Intraoperative guidance in parathyroid surgery using near-infrared fluorescence imaging and low-dose XXXX .

@entity1 @entity459 @entity6693 @entity3243 @entity652
BACKGROUND: Identification of diseased and normal parathyroid glands during parathyroid surgery can be challenging. The aim of this study was to assess whether near-infrared (NIR) fluorescence imaging using administration of a low-dose @entity6693 (MB) at the start of the operation could provide optical guidance during parathyroid surgery and assist in the detection of @entity3243 . METHODS: @entity1 diagnosed with @entity459 planned for parathyroidectomy were included. @entity1 received 0.5 mg/kg MB intravenously directly after start of anesthesia. During the operation, NIR fluorescence imaging was performed to identify @entity3243 . Imaging results were compared with a previous published feasibility study in which 12 @entity1 received MB after intraoperative identification of the @entity652 . RESULTS: A total of 13 @entity1 were included in the current study. In 10 of 12 @entity1 with a histologically proven @entity652 , the @entity652 was fluorescent. Mean signal to background ratio was 3.1    2.8. Mean diameter of the resected lesions was 17    9 mm (range 5-28 mm). @entity652 could be identified up to 145 minutes after administration, which was the longest timespan until resection. Interestingly, in 3 @entity1 , a total of 6 normal parathyroid glands (median diameter 2.5 mm) with a signal to background ratio of 1.8    0.4 were identified using NIR fluorescence imaging. CONCLUSION: Early administration of low-dose MB provided guidance during parathyroidectomy by identifying both @entity3243 and normal parathyroid glands. In @entity1 in whom difficult identification of the @entity3243 is expected or when normal glands have to be identified, the administration of MB may improve surgical outcome.
