1
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Hren R, Brezar SK, Marhl U, Sersa G. Laser speckle contrast imaging of perfusion in oncological clinical applications: a literature review. Radiol Oncol 2024; 58:326-334. [PMID: 39287164 PMCID: PMC11406933 DOI: 10.2478/raon-2024-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/26/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Laser speckle coherence imaging (LSCI) is an emerging imaging modality that enables noninvasive visualization and assessment of tissue perfusion and microcirculation. In this article, we evaluated LSCI in imaging perfusion in clinical oncology through a systematic review of the literature. METHODS The inclusion criterion for the literature search in PubMed, Web of Science and Scopus electronic databases was the use of LSCI in clinical oncology, meaning that all animal, phantom, ex vivo, experimental, research and development, and purely methodological studies were excluded. RESULTS Thirty-six articles met the inclusion criteria. The anatomic locations of the neoplasms in the selected articles were brain (5 articles), breasts (2 articles), endocrine glands (4 articles), skin (12 articles), and the gastrointestinal tract (13 articles). CONCLUSIONS While LSCI is emerging as an appealing imaging modality, it is crucial for more clinical sites to initiate clinical trials. A lack of standardized protocols and interpretation guidelines are posing the most significant challenge.
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Affiliation(s)
- Rok Hren
- Faculty of Mathematics and Physics, Ljubljana, Slovenia
- Institute of Mathematics, Physics, and Mechanics, Ljubljana, Slovenia
- Syreon Research Institute, Budapest, Hungary
| | | | - Urban Marhl
- Institute of Mathematics, Physics, and Mechanics, Ljubljana, Slovenia
| | - Gregor Sersa
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
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2
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Yeum I, Ko D, Lee G, Seok H, Jung B. Dual-mode optical projection mapping system: integration of laser speckle contrast and subcutaneous vein imaging. Biomed Eng Lett 2024; 14:1125-1135. [PMID: 39220033 PMCID: PMC11362447 DOI: 10.1007/s13534-024-00400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 09/04/2024] Open
Abstract
Dual-mode optical imaging can simultaneously provide morphological and functional information. Furthermore, it can be integrated with projection mapping method to directly observe the images in the region of interest. This study was aimed to develop a dual-mode optical projection mapping system (DOPMS) that obtains laser speckle contrast image (LSCI) and subcutaneous vein image (SVI) and projects onto the region of interest, minimizing the spatial misalignment between the regions captured by the camera and projected by a projector. In in vitro and in vivo studies, LSCI and SVI were obtained and projected under single-mode illumination, where either the laser or light-emitting diode (LED) was activated, and under dual-mode illumination, where the laser and LED were activated simultaneously. In addition, fusion image (FI) of LSCI and SVI was implemented to selectively observe blood perfusion in the vein. DOPMS successfully obtained LSCI, SVI, and FI and projected them onto the identical region of interest, minimizing spatial misalignment. Single-mode illumination resulted in relatively clearer and noise-free images. Dual-mode illumination introduced speckle noise to SVI and FI but enabled real-time imaging by simultaneously employing LSCI, SVI, and FI. FI may be more effective for quasi-static evaluations before and after treatment under single-mode illumination and for real-time evaluation during treatment under dual-mode illumination owing to its faster image processing, albeit with a potential tradeoff in image quality.
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Affiliation(s)
- Insun Yeum
- Department of Biomedical Engineering, Yonsei University, Wonju-Si, Republic of Korea
| | - Donghwan Ko
- Department of Biomedical Engineering, Yonsei University, Wonju-Si, Republic of Korea
| | - Gyujin Lee
- Department of Biomedical Engineering, Yonsei University, Wonju-Si, Republic of Korea
| | - Hoik Seok
- Department of Biomedical Engineering, Yonsei University, Wonju-Si, Republic of Korea
| | - Byungjo Jung
- Department of Biomedical Engineering, Yonsei University, Wonju-Si, Republic of Korea
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3
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Hu J, Xing J, Shao P, Ma X, Li P, Liu P, Zhang R, Chen W, Lei W, Xu RX. Raman spectroscopy with an improved support vector machine for discrimination of thyroid and parathyroid tissues. JOURNAL OF BIOPHOTONICS 2024; 17:e202400084. [PMID: 38890800 DOI: 10.1002/jbio.202400084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/20/2024]
Abstract
The objective of this study was to discriminate thyroid and parathyroid tissues using Raman spectroscopy combined with an improved support vector machine (SVM) algorithm. In thyroid surgery, there is a risk of inadvertently removing the parathyroid glands. At present, there is a lack of research on using Raman spectroscopy to discriminate parathyroid and thyroid tissues. In this article, samples were obtained from 43 individuals with thyroid and parathyroid tissues for Raman spectroscopy analysis. This study employed partial least squares (PLS) to reduce dimensions of data, and three optimization algorithms are used to improve the classification accuracy of SVM algorithm model in spectral analysis. The results show that PLS-GA-SVM algorithm has higher diagnostic accuracy and better reliability. The sensitivity of this algorithm is 94.67% and the accuracy is 94.44%. It can be concluded that Raman spectroscopy combined with the PLS-GA-SVM diagnostic algorithm has significant potential for discriminating thyroid and parathyroid tissues.
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Affiliation(s)
- Jie Hu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
| | - Jinyu Xing
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
- Institute of Advanced Technology, University of Science and Technology of China, Hefei, China
| | - Pengfei Shao
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
| | - Xiaopeng Ma
- First Affiliated Hospital, University of Science and Technology of China, Hefei, China
| | - Peikun Li
- General Surgery Department, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Liu
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
| | - Ru Zhang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
| | - Wei Chen
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
| | - Wang Lei
- General Surgery Department, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ronald X Xu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, China
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
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4
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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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5
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Sahu A, Zameer MM, Rao S, D’Cruz A. Sestamibi-guided thoracoscopic excision of functional mediastinal parathyroid adenoma in a child: A case report and review of literature. J Minim Access Surg 2024; 20:102-104. [PMID: 37282424 PMCID: PMC10898640 DOI: 10.4103/jmas.jmas_190_22] [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: 07/06/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 03/19/2023] Open
Abstract
Primary hyperparathyroidism secondary to ectopic parathyroid (in anterior mediastinum) is rare in children. We report the case of a 12-year-old girl with a history of multiple fractures, renal calculi and limb deformities. She was diagnosed with hyperparathyroidism secondary to an intrathymic parathyroid adenoma. Sestamibi scan showed a lesion in the anterior mediastinum. A biochemical evaluation revealed hypercalcaemia, elevated alkaline phosphatase and parathormone levels. The lesion was marked with radioisotope and confirmed intraoperatively using a gamma camera. The child underwent thoracoscopic left thymectomy with the adenoma. Immediate decrease in calcium and parathyroid hormone values were noted intraoperatively and serial monitoring showed a downward trend. On follow-up, the child is doing well. Ectopic parathyroid adenoma is very rare. CT with radioisotope scans is helpful in diagnosis. Thoracoscopic excision of ectopic adenoma is safe in children.
