Progress in identification of parathyroid gland in thyroid surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZUO Qian , WANG Gang ,  WU Linfeng

The Second Ward of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China;

Corresponding author：

WU Linfeng, Email: Wulinfeng1020@126.com

Keywords：

parathyroid gland; identification; total thyroidectomy; lymph node; fat; review

DOI：

10.7507/1007-9424.201907094

Video：

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Objective To summarize the latest progress of parathyroid gland identification in thyroid surgery, and to provide some reference for improving the clinical efficacy.Method The literatures about the identification of parathyroid gland in thyroid surgery in recent years were collected to make an review.Results There were many methods for identifying parathyroid gland in thyroid surgery, such as naked eye identification method, intraoperative frozen section, intraoperative staining identification method, intraoperative optical identification method, intraoperative parathyroid hormone assay, γ-detector, and histological identification, each method had its own advantages and disadvantages.Conclusion The identification of parathyroid gland does not only depend on a certain method, but also require surgeons to enhance their ability to distinguish parathyroid gland.

Citation： ZUO Qian, WANG Gang, WU Linfeng. Progress in identification of parathyroid gland in thyroid surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(3): 358-362. doi: 10.7507/1007-9424.201907094 Copy

1.	Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab, 2016, 101(6): 2300-2312.
2.	Almquist M, Ivarsson K, Nordenström E, et al. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. Br J Surg, 2018, 105(10): 1313-1318.
3.	Zhu J, Tian W, Xu Z, et al. Expert consensus statement on parathyroid protection in thyroidectomy. Ann Transl Med, 2015, 3(16): 230.
4.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
5.	中国医师协会外科医师分会甲状腺外科医师委员会. 经胸前入路腔镜甲状腺手术专家共识. 中国实用外科杂志, 2017, 37(12): 1369-1373.
6.	McWade MA, Paras C, White LM, et al. A novel optical approach to intraoperative detection of parathyroid glands. Surgery, 2013, 154(6): 1371-1377.
7.	Dudley NE. Methylene blue for rapid identification of the parathyroids. Br Med J, 1971, 3(5776): 680-681.
8.	钟琦, 房居高, 马泓智, 等. 经静脉低剂量亚甲蓝甲状旁腺定位在甲状腺手术中的初步应用. 中国耳鼻咽喉头颈外科, 2016, 23(5): 247-249.
9.	Patel HP, Chadwick DR, Harrison BJ, et al. Systematic review of intravenous methylene blue in parathyroid surgery. Br J Surg, 2012, 99(10): 1345-1351.
10.	Piromchai P, Juengtrakool T, Laohasiriwong S, et al. The sensitivity and specificity of methylene blue spray to identify the parathyroid gland during thyroidectomy. Peer J, 2019, 7: e6376.
11.	Sari S, Aysan E, Muslumanoglu M, et al. Safe thyroidectomy with intraoperative methylene blue spraying. Thyroid Res, 2012, 5(1): 15-19.
12.	朱精强, 汪洵理, 魏涛, 等. 纳米碳甲状旁腺负显影辨认保护技术在甲状腺癌手术中的应用. 中国普外基础与临床杂志, 2013, 20(9): 992-994.
13.	Yan S, Zhao W, Wang B, et al. Preoperative injection of carbon nanoparticles is beneficial to the patients with thyroid papillary carcinoma: from a prospective study of 102 cases. Medicine (Baltimore), 2018, 97(27): e11364.
14.	Liu Y, Li L, Yu J, et al. Carbon nanoparticle lymph node tracer improves the outcomes of surgical treatment in papillary thyroid cancer. Cancer Biomark, 2018, 23(2): 227-233.
