Page 104 - Fluorescence-guided cancer surgery

102
Chapter 7
RESULTS
Patient characteristics
Thirteen consecutive patients with primary hyperparathyroidism planned for surgical resection of a parathyroid adenoma were included in this study. Patient and surgical characteristics are shown in Table 1. Mean age was 53 years (range, 21 – 75) and 5 patients were male. Mean BMI was 26.6 ± 3.6, mean preoperative calcium level was 2.8 ± 0.1 mmol/L and mean preoperative PTH level was 11.9 ± 7.2 pmol/L. All patients were diagnosed with primary hyperparathyroidism and in one patient this was associated with multiple endocrine neoplasia (MEN) 1 syndrome. One patient was treated for recurrent disease, after earlier resection of a parathyroid adenoma. The mean diameter of the resected lesions was 17 ± 9 mm (range 5 - 28 mm).
Preoperative imaging
Table 2 shows the preoperative imaging characteristics. In 12 out of 13 patients, a 99mTc-sestamibi single-photon emission computed tomography (SPECT)/ CT was performed. In 8 of 13 patients, a suspected parathyroid adenoma could be localized, whereas in 4 patients no evidence for localization of the adenoma was found. In 12 of 13 patients preoperative US was performed. In 5 patients a lesion suspect for parathyroid adenoma was identi ed. In 1 patient no preoperative US was performed because she was referred from a foreign clinical for surgery and 99mTc-sestamibi SPECT/CT showed clear localization of a parathyroid adenoma.
Intraoperative NIR uorescence imaging
In 9 out of 13 patients, intraoperative NIR uorescence imaging clearly identi ed a parathyroid adenoma or hyperplastic parathyroid gland. Figure 1 shows a representative example of the intraoperative uorescent signal in a parathyroid adenoma. The mean SBR of the identi ed NIR uorescent adenomas or hyperplastic parathyroid glands was 3.1 ± 2.8.