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Affiliation(s)
- Avilash Sahu
- Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India
| | - M. M. Zameer
- Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India
| | - Sanjay Rao
- Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India
| | - Ashley D’Cruz
- Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India
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6
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Juarez-Ramirez JC, Coyotl-Ocelotl B, Choi B, Ramos-Garcia R, Spezzia-Mazzocco T, Ramirez-San-Juan JC. Improved spatial speckle contrast model for tissue blood flow imaging: effects of spatial correlation among neighboring camera pixels. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:125002. [PMID: 38074216 PMCID: PMC10704254 DOI: 10.1117/1.jbo.28.12.125002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023]
Abstract
Significance Speckle contrast analysis is the basis of laser speckle imaging (LSI), a simple, inexpensive, noninvasive technique used in various fields of medicine and engineering. A common application of LSI is the measurement of tissue blood flow. Accurate measurement of speckle contrast is essential to correctly measure blood flow. Variables, such as speckle grain size and camera pixel size, affect the speckle pattern and thus the speckle contrast. Aim We studied the effects of spatial correlation among adjacent camera pixels on the resulting speckle contrast values. Approach We derived a model that accounts for the potential correlation of intensity values in the common experimental situation where the speckle grain size is larger than the camera pixel size. In vitro phantom experiments were performed to test the model. Results Our spatial correlation model predicts that speckle contrast first increases, then decreases as the speckle grain size increases relative to the pixel size. This decreasing trend opposes what is observed with a standard speckle contrast model that does not consider spatial correlation. Experimental data are in good agreement with the predictions of our spatial correlation model. Conclusions We present a spatial correlation model that provides a more accurate measurement of speckle contrast, which should lead to improved accuracy in tissue blood flow measurements. The associated correlation factors only need to be calculated once, and open-source software is provided to assist with the calculation.
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Affiliation(s)
| | - Beatriz Coyotl-Ocelotl
- Instituto Nacional de Astrofisica, Optica y Electronica, Departamento de Optica, Tonantzintla, Mexico
| | - Bernard Choi
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Department of Surgery, Irvine, California, United States
| | - Ruben Ramos-Garcia
- Instituto Nacional de Astrofisica, Optica y Electronica, Departamento de Optica, Tonantzintla, Mexico
| | - Teresita Spezzia-Mazzocco
- Instituto Nacional de Astrofisica, Optica y Electronica, Departamento de Optica, Tonantzintla, Mexico
| | - Julio C. Ramirez-San-Juan
- Instituto Nacional de Astrofisica, Optica y Electronica, Departamento de Optica, Tonantzintla, Mexico
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7
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Mannoh EA, Baregamian N, Thomas G, Solόrzano CC, Mahadevan-Jansen A. Comparing laser speckle contrast imaging and indocyanine green angiography for assessment of parathyroid perfusion. Sci Rep 2023; 13:17270. [PMID: 37828222 PMCID: PMC10570279 DOI: 10.1038/s41598-023-42649-2] [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: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
Accurate intraoperative assessment of parathyroid blood flow is crucial to preserve function postoperatively. Indocyanine green (ICG) angiography has been successfully employed, however its conventional application has limitations. A label-free method overcomes these limitations, and laser speckle contrast imaging (LSCI) is one such method that can accurately detect and quantify differences in parathyroid perfusion. In this study, twenty-one patients undergoing thyroidectomy or parathyroidectomy were recruited to compare LSCI and ICG fluorescence intraoperatively. An experimental imaging device was used to image a total of 37 parathyroid glands. Scores of 0, 1 or 2 were assigned for ICG fluorescence by three observers based on perceived intensity: 0 for little to no fluorescence, 1 for moderate or patchy fluorescence, and 2 for strong fluorescence. Speckle contrast values were grouped according to these scores. Analyses of variance were performed to detect significant differences between groups. Lastly, ICG fluorescence intensity was calculated for each parathyroid gland and compared with speckle contrast in a linear regression. Results showed significant differences in speckle contrast between groups such that parathyroids with ICG score 0 had higher speckle contrast than those assigned ICG score 1, which in turn had higher speckle contrast than those assigned ICG score 2. This was further supported by a correlation coefficient of -0.81 between mean-normalized ICG fluorescence intensity and speckle contrast. This suggests that ICG angiography and LSCI detect similar differences in blood flow to parathyroid glands. Laser speckle contrast imaging shows promise as a label-free alternative that overcomes current limitations of ICG angiography for parathyroid assessment.
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Affiliation(s)
- Emmanuel A Mannoh
- Vanderbilt Biophotonics Center, Vanderbilt University, PMB 351631, Nashville, TN, 37235, USA.
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA.
| | - Naira Baregamian
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Vanderbilt University, PMB 351631, Nashville, TN, 37235, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
| | - Carmen C Solόrzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center, Vanderbilt University, PMB 351631, Nashville, TN, 37235, USA.
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA.
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
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8
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Park S, Yeum I, Ko D, Jung B. Projection mapping system for laser speckle contrast image: feasibility study for clinical application. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:096001. [PMID: 37671114 PMCID: PMC10476001 DOI: 10.1117/1.jbo.28.9.096001] [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: 02/02/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023]
Abstract
Significance Laser speckle contrast images (LSCIs) have been utilized to monitor blood flow perfusion. However, they have conventionally been observed on monitor screens, resulting in potential spatial mismatching between the imaging region of interest (IROI) and monitor screen. Aim This study proposes a projection mapping (PM) system for LSCIs (PMS_LSCI) that projects LSCIs to directly observe the blood flow perfusion in the IROI. Approach The PMS_LSCI consists of a camera, imaging optics, a laser projector, and graphic user interface software. The spatial matching in the regions of interest was performed by adjusting the software screen of the LSCI in the IROI and evaluated by conducting in-vitro and in-vivo studies. An additional in-vivo study was performed to investigate the feasibility of real-time PM of the LSCI. Results The spatial mismatching in the regions of interest was ranged from 2.74% to 6.47% depending on the surface curvature. The PMS_LSCI could enable real-time PM of LSCI at four different blood flow states depending on blood pressure. Conclusions The PMS_LSCI projects the LSCI in the IROI by interacting with a projector instead of the monitor screen. The PMS_LSCI presented clinical feasibility in the in-vitro and in-vivo studies.
