Preliminary Application Of Near Infrared Autofluorescence Detection In Parathyroid Gland

Objective: Combined with the recent reports on the identification of parathyroid glands by near infrared autofluorescence imaging and the preliminary experiments of animals,then through the actual clinical cases,to analysis and comparison the advantages and disadvantages of near-infrared autofluorescence imaging technology,nano-carbon negative imaging technology and conventional naked eye recognition technology in the intraoperative identification of parathyroid glands,to preliminary evaluation of the effectiveness,safety and feasibility of near infrared autofluorescence imaging in identifying parathyroid glands,to explore the application of near infrared autofluorescence imaging in the identification of parathyroid gland.Methods:1.Animal pretest : two female SD rats were selected for the study.The thyroid gland,parathyroid gland,and perithyroid tissue of SD rats were removed,and the parathyroid glands of SD rats were detected by near infrared autofluorescence imaging in vitro.Finally,Pathological biopsy were performed to confirm whether they were parathyroid glands of rats.2.Clinical trials: the clinical trial retrospectively analyzed the clinical data of 42 patients in the affiliated hospital of the university of south China from December 2018 to March 2020 who needed open surgery for thyroid malignancy(the surgical method was total resection of the thyroid on one side and lymph node dissection in the central region on the other side,and the contralateral exploration was needed,but there was no limitation on surgery and dissection).There were 14 patients in the experimental group(group A,near infrared autofluorescence imaging group),14 patients in the control group(group B Nano-carbon negative imaging group)and 14 patients in the control group(group C Conventional naked eye recognition group).The number of parathyroid glands that can be identified during the operation,time consuming(how long it takes to identify parathyroid gland during operation),incidence of postoperative hypocalcemia,incidence of postoperative symptomatic hypocalcemia,operation difficulty,whether it is an invasive operation of the three groups were compared to observed the clinical effect of near infrared autofluorescence imaging on intraoperative identification of parathyroid glands.Results:1.Animal preliminary results: the rats parathyroid glands identified by near infrared autofluorescence imaging was confirmed to be rats parathyroid tissue by pathological section.2.The number of parathyroid glands identified during the operation was(3.21±0.58)in the experimental group(group A),(2.64±0.50)in the control group(group B)and(2.07±0.62)in the control group(group C).The number of parathyroid glands identified during operation in the experimental group(group A)was more than that in the control group(group B)and the control group(group C).The difference was significant(p < 0.05).3.Time consuming(how long it takes to identify parathyroid gland during operation): the average time to identify parathyroid glands was(4.42±0.79)minutes in the experimental group(group A),(10.53±1.04)minutes in the control group(group B),and(9.83±1.28)minutes in the control group(group C).The average time taken to identify the parathyroid glands in the experimental group(group A)was shorter than that in the control group(group B)and the control group(group C).The difference was significant(p < 0.05).4.Incidence of postoperative hypocalcemia:the incidence of postoperative hypocalcemia in the experimental group(group A)was 7.1%,the incidence of postoperative hypocalcemia in the control group(group B)was 42.9%,the incidence of postoperative hypocalcemia in the control group(group C)was 57.1%,there was a significant difference in the incidence of postoperative hypocalcemia between the three groups(p<0.05).The incidence of postoperative hypocalcemia was the lowest in the experimental group(group A).5.Incidence of postoperative symptomatic hypocalcemia: the incidence of postoperative symptomatic hypocalcemia in the experimental group(group A)was 7.1%;the incidence ofpostoperative symptomatic hypocalcemia in the control group(group B)was 42.9%;the incidence of postoperative symptomatic hypocalcemia in the control group(group C conventional visual recognition group)was35.7%,with no significant difference(p>,0.05),but the incidence of postoperative symptomatic hypocalcemia in the experimental group(group A)was slightly lower.6.Whether it is an invasive operation:In the experimental group(group A),no exogenous fluorescent contrast agent was injected into the parathyroid gland during operation,and there was no need for direct contact with the human body;The control group(group B)needs to inject drugs around the thyroid tumor when identifying the parathyroid gland during operation,and there is a risk of drug allergy;In the control group(group C,routine naked eye recognition group),there was no need to inject drugs or contact with the human body when identifying the parathyroid gland during operation.7.Operation difficulty: The experimental group(group A),it is necessary to operate a specific instrument to identify the parathyroid gland during operation,but the instrument is simple to operate,the learning cycle is short,and does not need to be operated by professionals;The control group(group B)needs to be injected with drugs to identify the parathyroid gland during operation,which requires professionals to operate,and has certain injection skills during drug injection,which requires a long time of study;The control group(group C),the intraoperative recognition of parathyroid gland depends on the experience of the surgeon,which requires experienced surgeons to do so.Conclusions: The number of parathyroid glands identified by near infrared autofluorescence imaging during the identification of parathyroid glands was large,the time was short,the incidence of postoperative hypocalcemia was low,and the operation was simple and non-invasive.It is safe,effective and feasible in parathyroidological identification.