 10.1002/lsm.22632] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Endoscopic examination followed by tissue biopsy is the gold standard in the evaluation of lesions of the upper aerodigestive tract. However, it can be difficult to distinguish between healthy mucosa, dysplasia, and invasive carcinoma. Optical coherence tomography (OCT) is a non-invasive technique which acquires high-resolution, cross-sectional images of tissue in vivo. Integrated into a surgical microscope, it allows the intraoperative evaluation of lesions simultaneously with microscopic visualization. STUDY DESIGN In a prospective case series, we evaluated the use of OCT integrated into a surgical microscope during microlaryngoscopy to help differentiating various laryngeal pathologies. METHODS 33 patients with laryngeal pathologies were examined with an OCT- microscope (OPMedT iOCT-camera, HS Hi-R 1000G-microscope, Haag-Streit Surgical GmbH, Wedel, Germany) during microlaryngoscopy. The suspected intraoperative diagnoses were compared to the histopathological reports of subsequent tissue biopsies. RESULTS Hands-free non-contact OCT revealed high-resolution images of the larynx with a varying penetration depth of up to 1.2 mm and an average of 0.6 mm. Picture quality was variable. OCT showed disorders of horizontal tissue layering in dysplasias with a disruption of the basement membrane in carcinomas. When comparing the suspected diagnosis during OCT-supported microlaryngoscopy with histology, 79% of the laryngeal lesions could be correctly identified. Premalignant lesions were difficult to diagnose and falsely classified as carcinoma. CONCLUSION OCT integrated into a surgical microscope seems to be a promising adjunct tool to discriminate pathologies of the upper aerodigestive tract intraoperatively. However, picture quality and penetration depth were variable. Although premalignant lesions were difficult to diagnose, the system proved overall helpful for the intraoperative discrimination of benign and malignant tumors. Further studies will be necessary to define its value in the future. Lasers Surg. Med. 49:490-497, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Anna S Englhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Tom Betz
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Veronika Volgger
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Eva Lankenau
- OptoMedical Technologies GmbH, Maria-Goeppert-Strasse 9, 23562 Lübeck, Germany
| | - Georg J Ledderose
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Feodor-Lynen-Str.19, 81377 Munich, Germany
| | - Christian Homann
- Laser-Forschungslabor, LIFE-Zentrum, Klinikum der Universität München, Feodor-Lynen-Str.19, 81377 Munich, Germany
| | - Christian S Betz
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany
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Hou F, Yu Y, Liang Y. Automatic identification of parathyroid in optical coherence tomography images. Lasers Surg Med 2017; 49:305-311. [PMID: 28129441 DOI: 10.1002/lsm.22622] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The identification and preservation of parathyroid is a major problem in thyroid surgery. In order to solve this problem, optical coherence tomography was involved as a real-time, non-invasive high-resolution imaging technique. This study demonstrated an effective and fast method to distinguish parathyroid tissue from thyroid, lymph node, and adipose tissue in their ex vivo optical coherence tomography (OCT) images automatically. METHODS OCT images were obtained from parathyroid, thyroid, lymph node, and adipose tissue, respectively. A classification and an identification system based on texture features analysis and back propagation artificial neural network (BP-ANN) were established to classify the four types of tissue and identify each of the four types automatically. RESULTS A total of 248 OCT images were taken from 16 patients undergoing thyroidectomy. The accuracy of classification for parathyroid, thyroid, lymph node, and adipose were 99.21, 98.43, 97.65, and 98.43%, respectively. CONCLUSION The proposed automatic identification method is capable of distinguishing among parathyroid, thyroid, lymph, and adipose automatically and effectively. Compared with the identification results of human, it has a better accuracy and reliability. For identifying parathyroid from the other entities, it has a satisfying performance. Lasers Surg. Med. 49:305-311, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Fang Hou
- Institute of Modern Optics, Nankai University, Key Laboratory of Optical Information Science and Technology, Ministry of Education, Tianjin, 300071, China
| | - Yang Yu
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute & Hospital, Oncology Key Laboratory of Cancer Prevention & Therapy, Tianjin, 300060, China