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Affiliation(s)
- Subin Park
- Yonsei University, Department of Biomedical Engineering, Wonju-Si, Republic of Korea
| | - Insun Yeum
- Yonsei University, Department of Biomedical Engineering, Wonju-Si, Republic of Korea
| | - Donghwan Ko
- Yonsei University, Department of Biomedical Engineering, Wonju-Si, Republic of Korea
| | - Byungjo Jung
- Yonsei University, Department of Biomedical Engineering, Wonju-Si, Republic of Korea
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9
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Gopal JP, Vaz O, Varley R, Spiers H, Goldsworthy MA, Siddagangaiah V, Lock B, Sharma V, Summers A, Moinuddin Z, van Dellen D, Augustine T. Using Laser Speckle Contrast Imaging to Quantify Perfusion Quality in Kidney and Pancreas Grafts on Vascular Reperfusion: A Proof-of-Principle Study. Transplant Direct 2023; 9:e1472. [PMID: 37090123 PMCID: PMC10118345 DOI: 10.1097/txd.0000000000001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 04/25/2023] Open
Abstract
The accuracy of intraoperative graft perfusion assessment still remains subjective, with doppler examination being the only objective adjunct. Laser speckle contrast imaging (LSCI) has been used to assess intraoperative blood flow in neurosurgery and in various surgical specialties. Despite its ability to accurately quantify perfusion at the microvascular level, it has not been clinically evaluated in kidney/kidney-pancreas transplantation for perfusion characterization. We aimed to evaluate the utility of LSCI and identify objective parameters that can be quantified at reperfusion. Methods This study was registered in ClinicalTrials.gov (NCT04202237). The Moor FLPI-2 blood flow imager was used in 4 patients (1 Simultaneous Pancreas and Kidney, 2 deceased, and 1 living donor kidney transplants) during reperfusion to capture reperfusion data. The following parameters were measured: flux (average speed × concentration of moving red blood cells in the sample volume), doppler centroid, total and valid pixels, valid rate, and total and valid area. Flux data were analyzed with Moor FLPI analysis software. Results The perfusion characteristics and flux images correlated with initial graft function. Conclusions LSCI is a safe, noncontact imaging modality that provides real-time, accurate, high-resolution, full field blood flow images and a wide range of flux data to objectively quantify organ reperfusion intraoperatively in kidney/kidney-pancreas transplantation. This modality could be used to develop a robust numerical quantification system for the evaluation and reporting of intraoperative organ perfusion, and aid intraoperative decision-making. Perfusion data could be combined with biomarkers and immunological parameters to more accurately predict graft outcomes.
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Affiliation(s)
- Jeevan Prakash Gopal
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Department of General Surgery, The Queen Elizabeth Hospital King’s Lynn NHS Trust, King’s Lynn, United Kingdom
| | - Osborne Vaz
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Rebecca Varley
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Harry Spiers
- Department of Transplantation, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Matthew A. Goldsworthy
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Vishwanath Siddagangaiah
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Brian Lock
- Moor Instruments Ltd, Axminster, United Kingdom
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Angela Summers
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- University of Manchester-Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, United Kingdom
| | - Zia Moinuddin
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - David van Dellen
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
- University of Manchester-Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, United Kingdom
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10
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Baregamian N, Sekhar KR, Krystofiak ES, Vinogradova M, Thomas G, Mannoh E, Solórzano CC, Kiernan CM, Mahadevan-Jansen A, Abumrad N, Freeman ML, Weiss VL, Rathmell JC, Rathmell WK. Engineering functional 3-dimensional patient-derived endocrine organoids for broad multiplatform applications. Surgery 2023; 173:67-75. [PMID: 36400581 PMCID: PMC9939934 DOI: 10.1016/j.surg.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent advancements in 3-dimensional patient-derived organoid models have revolutionized the field of cancer biology. There is an urgent need for development of endocrine tumor organoid models for medullary thyroid carcinoma, adrenocortical carcinoma, papillary thyroid carcinoma, and a spectrum of benign hyperfunctioning parathyroid and adrenal neoplasms. We aimed to engineer functionally intact 3-dimensional endocrine patient-derived organoids to expand the in vitro and translational applications for the advancement of endocrine research. METHODS Using our recently developed fine needle aspiration-based methodology, we established patient-derived 3-dimensional endocrine organoid models using prospectively collected human papillary thyroid carcinoma (n = 6), medullary thyroid carcinoma (n = 3), adrenocortical carcinoma (n = 3), and parathyroid (n = 5). and adrenal (n = 5) neoplasms. Multiplatform analyses of endocrine patient-derived organoids and applications in oncoimmunology, near-infrared autofluorescence, and radiosensitization studies under 3-dimensional in vitro conditions were performed. RESULTS We have successfully modeled and analyzed the complex endocrine microenvironment for a spectrum of endocrine neoplasms in 3-dimensional culture. The endocrine patient-derived organoids recapitulated complex tumor microenvironment of endocrine neoplasms morphologically and functionally and maintained cytokine production and near-infrared autofluorescence properties. CONCLUSION Our novel engineered endocrine patient-derived organoid models of thyroid, parathyroid and adrenal neoplasms represent an exciting and elegant alternative to current limited 2-dimensional systems and afford future broad multiplatform in vitro and translational applications, including in endocrine oncoimmunology.
