Page 103 - Fluorescence-guided cancer surgery

Intraoperative guidance in parathyroid surgery 101
Intraoperative NIR uorescence imaging
For NIR uorescence imaging, the Mini-FLARE imaging system was used15. Brie y, the system consists of 2 wavelength isolated light sources: a “white” light source, generating 26,600 lx of 400 to 650 nm light, and a “near-infrared” light source, generating 1.08 mW/came of ≈ 670 nm light. Color video and NIR uorescence images are simultaneously acquired and displayed in real time using custom optics and software that separate the color video and NIR uorescence images. A pseudo-colored (lime green) merged image of the color video and NIR uorescence images is also displayed. The imaging head is attached to a exible gooseneck arm, which permits positioning of the imaging head at extreme angles virtually anywhere over the surgical eld. For intraoperative use, the imaging head and imaging system pole stand are wrapped in a sterile shield and drape (Medical Technique Inc., Tucson, AZ).
Comparison between early and late MB administration protocol
The obtained results were compared to the previous performed and published feasibility trial (NTR3403)14. This trial was performed using the same imaging system and identical surgical workup. In both studies, patients received 0.5 mg/kg MB. The only di erence was that in the previous published study, MB was administered directly after surgical exposure of the suspected parathyroid adenoma. In the current study, MB was administered directly after start of anesthesia, before the surgical incision and assisted with parathyroid adenoma identi cation.
Statistical analysis
For statistical analysis, SPSS statistical software package (Version 20.0, Chicago, IL) was used. Signal-to-background ratios (SBR) were calculated by dividing the uorescent signal in the parathyroid adenoma by uorescent signal of surrounding healthy tissue. Patient age and body mass index (BMI) were reported in mean and range and SBR was reported in mean and standard deviation. To compare characteristics between di erent administration protocols, the independent-sample t test and chi-square test were used was used. P < 0.05 was considered signi cant.