15.	潘金强, 杨梅, 耿中利. 纳米炭混悬液在甲状腺癌全甲状腺切除中央区淋巴结清扫术中的应用价值. 解放军预防医学杂志, 2018, 36(11): 1473-1474, 1490.
16.	Prosst RL, Gahlen J, Schnuelle P, et al. Fluorescence-guided minimally invasive parathyroidectomy: a novel surgical therapy for secondary hyperparathyroidism. Am J Kidney Dis, 2006, 48(2): 327-331.
17.	Elbassiouny S, Fadel M, Elwakil T, et al. Photodynamic diagnosis of parathyroid glands with nano-stealth aminolevulinic acid liposomes. Photodiagnosis Photodyn Ther, 2018, 21: 71-78.
18.	Kim SW, Lee HS, Lee KD. Intraoperative real-time localization of parathyroid gland with near infrared fluorescence imaging. Gland Surg, 2017, 6(5): 516-524.
19.	Suh YJ, Choi JY, Chai YJ, et al. Indocyanine green as a near-infrared fluorescent agent for identifying parathyroid glands during thyroid surgery in dogs. Surg Endosc, 2015, 29(9): 2811-2817.
20.	Sadowski SM, Vidal Fortuny J, Triponez F. A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques. Gland Surg, 2017, 6(Suppl 1): S30-S37.
21.	赵烨, 赵菁, 张俐娜, 等. 显影技术在甲状腺癌术中对甲状旁腺的保护作用. 新医学, 2018, 49(12): 847-852.
22.	Das K, Stone N, Kendall C, et al. Raman spectroscopy of parathyroid tissue pathology. Lasers Med Sci, 2006, 21(4): 192-197.
23.	Paras C, Keller M, White L, et al. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011, 16(6): 067012.
24.	De Leeuw F, Breuskin I, Abbaci M, et al. Intraoperative near-infrared imaging for parathyroid gland identification by auto-fluorescence: a feasibility study. World J Surg, 2016, 40(9): 2131-2138.
25.	Ladurner R, Sommerey S, Arabi NA, et al. Intraoperative near-infrared autofluorescence imaging of parathyroid glands. Surg Endosc, 2017, 31(8): 3140-3145.
26.	Sommerey S, Al Arabi N, Ladurner R, et al. Intraoperative optical coherence tomography imaging to identify parathyroid glands. Surg Endosc, 2015, 29(9): 2698-2704.
27.	黄海燕, 李浩, 林少建, 等. 甲状腺术中应用抽吸组织测定甲状旁腺激素的临床意义. 中华耳鼻咽喉头颈外科杂志, 2013, 48(11): 934-938.
28.	Bian XH, Li SJ, Zhou L, et al. Applicability of rapid intraoperative parathyroid hormone assay through fine needle aspiration to identify parathyroid tissue in thyroid surgery. Exp Ther Med, 2016, 12(6): 4072-4076.
29.	何高飞, 高力, 宋春轶, 等. 术中甲状旁腺辨识方法的研究进展. 中华内分泌外科杂志, 2017, 11(4): 345-348.
30.	张进军, 夏文飞, 沈文状, 等. 免疫胶体金法甲状旁腺快速鉴定技术及其临床应用价值研究. 中国实用外科杂志, 2018, 38(2): 227-230, 237.
31.	Gencoglu EA, Aktas A. The efficacy of low and high dose (99m)Tc-MIBI protocols for intraoperative identification of hyperplastic parathyroid glands in secondary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol, 2014, 33(4): 210-214.
32.	陈隽, 郑雯洁, 周秦毅, 等. 纳米碳负显像结合^99mTc-MIBI术中定位甲状旁腺的研究. 临床耳鼻咽喉头颈外科杂志, 2016, 30(18): 1463-1466.
33.	Grubbs EG, Mittendorf EA, Perrier ND, et al. Gamma probe identification of normal parathyroid glands during central neck surgery can facilitate parathyroid preservation. Am J Surg, 2008, 196(6): 931-935, 935-936.
34.	Wei H, Huang M, Fan J, et al. Intraoperative rapid aspiration cytological method for parathyroid glands identification and protection. Endocr J, 2019, 66(2): 135-141.
35.	Ambe PC, Brömling S, Knoefel WT, et al. Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients. Patient Saf Surg, 2014, 8(1): 45.
36.	孟庆辉, 王子恒, 吴伟华, 等. 甲状旁腺术中不染色快速组织学鉴定的应用价值. 哈尔滨医科大学学报, 2010, 44(6): 625-626.
37.	孙玮笛, 李晓江. 甲状腺手术中甲状旁腺辨认及保护方法的探讨. 世界最新医学信息文摘, 2019, 19(42): 72-73, 75.
38.	朱精强, 田文, 苏安平. 甲状腺围手术期甲状旁腺功能保护指南 (2018版). 中国实用外科杂志, 2018, 38(10): 1108-1113.

1. Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab, 2016, 101(6): 2300-2312.
2. Almquist M, Ivarsson K, Nordenström E, et al. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. Br J Surg, 2018, 105(10): 1313-1318.
3. Zhu J, Tian W, Xu Z, et al. Expert consensus statement on parathyroid protection in thyroidectomy. Ann Transl Med, 2015, 3(16): 230.
4. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
5. 中国医师协会外科医师分会甲状腺外科医师委员会. 经胸前入路腔镜甲状腺手术专家共识. 中国实用外科杂志, 2017, 37(12): 1369-1373.
6. McWade MA, Paras C, White LM, et al. A novel optical approach to intraoperative detection of parathyroid glands. Surgery, 2013, 154(6): 1371-1377.
7. Dudley NE. Methylene blue for rapid identification of the parathyroids. Br Med J, 1971, 3(5776): 680-681.
8. 钟琦, 房居高, 马泓智, 等. 经静脉低剂量亚甲蓝甲状旁腺定位在甲状腺手术中的初步应用. 中国耳鼻咽喉头颈外科, 2016, 23(5): 247-249.
9. Patel HP, Chadwick DR, Harrison BJ, et al. Systematic review of intravenous methylene blue in parathyroid surgery. Br J Surg, 2012, 99(10): 1345-1351.
10. Piromchai P, Juengtrakool T, Laohasiriwong S, et al. The sensitivity and specificity of methylene blue spray to identify the parathyroid gland during thyroidectomy. Peer J, 2019, 7: e6376.
11. Sari S, Aysan E, Muslumanoglu M, et al. Safe thyroidectomy with intraoperative methylene blue spraying. Thyroid Res, 2012, 5(1): 15-19.
12. 朱精强, 汪洵理, 魏涛, 等. 纳米碳甲状旁腺负显影辨认保护技术在甲状腺癌手术中的应用. 中国普外基础与临床杂志, 2013, 20(9): 992-994.
13. Yan S, Zhao W, Wang B, et al. Preoperative injection of carbon nanoparticles is beneficial to the patients with thyroid papillary carcinoma: from a prospective study of 102 cases. Medicine (Baltimore), 2018, 97(27): e11364.
14. Liu Y, Li L, Yu J, et al. Carbon nanoparticle lymph node tracer improves the outcomes of surgical treatment in papillary thyroid cancer. Cancer Biomark, 2018, 23(2): 227-233.
15. 潘金强, 杨梅, 耿中利. 纳米炭混悬液在甲状腺癌全甲状腺切除中央区淋巴结清扫术中的应用价值. 解放军预防医学杂志, 2018, 36(11): 1473-1474, 1490.
16. Prosst RL, Gahlen J, Schnuelle P, et al. Fluorescence-guided minimally invasive parathyroidectomy: a novel surgical therapy for secondary hyperparathyroidism. Am J Kidney Dis, 2006, 48(2): 327-331.
17. Elbassiouny S, Fadel M, Elwakil T, et al. Photodynamic diagnosis of parathyroid glands with nano-stealth aminolevulinic acid liposomes. Photodiagnosis Photodyn Ther, 2018, 21: 71-78.
18. Kim SW, Lee HS, Lee KD. Intraoperative real-time localization of parathyroid gland with near infrared fluorescence imaging. Gland Surg, 2017, 6(5): 516-524.
19. Suh YJ, Choi JY, Chai YJ, et al. Indocyanine green as a near-infrared fluorescent agent for identifying parathyroid glands during thyroid surgery in dogs. Surg Endosc, 2015, 29(9): 2811-2817.