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Affiliation(s)
- Naira Baregamian
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Konjeti R Sekhar
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Giju Thomas
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN
| | - Emmanuel Mannoh
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN
| | - Carmen C Solórzano
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Colleen M Kiernan
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Naji Abumrad
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael L Freeman
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Vivian L Weiss
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey C Rathmell
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - W Kimryn Rathmell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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11
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Hellmann M, Kalinowski L, Cracowski JL. Laser speckle contrast imaging to assess microcirculation. Cardiol J 2022; 29:1028-1030. [PMID: 36342035 PMCID: PMC9788749 DOI: 10.5603/cj.a2022.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marcin Hellmann
- Department of Cardiac Diagnostics, Medical University of Gdansk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdansk, Poland,BioTechMed Center, Department of Mechanics of Materials and Structures, Gdansk University of Technology, Gdansk, Poland
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12
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Muacevic A, Adler JR, Fallatah S, Almehmadi RA, Aljuaid H, Alsalem AS, Mahfouz MEM, Alosaimi M. Prevalence and Risk Factors for Hypoparathyroidism Following Total Thyroidectomy in Taif City. Cureus 2022; 14:e32460. [PMID: 36644104 PMCID: PMC9834760 DOI: 10.7759/cureus.32460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background Postoperative hypoparathyroidism has been investigated in health records and surgical cohorts, but the results have been highly variable and imprecise. It is not clear how often endocrinologists encounter this hormone deficit in clinical practice. Thus, the aim of this study is to determine the incidence of permanent hypoparathyroidism and the factors associated with it in a group of post-thyroidectomy patients followed at three tertiary care institutions in Taif city. Materials and Methods A retrospective cohort analysis was done to examine patients who had a total thyroidectomy in the city of Taif between January 1, 2015, and December 31, 2019. Patients were eligible for the study if they received total thyroidectomy, were above the age of 18 years, had surgical and pathological data available, and had been monitored in the same institution for at least a year after their thyroidectomy. Patients who did not return for follow-up care following surgery were excluded from the study. Results The incidence of hypoparathyroidism was 10.3%, and females had a higher prevalence (12.1%) than males (3.2%). In patients with two and three parathyroid glands, hypoparathyroidism was found to be more prevalent (33.3% and 25.5%) in permanent histological sections. There was no single independent risk factor for hypoparathyroidism according to a logistic regression model. Conclusion The incidence rate of hypoparathyroidism following total thyroidectomy was about 10.3%. There were no independent risk factors identified for hypoparathyroidism after total thyroidectomy. Permanent hypoparathyroidism severely affects the quality of life, and research should be done to prevent its incidence after thyroidectomy.
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13
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Pasieka JL, Wentworth K, Yeo CT, Cremers S, Dempster D, Fukumoto S, Goswami R, Houillier P, Levine MA, Pasternak JD, Perrier ND, Sitges-Serra A, Shoback DM. Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review. J Bone Miner Res 2022; 37:2586-2601. [PMID: 36153665 PMCID: PMC10364481 DOI: 10.1002/jbmr.4714] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 01/19/2023]
Abstract
The approach utilized a systematic review of the medical literature executed with specifically designed criteria that focused on the etiologies and pathogenesis of hypoparathyroidism. Enhanced attention by endocrine surgeons to new knowledge about parathyroid gland viability are reviewed along with the role of intraoperative parathyroid hormone (ioPTH) monitoring during and after neck surgery. Nonsurgical etiologies account for a significant proportion of cases of hypoparathyroidism (~25%), and among them, genetic etiologies are key. Given the pervasive nature of PTH deficiency across multiple organ systems, a detailed review of the skeletal, renal, neuromuscular, and ocular complications is provided. The burden of illness on affected patients and their caregivers contributes to reduced quality of life and social costs for this chronic endocrinopathy. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Janice L Pasieka
- Clinical Professor of Surgery and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kelly Wentworth
- Assistant Adjunct Professor of Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Caitlin T Yeo
- Clinical Lecturer of Surgery and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Serge Cremers
- Associate Professor of Pathology and Cell Biology and Medicine, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - David Dempster
- Professor of Clinical Pathology and Cell Biology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Seiji Fukumoto
- Specially Appointed Professor, Fujii Memorial Institute of Medical Sciences, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Ravinder Goswami
- Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Pascal Houillier
- Département de Physiologie, Professor of Physiology, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Michael A Levine
- Professor Emeritus of Pediatrics and Medicine, University of Pennsylvania, Director, Center for Bone Health, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse D Pasternak
- Endocrine Surgery Section Head, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nancy D Perrier
- Professor of Surgery, University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Section of Surgical Endocrinology, Houston, TX, USA
| | - Antonio Sitges-Serra
- Emeritus Professor, Universitat Autònoma de Barcelona, Endocrine Surgery, Hospital del Mar, Barcelona, Spain
| | - Dolores M Shoback
- Professor of Medicine, University of California, San Francisco, Endocrine Research Unit, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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14
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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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15
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Heterogeneity in Utilization of Optical Imaging Guided Surgery for Identifying or Preserving the Parathyroid Glands—A Meta-Narrative Review. Life (Basel) 2022; 12:life12030388. [PMID: 35330139 PMCID: PMC8955594 DOI: 10.3390/life12030388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy. Over the past years, optical imaging techniques, such as parathyroid autofluorescence, indocyanine green (ICG) angiography, and laser speckle contrast imaging (LSCI) have been employed to save parathyroid glands during thyroid surgery. This study provides an overview of the utilized methods of the optical imaging techniques during total thyroidectomy for parathyroid gland identification and preservation. Methods: PUBMED, EMBASE and Web of Science were searched for studies written in the English language utilizing parathyroid autofluorescence, ICG-angiography, or LSCI during total thyroidectomy to support parathyroid gland identification or preservation. Case reports, reviews, meta-analyses, animal studies, and post-mortem studies were excluded after the title and abstract screening. The data of the studies were analyzed qualitatively, with a focus on the methodologies employed. Results: In total, 59 articles were included with a total of 6190 patients. Overall, 38 studies reported using parathyroid autofluorescence, 24 using ICG-angiography, and 2 using LSCI. The heterogeneity between the utilized methodology in the studies was large, and in particular, regarding study protocols, imaging techniques, and the standardization of the imaging protocol. Conclusion: The diverse application of optical imaging techniques and a lack of standardization and quantification leads to heterogeneous conclusions regarding their clinical value. Worldwide consensus on imaging protocols is needed to establish the clinical utility of these techniques for parathyroid gland identification and preservation.
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16
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Oh E, Lee HC, Kim Y, Ning B, Lee SY, Cha J, Kim WW. A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand-held imager. Lasers Surg Med 2022; 54:399-406. [PMID: 34481419 PMCID: PMC8894507 DOI: 10.1002/lsm.23478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/06/2021] [Accepted: 08/21/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Intraoperative localization and preservation of parathyroid glands (PGs) are challenging during thyroid surgery. A new noninvasive technique of combined near-infrared PG autofluorescence detection and dye-free imaging angiography that allows intraoperative feedback has recently been introduced. The objective of this study was to evaluate this technique in real-time. MATERIALS AND METHODS A pilot feasibility study of a portable imaging device in four patients who underwent either thyroid lobectomy or total thyroidectomy is presented. PG autofluorescence and vascularity/tissue perfusion were monitored using a real-time screen display during the surgical procedure. RESULTS Three lobectomies and one total thyroidectomy were performed. Among the nine PGs identified by the operating surgeon, eight PGs were confirmed using the autofluorescence device. Each PG was successfully determined to be either well-perfused or devascularized, and devascularized PGs were autotransplanted. CONCLUSIONS The preliminary results suggest that the combination of PG autofluorescence detection and dye-free angiography can potentially be used to assess PG function. With further validation studies, the effectiveness of this technique in clinical practice can be further delineated.
