Wm. White et al., A novel, noninvasive imaging technique for intraoperative assessment of parathyroid glands: Confocal reflectance microscopy, SURGERY, 128(6), 2000, pp. 1088-1100
Background. Successful surgical management of primary hyperparathyroidism r
equires the ability to identify and distinguish normal from abnormal parath
yroid tissue. Microscopic pathologic confirmation often helps with the diag
noses and decisions regarding the extent of parathyroid resection. Confocal
reflectance microscopy (CRM) is an optical method of noninvasively imaging
tissue without fixation, sectioning, and staining as in standard histopath
ology. The goal of this study was to determine if CRM imaging could be used
to distinguish normal from diseased parathyroid tissue intraoperatively.
Methods. In this study, 44 parathyroid glands from 21 patients undergoing o
perations for primary hyperparathyroidism were imaged immediately after exc
ision. CRM images were compared with conventional hematoxylin-and-eosin sta
ined sections obtained from the same gland. The percentage area occupied by
fat cells was calculated in images of both normal and diseased glands.
Results, Characteristic microscopic features of parathyroid glands were dis
tinguishable by CRM and correlated well with, histopathology. The stromal f
at content of normal and diseased glands could easily be determined. The pe
rcentage area occupied by fat cells differed significantly (P < .00001) in
normal glands (average, 23.0% +/- 10.9%) and adenomatous glands (average, 0
.4% +/- 0.7%).
Conclusions. CRM imaging rapidly revealed microscopic features that reliabl
y differentiated normal and diseased parathyroid glands. The success of thi
s preliminary ex vivo study promotes interest in further development of an
in situ probe for in vivo clinical diagnostic use.