Page 108 - Fluorescence-guided cancer surgery
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Chapter 7
Mean time interval between administration of MB and detection of the adenoma was 77 ± 34 minutes. Parathyroid adenomas could be identi ed up to 145 minutes after administration, which was the longest timespan until resection. No adverse e ects regarding the use of MB or NIRF uorescence imaging were seen.
Correlation 99mTc-sestamibi-SPECT/CT scan and NIR uorescence imaging
In all patients where a suspected adenoma was identi ed on 99mTc-sestamibi- SPECT/CT, the resected parathyroid tissue was uorescent (8 out of 8). Moreover, when analyzing all patients with an adenoma (N=12) that received a 99mTc- sestamibi-SPECT/CT (N=11), concordance between 99mTc-sestamibi-SPECT/ CT status and NIR uorescence status of the resected lesion was observed in 10 out of 11 patients. In 1 patient where the 99mTc-sestamibi-SPECT/CT was negative, the adenoma appeared to be uorescent, and in 1 patient where the 99mTc-sestamibi-SPECT/CT was negative, 2 normal glands were identi ed using NIR uorescence imaging.
Comparison between early and late MB administration protocol
There were no signi cant di erences in patient characteristics between of the current study and the previous reported study regarding age, gender, BMI, preoperative calcium, preoperative PTH and diameter (Table 3). The most important di erence, although not signi cant, was found in SBR between di erent administration protocols. Mean SBR was 3.1 in the early administration group versus 6.1 in the group that received MB after surgical exposure of the adenoma (P=0.08; mean di erence 2.95; -0.40 - 6.29 95% CI).
Table 3. Comparison between early and late Methylene blue administration
Characteristic
Sex Female Male
Age
BMI
Preoperative calcium Preoperative PTH Diameter
SBR
Early MB administration (N=13)
Late MB administration P-value (N=12)
89 5 3
Mean Mean
0.67
53 56 0.65 26.7 27.1 0.82 2.79 2.68 0.42 12.2 119.4 0.22 17 16 0.80 3.11 6.10 0.08
Abbreviations: BMI, Body mass index; MB, Methylene Blue; PTH, parathyroid hormone; SBR, signal-to-Background ratio.