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Affiliation(s)
- Eugene Oh
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21212 USA,Sheikh Zayed Surgical Institute, Children’s National Hospital, 111 Michigan Ave., NW Washington, DC 20010, USA
| | - Hun Chan Lee
- Dept. of Mechanical Engineering, Boston University, 110 Cummington Mall Boston, MA 02215 USA
| | - Yoseph Kim
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21212 USA
| | - Bo Ning
- Sheikh Zayed Surgical Institute, Children’s National Hospital, 111 Michigan Ave., NW Washington, DC 20010, USA
| | - Seung Yup Lee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr. NE, Atlanta, GA 30322 USA,Department of Electrical and Computer Engineering, Kennesaw State University, 840 Polytechnic Lane, Marietta, GA 30060, USA
| | - Jaepyeong Cha
- Sheikh Zayed Surgical Institute, Children’s National Hospital, 111 Michigan Ave., NW Washington, DC 20010, USA,George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington DC, USA,Corresponding authors: Jaepyeong Cha, PhD, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, or , Tel: 202-476-6426; Wan Wook Kim, MD PhD, Department of Surgery, Kyungpook National University School of Medicine, 807 Hogukno, Buk-gu, Daegu 41404, South Korea, , Tel: 82-53-200-2705, Fax: 82-53-200-2027
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro Buk-gu, Daegu, South Korea, 41404,Corresponding authors: Jaepyeong Cha, PhD, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, or , Tel: 202-476-6426; Wan Wook Kim, MD PhD, Department of Surgery, Kyungpook National University School of Medicine, 807 Hogukno, Buk-gu, Daegu 41404, South Korea, , Tel: 82-53-200-2705, Fax: 82-53-200-2027
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17
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Management of Primary Hyperparathyroidism. Indian J Surg Oncol 2022; 13:143-151. [PMID: 35462664 PMCID: PMC8986895 DOI: 10.1007/s13193-021-01319-3] [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: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) is the unregulated overproduction of parathyroid hormone (PTH) resulting in abnormal calcium homeostasis. The disease profile has evolved over the last century from symptomatic hyperparathyroidism to asymptomatic hyperparathyroidism. Primary hyperparathyroidism is a biochemical diagnosis. Parathyroidectomy is the only established cure for this disease. Every effort is made to localize the offending gland preoperaively with various imaging modalities. These localization studies along with intraoperative parathormone monitoring will direct the surgeon to either a focused parathyroidectomy or a four gland exploration. All symptomatic patients and asymptomatic patients who meet the criteria for surgery should undergo parathyroidectomy if no medical contraindications exist. Pharmacologic approaches are reserved for those patients unfit or unwilling to undergo surgery.
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18
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Oh E, Kim Y, Ning B, Lee SY, Kim WW, Cha J. Development of a non-invasive, dual-sensor handheld imager for intraoperative preservation of parathyroid glands. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7408-7411. [PMID: 34892809 DOI: 10.1109/embc46164.2021.9630503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intraoperative localization and preservation of parathyroid glands (PTGs) are challenging during thyroid surgery. Using a technique of combined near-infrared PTG autofluorescence detection and dye-free imaging angiography, this study developed a portable device for localization of PTGs and assessment of viability by confirming tissue perfusion. The imager's performance was evaluated through a pilot clinical study (N=10).
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19
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Mannoh EA, Thomas G, Baregamian N, Rohde SL, Solórzano CC, Mahadevan-Jansen A. Assessing Intraoperative Laser Speckle Contrast Imaging of Parathyroid Glands in Relation to Total Thyroidectomy Patient Outcomes. Thyroid 2021; 31:1558-1565. [PMID: 34078120 PMCID: PMC8917893 DOI: 10.1089/thy.2021.0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Accurate assessment of parathyroid gland vascularity is important during thyroidectomy to preserve the function of parathyroid glands and to prevent postoperative hypocalcemia. Laser speckle contrast imaging (LSCI) has been shown to be accurate in detecting differences in parathyroid vascularity. In this surgeon-blinded prognostic study, we evaluate the relationship between intraoperative LSCI measurements and postoperative outcomes of total thyroidectomy patients. Methods: Seventy-two thyroidectomy patients were included in this study. After thyroid resection, an LSCI device was used to image all parathyroid glands identified, and a speckle contrast value was calculated for each. An average value was calculated for each patient, and the data were grouped according to whether the patient had normal (16-77 pg/mL) or low levels of parathyroid hormone (PTH) measured on postoperative day 1 (POD1). The aim of this study was to establish a speckle contrast threshold for classifying a parathyroid gland as adequately perfused and to determine how many such glands are required for normal postoperative parathyroid function. Results: A speckle contrast limit of 0.186 separated the normoparathyroid and hypoparathyroid groups with 87.5% sensitivity and 84.4% specificity: 7 of 8 patients with low PTH on POD1 had an average parathyroid speckle contrast above this limit, while 54 of 64 patients with normal postoperative PTH had an average parathyroid speckle contrast below this limit. Taking this value as the threshold for adequate parathyroid perfusion, it was determined that only one vascularized gland was needed for normal postoperative parathyroid function: 64 of 69 patients (92.8%) with at least one vascularized gland (determined by LSCI) had normal postoperative PTH, while all 3 patients (100%) with no vascularized glands had low postoperative PTH. Overall, the rates of temporary and permanent hypoparathyroidism in this study were 8.3% and 1.4%, respectively. Conclusions: LSCI is a promising technique for assessing parathyroid gland vascularity. It has the potential to help reduce the incidence of hypocalcemia after thyroidectomy by providing surgeons with additional information during surgery to aid in the preservation of parathyroid function.