| | - Yanmei Liang
- Institute of Modern Optics, Nankai University, Key Laboratory of Optical Information Science and Technology, Ministry of Education, Tianjin, 300071, China
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Tonutti M, Elson DS, Yang GZ, Darzi AW, Sodergren MH. The role of technology in minimally invasive surgery: state of the art, recent developments and future directions. Postgrad Med J 2016; 93:159-167. [DOI: 10.1136/postgradmedj-2016-134311] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/13/2016] [Accepted: 10/28/2016] [Indexed: 01/18/2023]
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Lee HS, Shin SW, Bae JK, Jung WG, Kim SW, Oak C, Chun BK, Ahn YC, Lee BJ, Lee KD. Preliminary study of optical coherence tomography imaging to identify microscopic extrathyroidal extension in patients with papillary thyroid carcinoma. Lasers Surg Med 2015; 48:371-6. [PMID: 26718751 DOI: 10.1002/lsm.22466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the feasibility of using optical coherence tomography (OCT), to identify microscopic extrathyroidal extension (mETE) in ex vivo thyroidectomy specimens of patients who underwent thyroidectomy for the treatment of papillary thyroid carcinoma (PTC). METHODS A total of 170 ex vivo OCT images of the tumor, were acquired just after completion of thyroidectomy in 17 patients. The OCT images of each patient were separately evaluated by two blinded investigators, and the outcomes were compared with the histopathology reports. RESULTS The sensitivity and specificity of mETE identification from the OCT images were 81.4% and 86.0%, respectively, for the first investigator, and 82.9% and 87.0%, respectively, for the second investigator. Substantial agreement between the investigators was verified by Cohen's κ (Cohen's κ = 0.772). CONCLUSION In this preliminary study of a limited series of ex vivo thyroidectomy specimens, we verified the feasibility of OCT as a method of identifying mETE in patients with PTC.
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Affiliation(s)
- Hyoung Shin Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea.,Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea
| | - Sung Won Shin
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Jung Kweon Bae
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Woong Gyu Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea.,Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea
| | - Chulho Oak
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea.,Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Bong Kwon Chun
- Department of Pathology, Kosin University College of Medicine, Busan, South Korea
| | - Yeh-Chan Ahn
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, Busan, Korea.,Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, Busan, South Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Medical Research Institute, Busan, South Korea
| | - Kang Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea
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[Optical coherence tomography for differentiation of parathyroid gland tissue]. Chirurg 2015; 87:416-22. [PMID: 26661948 DOI: 10.1007/s00104-015-0120-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a high-resolution imaging technique that allows the identification of microarchitectural features in real-time. OBJECTIVE Can OCT be used to differentiate parathyroid tissue from other cervical tissue entities? MATERIAL AND METHODS All investigations were carried out during cervical operations. Initially, ex vivo images were analyzed to define morphological imaging criteria for each tissue entity. These criteria were used to evaluate a first series of ex vivo images. In a second phase the practicability of the technique was investigated in vivo and in the third phase backscattering intensity measurements were analyzed employing linear discriminant analysis (LDA). RESULTS In the ex vivo series parathyroid tissue could be differentiated from other tissue entities with a sensitivity and specificity of 84 % and 94 %, respectively. Parathyroid tissue was correctly identified in the in vivo series in only 69.2 %. The analysis of backscattering intensity profiles employing LDA reliably distinguished between the different tissue types. CONCLUSION The OCT images displayed typical characteristics for each tissue entity. Due to technical problems in handling the probe the in vivo OCT images were of much poorer quality. Backscattering intensity measurements illustrated that OCT images provide an individual profile for each tissue entity independent of the defined morphological assessment criteria. The results show that OCT is fundamentally suitable for intraoperative differentiation of tissues.
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