|Table of Contents|

Near-infrared fluorescent/indocyanine green imaging combined with carbon nanoparticles in thyroid cancer parathyroid gland identification during total resection

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 15
Page:
2752-2759
Research Field:
Publishing date:

Info

Title:
Near-infrared fluorescent/indocyanine green imaging combined with carbon nanoparticles in thyroid cancer parathyroid gland identification during total resection
Author(s):
ZHENG Lu1; TANG Tong1; WANG Shuai1; MENG Lei1; XU Weimin1; WANG Zhitao2; CAI Huiming3
1.Department of Thyroid and Breast Surgery;2.Department of Hematology,the Second Affiliated Hospital of Anhui Medical University, Anhui Hefei 230601,China;3.Nanjing Nuoyuan Medical Instrument Co.,LTD.,Jiangsu Nanjing 210004,China.
Keywords:
near-infrared fluorescent/indocyanine greenimaging; nano-carbon; hyroid cancer;  hypoparathyroidism
PACS:
R736.1
DOI:
10.3969/j.issn.1672-4992.2024.15.010
Abstract:
Objective:To evaluate the efficacy of near-infrared fluorescent/indocyanine green (NIRF/ICG) combined with carbon nanoparticles in the identification of parathyroid gland during total thyroidectomy.Methods:The clinical data of 100 patients with thyroid cancer undergoing total thyrotomy in our hospital were selected,and the patients were divided into 50 cases using nano carbon alone and 50 cases using near infrared/indocyanine green fluorescence imaging combined with nano carbon according to the time of admission.In the combined group,near infrared/indocyanine green fluorescence imaging combined with carbon nanoparticles were used to identify parathyroid glands during operation,and parathyroid glands were quickly detected by intraoperative parathyroid strip.The identification rate and accuracy of parathyroid gland and the incidence of temporary and permanent parathyroid dysfunction were compared between the two groups.The risk of transient and permanent hypoparathyroidism was analyzed according to fluorescence intensity,and the factors affecting fluorescence intensity were investigated by single factor analysis.To explore the correlation between fluorescence intensity and the risk of transient parathyroid development.Results:There were no significant differences in gender,age,height,weight,body mass index (P=0.384 1) preoperative parathyroid hormone (PTH) (P=0.964 1) and preoperative serum calcium (P=0.356).The parathyroid identification rate of the combined group was 88% (176/200),and that of the nanocarb group was 63% (126/200),which had statistical significance (P＜0.01).The accuracy of the combined group was 96.59% (170/176),and that of the carbon nanoscale group was 87.30%(110/126).The difference was statistically significant (P＜0.01）.In the combined group,one parathyroid gland was mistakenly cut by routine pathology,while five parathyroid glands were found in the nano carbon group.Temporary decreased parathyroid function occurred in 10 cases in the combined group and 22 cases in the carbon nanoscale group one day after surgery.The blood calcium of the combined group was (2.15±0.07) mmol/L and that of the nano-carbon group was (2.09±0.10) mmol/L,and the difference was statistically significant (P=0.002 438).Six months after surgery,1 patient in the combination group had permanent parathyroid dysfunction,and 5 patients in the nano carbon group had permanent parathyroid dysfunction.Univariate regression analysis showed that gender (β=-0.383 541 6,95%CI:0.2~2.35,P=0.538 595 3）.Height (β=-0.044 147 54,95%CI:0.89~1.03,P=0.233 478 2).BMI (β=-0.173 074 1,95%CI:0.66~1.04,P=0.125 803 6).Age (β=-0.008 371 99,95%CI:0.94~1.04,P=0.742 1).Parathyroid classification(β=18.460 56, 95%CI:0.94~1.04,P=0.233 478 2).Preoperative blood calcium(β=-1.765 215,95%CI:0~328.74,P=0.650 233 9).Preoperative PTH(β=0.022 139 24,95%CI:0.91~1.14,P=0.690 276) had no effect on FI.Fluorescence intensity FI was negatively associated with the risk of postoperative hypoparathyroidism.Conclusion:NIR/Indocyanine green fluorescence imaging combined with carbon nanotechnology is safe and effective for identification of parathyroid glands,which can improve the identification rate of parathyroid glands,reduce misincision,shorten the time of parathyroid glands in vitro,improve the survival rate of parathyroid transplantation.To assess the risk of temporary post-operative hypoparathyroidism,and reduce the incidence of permanent postoperative hypoparathyroid function.

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Memo

Memo:
National Natural Science Foundation of China（No.82200825）;国家自然基金青年项目（编号：82200825）；吴阶平医学基金会临床科研专项资助基金(编号:320.6750.2021-10-25)；安徽省高等教育人文社会科学重点项目（编号：SK2021A0167）；安徽医科大学校科研基金资助项目(编号：2018xkj038）
Last Update: 2024-06-28