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Affiliation(s)
- Emmanuel A. Mannoh
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Naira Baregamian
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah L. Rohde
- Department of Otolaryngology—Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carmen C. Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Address correspondence to: Anita Mahadevan-Jansen, PhD, Department of Biomedical Engineering, Vanderbilt University, Station B, Box 351631, Nashville, TN 37235, USA
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20
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Tjahjono R, Nguyen K, Phung D, Riffat F, Palme CE. Methods of identification of parathyroid glands in thyroid surgery: A literature review. ANZ J Surg 2021; 91:1711-1716. [PMID: 34414647 DOI: 10.1111/ans.17117] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/17/2021] [Accepted: 07/24/2021] [Indexed: 01/19/2023]
Abstract
Intra-operative identification and preservation of parathyroid glands is an important but challenging aspect of thyroid surgery. Failure to do so may lead to transient or permanent hypocalcaemia, where the latter represents a serious complication causing life-long morbidity. It would be beneficial, therefore, if a simple and reliable modality can be developed to assist in the identification of parathyroid glands intra-operatively. The aim of this literature review is to provide an overview of intra-operative modalities used to identify parathyroid glands with a particular focus on near-infrared autofluorescence (NIRAF). Twenty-seven studies were considered relevant in this literature review. Several modalities have been used to aid parathyroid gland identification, including Raman spectroscopy, indocyanine green angiography, and NIRAF. NIRAF technology allows parathyroid glands to spontaneously give off light (autofluorescence) when exposed to near-infrared light at a wavelength of 785 nm, creating a contrast between tissues to allow intra-operative differentiation. Studies utilising NIRAF technology were able to identify 76.3%-100% of parathyroid glands intra-operatively. Furthermore, two randomised controlled trials comparing NIRAF and white light showed that the use of NIRAF was able to significantly increase the mean number of parathyroid glands detected and reduce the incidence of post-operative hypocalcaemia. NIRAF is an emerging tool that has been shown to increase the number of intra-operative parathyroid gland identification and reduce the rate of post-operative hypocalcaemia in a safe and reproducible manner. Future trials are needed to evaluate the real-life impact of NIRAF technology in outcomes of patients following thyroid surgery.
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Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Nguyen
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Daniel Phung
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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21
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Mannoh EA, Parker LB, Thomas G, Solórzano CC, Mahadevan-Jansen A. Development of an imaging device for label-free parathyroid gland identification and vascularity assessment. JOURNAL OF BIOPHOTONICS 2021; 14:e202100008. [PMID: 33583122 PMCID: PMC8556476 DOI: 10.1002/jbio.202100008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
During thyroid surgeries, it is important for surgeons to accurately identify healthy parathyroid glands and assess their vascularity to preserve their function postoperatively, thus preventing hypoparathyroidism and hypocalcemia. Near infrared autofluorescence detection enables parathyroid identification, while laser speckle contrast imaging allows assessment of parathyroid vascularity. Here, we present an imaging system combining the two techniques to perform both functions, simultaneously and label-free. An algorithm to automate the segmentation of a parathyroid gland in the fluorescence image to determine its average speckle contrast is also presented, reducing a barrier to clinical translation. Results from imaging ex vivo tissue samples show that the algorithm is equivalent to manual segmentation. Intraoperative images from representative procedures are presented showing successful implementation of the device to identify and assess vascularity of healthy and diseased parathyroid glands.
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Affiliation(s)
- Emmanuel A. Mannoh
- Vanderbilt Biophotonics Center, Nashville, TN 37235
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Logan B. Parker
- Vanderbilt Biophotonics Center, Nashville, TN 37235
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Nashville, TN 37235
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Carmen C. Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center, Nashville, TN 37235
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235
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22
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Abstract
OBJECTIVE With the recent approval of 2 NIRAF-based devices for label-free identification of PG by the Food and Drug Administration, it becomes crucial to educate the surgical community on the realistic scope of this emerging technology. Here, we have compiled a review of studies that utilize NIRAF and present a critical appraisal of this technique for intraoperative PG detection. BACKGROUND Failure to visualize PGs could lead to accidental damage/excision of healthy PGs or inability to localize diseased PGs, resulting in postsurgical complications. The discovery that PGs have NIRAF led to new avenues for intraoperatively identifying PGs with high accuracy in real-time. METHODS Using the following key terms: "parathyroid, near infrared, autofluorescence" in various search engines such as PubMed and Google Scholar, we identified various publications relevant to this review of NIRAF as a technique for PG identification. Articles were excluded if they focused solely on contrast agents, served as commentaries/overviews on NIRAF or were not written in English. RESULTS To date, studies have investigated the potential of NIRAF detection for (i) identifying PG tissues intraoperatively, (ii) locating PGs before or after dissection, (iii) distinguishing healthy from diseased PGs, and (iv) minimizing postoperative hypocalcemia after total thyroidectomy. CONCLUSIONS Because NIRAF-based identification of PG is noninvasive and label-free, the popularity of this approach has considerably surged. As the present limitations of various technologies capable of NIRAF detection are identified, we anticipate that newer device iterations will continue to be developed enhancing the current merits of these modalities to aid surgeons in identifying and preserving PGs. However, more concrete and long-term outcome studies with these modalities are essential to determine the impact of this technique on patient outcome and actual cost-benefits.
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23
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Solórzano CC, Thomas G, Berber E, Wang TS, Randolph GW, Duh QY, Triponez F. Current state of intraoperative use of near infrared fluorescence for parathyroid identification and preservation. Surgery 2020; 169:868-878. [PMID: 33139065 DOI: 10.1016/j.surg.2020.09.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Finding and preserving normal parathyroid glands or localizing and removing diseased parathyroid glands are crucial steps to successful thyroid and parathyroid operations. Using near-infrared fluorescence detection to identify parathyroid glands during thyroid and parathyroid operations has lately gained widespread recognition, with 2 Food and Drug Administration-cleared devices currently in the market. We aim to update the endocrine surgery community on how near-infrared fluorescence detection can be most optimally used for rapid intraoperative parathyroid gland identification or preservation. METHODS A literature review was performed using the key terms: "parathyroid," "near infrared," and "fluorescence" in relevant search engines. Based on the reviewed literature and expert surgeons' opinions, recommendations were formulated for applying near-infrared fluorescence detection to identify or preserve parathyroid glands during cervical endocrine surgery. RESULTS The scope of near-infrared fluorescence detection can be broadly categorized into (1) using near-infrared auto-fluorescence to identify or locate both healthy and diseased parathyroid glands, and (2) using contrast-enhanced near-infrared fluorescence to evaluate parathyroid gland perfusion. The benefits and pitfalls for both near-infrared-based approaches are described herein. CONCLUSION Near-infrared fluorescence detection appears helpful for identification and likely preservation of parathyroid glands. We hope these recommendations will be valuable to the practicing endocrine surgeon as they consider incorporating these intraoperative adjuncts in their surgical practice.
