Page 102 - Fluorescence-guided cancer surgery

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Chapter 7
administered intravenously to assess feasibility. In 9 out of 12 patients, the exposed adenoma became uorescent after MB administration within 5 - 10 minutes. For intraoperative guidance in parathyroid surgery, it would be of great added value if MB could be administered before surgical exploration, resulting in faster identi cation of parathyroid adenomas.
Therefore, the aim of this study was to assess whether early MB administration provides guidance in parathyroid adenoma identi cation during surgery. Subsequently, the obtained results were compared with previous published data to compare early and late MB administration protocols.
MATERIALS AND METHODS
Clinical study
This study was approved by the Medical Ethics Committee of the Leiden University Medical Center and was performed in accordance with the ethical standards of the Helsinki Declaration of 1975. All patients planning to undergo a resection of a parathyroid adenoma for primary hyperparathyroidism were eligible for participation in the study. Exclusion criteria were pregnancy or lactation, the use of serotonin reuptake inhibitors, serotonin, and noradrenalin reuptake inhibitors and/or tricyclic antidepressants, severe renal failure, G6PD- de ciency, or an allergy to MB. All patients gave informed consent and were anonymized. Patients received standard of care diagnostic work-up, which for our center included a preoperative cervical US and a preoperative 99mTc- sestamibi-SPECT, combined with a low-dose computed tomography (CT) scan for preoperative surgical planning.
Directly before or after start of anesthesia, 0.5 mg/kg MB was administered intravenously over 5 minutes. During surgery, after subplatysmal dissection, retraction and initial exploration, visual inspection combined with NIR uorescence imaging was used for identi cation of parathyroid adenomas and normal parathyroid glands. After identi cation and resection of the adenoma, an intraoperative parathyroid hormone (PTH) assay was performed. Postoperative histopathological assessment of the resected specimen served as gold standard for parathyroid adenoma identi cation. No standard intraoperative frozen section analysis was performed.