20. Sadowski SM, Vidal Fortuny J, Triponez F. A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques. Gland Surg, 2017, 6(Suppl 1): S30-S37.
21. 赵烨, 赵菁, 张俐娜, 等. 显影技术在甲状腺癌术中对甲状旁腺的保护作用. 新医学, 2018, 49(12): 847-852.
22. Das K, Stone N, Kendall C, et al. Raman spectroscopy of parathyroid tissue pathology. Lasers Med Sci, 2006, 21(4): 192-197.
23. Paras C, Keller M, White L, et al. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt, 2011, 16(6): 067012.
24. De Leeuw F, Breuskin I, Abbaci M, et al. Intraoperative near-infrared imaging for parathyroid gland identification by auto-fluorescence: a feasibility study. World J Surg, 2016, 40(9): 2131-2138.
25. Ladurner R, Sommerey S, Arabi NA, et al. Intraoperative near-infrared autofluorescence imaging of parathyroid glands. Surg Endosc, 2017, 31(8): 3140-3145.
26. Sommerey S, Al Arabi N, Ladurner R, et al. Intraoperative optical coherence tomography imaging to identify parathyroid glands. Surg Endosc, 2015, 29(9): 2698-2704.
27. 黄海燕, 李浩, 林少建, 等. 甲状腺术中应用抽吸组织测定甲状旁腺激素的临床意义. 中华耳鼻咽喉头颈外科杂志, 2013, 48(11): 934-938.
28. Bian XH, Li SJ, Zhou L, et al. Applicability of rapid intraoperative parathyroid hormone assay through fine needle aspiration to identify parathyroid tissue in thyroid surgery. Exp Ther Med, 2016, 12(6): 4072-4076.
29. 何高飞, 高力, 宋春轶, 等. 术中甲状旁腺辨识方法的研究进展. 中华内分泌外科杂志, 2017, 11(4): 345-348.
30. 张进军, 夏文飞, 沈文状, 等. 免疫胶体金法甲状旁腺快速鉴定技术及其临床应用价值研究. 中国实用外科杂志, 2018, 38(2): 227-230, 237.
31. Gencoglu EA, Aktas A. The efficacy of low and high dose (99m)Tc-MIBI protocols for intraoperative identification of hyperplastic parathyroid glands in secondary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol, 2014, 33(4): 210-214.
32. 陈隽, 郑雯洁, 周秦毅, 等. 纳米碳负显像结合^99mTc-MIBI术中定位甲状旁腺的研究. 临床耳鼻咽喉头颈外科杂志, 2016, 30(18): 1463-1466.
33. Grubbs EG, Mittendorf EA, Perrier ND, et al. Gamma probe identification of normal parathyroid glands during central neck surgery can facilitate parathyroid preservation. Am J Surg, 2008, 196(6): 931-935, 935-936.
34. Wei H, Huang M, Fan J, et al. Intraoperative rapid aspiration cytological method for parathyroid glands identification and protection. Endocr J, 2019, 66(2): 135-141.
35. Ambe PC, Brömling S, Knoefel WT, et al. Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients. Patient Saf Surg, 2014, 8(1): 45.
36. 孟庆辉, 王子恒, 吴伟华, 等. 甲状旁腺术中不染色快速组织学鉴定的应用价值. 哈尔滨医科大学学报, 2010, 44(6): 625-626.
37. 孙玮笛, 李晓江. 甲状腺手术中甲状旁腺辨认及保护方法的探讨. 世界最新医学信息文摘, 2019, 19(42): 72-73, 75.
38. 朱精强, 田文, 苏安平. 甲状腺围手术期甲状旁腺功能保护指南 (2018版). 中国实用外科杂志, 2018, 38(10): 1108-1113.

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Progress in identification of parathyroid gland in thyroid surgery

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