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Affiliation(s)
- Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Tracy S Wang
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Gregory W Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Quan-Yang Duh
- Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco, CA
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Enny L, Ramakant P, Singh KR, Rana C, Garg S, Mishra AK. Efficacy of Fluorescein Green Dye in Assessing Intra-Operative Parathyroid Gland Vascularity and Predicting Post-Thyroidectomy Hypocalcaemia- A Novel Prospective Cohort Study. Indian J Endocrinol Metab 2020; 24:446-451. [PMID: 33489851 PMCID: PMC7810046 DOI: 10.4103/ijem.ijem_499_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/22/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Postoperative hypocalcaemia (POH) after total thyroidectomy (TT) is a common complication. Parathyroid hormone (PTH), an accurate predictor of POH cannot assess intra-operative viability of parathyroid glands (PGs). Different dyes including indocyanine green or carbon nanoparticles have been used, but they are expensive and not widely available. Fluorescein green dye (FD) has been used as a low-cost alternative to study viability of various organs, but seldom tried in visualizing PGs. This novel study aims to assess utility of FD in determining parathyroid viability and predicting POH. MATERIAL AND METHOD Total 72 out of 88 patients undergoing TT between January and December 2019 were included. Two ml of 25% FD was given intravenously before wound closure and attempts were made to visualize PGs under blue light. A numerical score was given according to the number of PGs visualized. Intact-PTH and corrected calcium were measured on postoperative day 1 and patients observed for POH. RESULTS No PGs were visualized in 6 patients, 1 in 13, 2 in 30, 3 in 16 & 4 in 7 patients. Mean PTH was 6, 16.9, 31.6, 33.2 and 48.5 respectively. Corrected-calcium was 7.08, 7.7, 7.9, 8.5 and 8.5 respectively. All patients with score 0 received supplementary IV calcium, while 53.8% (score-1), 30% (score-2), 0% (scores-3, 4) received the same. Sensitivity, specificity and ROC of PG score of ≥2 on FD in predicting POH were 100%, 44% and 0.83 respectively. CONCLUSION FD visualization of parathyroids post TT is feasible and can be used as low cost efficacious method to predict POH.
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Affiliation(s)
- Loreno Enny
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Pooja Ramakant
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Kul R. Singh
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Chanchal Rana
- Department of Pathology, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Surubhi Garg
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Anand K. Mishra
- Department of Endocrine Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
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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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Cheng W, Lu J, Zhu X, Hong J, Liu X, Li M, Li P. Dilated Residual Learning With Skip Connections for Real-Time Denoising of Laser Speckle Imaging of Blood Flow in a Log-Transformed Domain. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1582-1593. [PMID: 31725373 DOI: 10.1109/tmi.2019.2953626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Laser speckle contrast imaging (LSCI) is a wide-field and noncontact imaging technology for mapping blood flow. Although the denoising method based on block-matching and three-dimensional transform-domain collaborative filtering (BM3D) was proposed to improve its signal-to-noise ratio (SNR) significantly, the processing time makes it difficult to realize real-time denoising. Furthermore, it is still difficult to obtain an acceptable level of SNR with a few raw speckle images given the presence of significant noise and artifacts. A feed-forward denoising convolutional neural network (DnCNN) achieves state-of-the-art performance in denoising nature images and is efficiently accelerated by GPU. However, it performs poorly in learning with original speckle contrast images of LSCI owing to the inhomogeneous noise distribution. Therefore, we propose training DnCNN for LSCI in a log-transformed domain to improve training accuracy and it achieves an improvement of 5.13 dB in the peak signal-to-noise ratio (PSNR). To decrease the inference time and improve denoising performance, we further propose a dilated deep residual learning network with skip connections (DRSNet). The image-quality evaluations of DRSNet with five raw speckle images outperform that of spatially average denoising with 20 raw speckle images. DRSNet takes 35 ms (i.e., 28 frames per second) for denoising a blood flow image with 486×648 pixels on an NVIDIA 1070 GPU, which is approximately 2.5 times faster than DnCNN. In the test sets, DRSNet also improves 0.15 dB in the PSNR than that of DnCNN. The proposed network shows good potential in real-time monitoring of blood flow for biomedical applications.
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Baj J, Sitarz R, Łokaj M, Forma A, Czeczelewski M, Maani A, Garruti G. Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas. Molecules 2020; 25:E1724. [PMID: 32283730 PMCID: PMC7181220 DOI: 10.3390/molecules25071724] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023] Open
Abstract
Accurate pre-operative determination of parathyroid glands localization is critical in the selection of minimally invasive parathyroidectomy as a surgical treatment approach in patients with primary hyperparathyroidism (PHPT). Its importance cannot be overemphasized as it helps to minimize the harmful side effects associated with damage to the parathyroid glands such as in hypocalcemia, severe hemorrhage or recurrent laryngeal nerve dysfunction. Preoperative and intraoperative methods decrease the incidence of mistakenly injuring the parathyroid glands and allow for the timely diagnosis of various abnormalities, including parathyroid adenomas. This article reviews 139 studies conducted between 1970 and 2020 (49 years). Studies that were reviewed focused on several techniques including application of carbon nanoparticles, carbon nanoparticles with technetium sestamibi (99m Tc-MIBI), Raman spectroscopy, near-infrared autofluorescence, dynamic optical contrast imaging, laser speckle contrast imaging, shear wave elastography, and indocyanine green to test their potential in providing proper parathyroid glands' localization. Apart from reviewing the aforementioned techniques, this study focused on the applications that helped in the detection of parathyroid adenomas. Results suggest that applying all the reviewed techniques significantly improves the possibility of providing proper localization of parathyroid glands, and the application of indocyanine green has proven to be the 'ideal' approach for the diagnosis of parathyroid adenomas.
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Affiliation(s)
- Jacek Baj
- Chair and Department of Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (R.S.); (A.F.); (A.M.)
| | - Robert Sitarz
- Chair and Department of Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (R.S.); (A.F.); (A.M.)
- Department of Surgery, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-090 Lublin, Poland;
| | - Marek Łokaj
- Department of Surgery, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-090 Lublin, Poland;
| | - Alicja Forma
- Chair and Department of Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (R.S.); (A.F.); (A.M.)
| | - Marcin Czeczelewski
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-950 Lublin, Poland;
| | - Amr Maani
- Chair and Department of Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (R.S.); (A.F.); (A.M.)
| | - Gabriella Garruti
- Section of Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro” Medical School, 70124 Bari, Italy;
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Electrosclerotherapy as a Novel Treatment Option for Hypertrophic Capillary Malformations: A Randomized Controlled Pilot Trial. Dermatol Surg 2020; 46:491-498. [DOI: 10.1097/dss.0000000000002191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
This article reviews intraoperative decision making related to several important aspects of parathyroid surgery. These include how to systematically identify a missing gland, when to perform a unilateral versus bilateral exploration for cure, approaches to secondary hyperparathyroidism, management of familial hyperparathyroidism, and the treatment of parathyroid cancer. The management of intraoperative complications, such as recurrent laryngeal nerve injury and devascularization of parathyroid glands, also is discussed.
