VideoEndocrinology最新文献

Introduction: A 56-year-old woman was referred for thyroid nodules (TNs) found on a carotid ultrasonography (US). Her laboratories showed a normal thyroid stimulation hormone of 1.530 µIU/mL, normal thyroid hormone levels, and her thyroid antibodies were not elevated. Thyroid 2D US showed an isoechoic solid TN with regular margins measuring 12 × 8 × 10 mm (TR3) in the left thyroid lobe. 3D US demonstrated markedly irregular margins. The nodule volume was 0.52 cm³. Based on current American Thyroid Association and American College of Radiology-Thyroid Imaging, Reporting and Data System (ACR-TIRADS) guidelines, her nodule size would not fit the criteria for fine needle aspiration biopsy (FNAB).^1,2 However, because of the irregular margins seen on 3D US, FNAB was offered along with repeat US after 6 months. After considering her options, she requested FNAB. She underwent effective US guided FNAB of the left TN and the cytopathology report indicated follicular neoplasm Bethesda category IV. Subsequently, she had follow-up US guided FNAB for molecular testing with the Afirma's gene sequencing classifier (GSC). The report showed GSC suspicious with an NRAS mutation, indicating a 50% malignancy risk. She elected to have left hemithyroidectomy. The final surgical pathology report demonstrated a 12-mm follicular carcinoma.

Materials and methods: In our thyroid clinic, we utilize conventional 2D US and 3D US to evaluate TN for possible FNAB. Laboratory measurements were performed at Labcorp. Informed consent was given by the patient. The 3D image acquisition follows 2D US examination. The first step in 3D US image acquisition is identifying the target nodule utilizing 2D US. Next, the 3D sweep of the target nodule produces a 3D volume data set and observation of 3D-rendered images generated simultaneously from longitudinal, transverse, and coronal views. A 2D US image displays a TN only on one plane in two dimensions, longitudinal or transverse. The saved 3D volume data set can be viewed and manipulated later. We can reconstruct new images from different angles after the study is completed. The 3D image acquisition direction (front to back versus up to down) will create a different display image and volume slice. The examiner can choose the direction of 3D acquisition before 3D sweep. A 2D US image or machine lacks these qualities.

Discussion: This case illuminates recent advances in 3D US imaging and demonstrates that this technology may enhance the value of 2D US in diagnosing malignancy. This technology allows the user to create sequential cross-sectional images through the target nodule. The addition of coronal view to the existing 2D US has been an important contributing factor. Several recent publications have reported that 3D US can improve nodule selection criteria for FNAB.^3-5 Our clinic has routinely utilized 3D US technology for the past 4 years. W

Introduction: Hypoparathyroidism and hypocalcemia are common complications after thyroid surgery. Parathyroids may be incidentally damaged or removed because they are difficult to distinguish from surrounding tissue. Intraoperative optical technologies such as near infrared autofluorescence (NIRAF) are becoming increasingly popular to help identify parathyroids during thyroid surgery. The objective of this video is to introduce a developing NIRAF device called hANDY-i and compare the device with existing Food and Drug Administration approved technology.

Materials and methods: hANDY-i is developed by Optosurgical, LLC. The device consists of a coaxial 785 nm laser excitation module and coregistred red-green-blue and near-infrared cameras. Operation of the device and output from preliminary intraoperative use are shown.

Results: hANDY-i performs well, producing intuitive side-by-side NIRAF and RGB images of the operating field. The device demonstrates high contrast between suspected parathyroid glands and surrounding tissue. Operating theater, overhead lamps, and surgical headlights can all be used with the device. The device is also shown to be effective in both in vivo and ex vivo applications.

Conclusions: The prototype described advance NIRAF technology by reducing light sensitivity and improving output representation. In doing so, hANDY-i makes NIRAF more accessible and less obstructive to the surgical workflow.

Sources of funding: This study was supported by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health under Award Number R43EB030874.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Yoseph Kim is an employee of Optosurgical LLC. Jaepyeong Cha has ownership stake in Optosurgical LLC. For all other authors, no competing financial interests exist.Runtime of video: 7 mins 14 secs.