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McWade MA, Thomas G, Nguyen JQ, Sanders ME, Solórzano CC, Mahadevan-Jansen A. Enhancing Parathyroid Gland Visualization Using a Near Infrared Fluorescence-Based Overlay Imaging System. J Am Coll Surg 2019; 228:730-743. [PMID: 30769112 PMCID: PMC6487208 DOI: 10.1016/j.jamcollsurg.2019.01.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Misidentifying parathyroid glands (PGs) during thyroidectomies or parathyroidectomies could significantly increase postoperative morbidity. Imaging systems based on near infrared autofluorescence (NIRAF) detection can localize PGs with high accuracy. These devices, however, depict NIRAF images on remote display monitors, where images lack spatial context and comparability with actual surgical field of view. In this study, we designed an overlay tissue imaging system (OTIS) that detects tissue NIRAF and back-projects the collected signal as a visible image directly onto the surgical field of view instead of a display monitor, and tested its ability for enhancing parathyroid visualization. STUDY DESIGN The OTIS was first calibrated with a fluorescent ink grid and initially tested with parathyroid, thyroid, and lymph node tissues ex vivo. For in vivo measurements, the surgeon's opinion on tissue of interest was first ascertained. After the surgeon looked away, the OTIS back-projected visible green light directly onto the tissue of interest, only if the device detected relatively high NIRAF as observed in PGs. System accuracy was determined by correlating NIRAF projection with surgeon's visual confirmation for in situ PGs or histopathology report for excised PGs. RESULTS The OTIS yielded 100% accuracy when tested ex vivo with parathyroid, thyroid, and lymph node specimens. Subsequently, the device was evaluated in 30 patients who underwent thyroidectomy and/or parathyroidectomy. Ninety-seven percent of exposed tissue of interest was visualized correctly as PGs by the OTIS, without requiring display monitors or contrast agents. CONCLUSIONS Although OTIS holds novel potential for enhancing label-free parathyroid visualization directly within the surgical field of view, additional device optimization is required for eventual clinical use.
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Affiliation(s)
- Melanie A McWade
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - John Q Nguyen
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Melinda E Sanders
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN.
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To H, Otto G. Selective intra-operative parathyroid hormone in re-do neck exploration in parathyroidectomy: A case report. Int J Surg Case Rep 2019; 57:1-4. [PMID: 30875622 PMCID: PMC6416964 DOI: 10.1016/j.ijscr.2019.02.031] [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: 01/27/2019] [Accepted: 02/18/2019] [Indexed: 11/18/2022] Open
Abstract
Intra-operative parathyroid hormone (I-OPTH) measurement is essential in challenging cases, where there has not been localisation of the hyperfunction gland/s and/or redo neck surgery. The difficulty of the case is compounded by these factors. Appropriate methodology is required to perform and interpret I-OPTH, which includes specific and consistent location of sampling (ipsilateral internal jugular vein), and application of verified protocols. Appropriate use of I-OPTH can reduce operative time, cost and complications.
Introduction Intra-operative parathyroid hormone (I-OPTH) levels are an adjunct used in parathyroid surgery which provides assurance that parathyroidectomy surgery is complete and has removed the hypersecreting gland. Presentation of case A 78 year old female with no localisation on pre-operative imaging and had previous hemithyroidectomy. I-OPTH was used to guide the side and timing for completion of exploration, factors which reduced operative time, operative cost and avoided potential complications. Discussion Routine and selective I-OPTH may be used to guide parathyroidectomy, and this case highlights the methodology of use in a selective challenging case. Appropriate application and interpretation of results must be achieved to ensure adequate completion of surgery and cure for the patient. Conclusion Selective use of I-OPTH guides parathyroidectomy in challenging cases, and can be time and cost-effective when used appropriately.
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Affiliation(s)
- Henry To
- Department of Surgery, Lyell McEwin Hospital, Haydown Rd., Elizabeth Vale, South Australia, 5112, Australia.
| | - Gregory Otto
- Department of Surgery, Lyell McEwin Hospital, Haydown Rd., Elizabeth Vale, South Australia, 5112, Australia
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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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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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Mascagni P, Longo F, Barberio M, Seeliger B, Agnus V, Saccomandi P, Hostettler A, Marescaux J, Diana M. New intraoperative imaging technologies: Innovating the surgeon’s eye toward surgical precision. J Surg Oncol 2018; 118:265-282. [DOI: 10.1002/jso.25148] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Pietro Mascagni
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Fabio Longo
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Manuel Barberio
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Barbara Seeliger
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Vincent Agnus
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
| | - Paola Saccomandi
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | | | - Jacques Marescaux
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
| | - Michele Diana
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
- Department of General, Digestive and Endocrine Surgery; University of Strasbourg; Strasbourg France
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Abstract
PURPOSE Visualization and precise dissection of the parathyroid glands are a crucial step of thyroidectomy. Moreover, identification of parathyroid adenoma in patients with primary hyperparathyroidism can be challenging due to the possible abnormal location of the enlarged parathyroid. Near-infrared fluorescence (NIR) can be adopted during video-assisted neck surgery in addition to standard endoscopic magnification to enhance the visualization of the parathyroid tissue. METHODS Between July and August 2017, five patients (one male, four females) underwent video-assisted neck surgery at our hospital. One patient suffered from primary hyperparathyroidism. The four remaining patients underwent thyroidectomy for multinodular goiter or Graves' disease. The parathyroid glands were firstly identified by the video-assisted approach and then confirmed by the NIR visualization of the endogenous autofluorescence of the parathyroid tissue. Low-dose (2.5 mg/ml) indocyanine green was administered to visualize the vascular supply during and/or after the dissection. The standard dose of 2.5 mg (1 ml per injection) was used to allow repeated injection during the same procedure. RESULTS An endogenous parathyroid autofluorescence could be visualized by the NIR camera in all patients. The right upper parathyroid adenoma could be detected prior to fully dissection of the gland from the surrounding tissue. Twelve out of 16 parathyroid glands have been visually identified during four total thyroidectomies. Eleven glands showed an autofluorescence prior to indocyanine green (ICG) injection. Further, ICG injection has been used for guiding the dissection of the gland in three cases and for confirmation of the vascular supply at the end of the procedure in the remaining cases. There were neither intraoperative nor postoperative complications. CONCLUSION The 5-mm 30° NIR camera allows for enhanced visualization of the parathyroid tissue during video-assisted thyroidectomy. This promising tool can become standard for video-assisted neck surgery.
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