{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:52:26Z","timestamp":1753890746129,"version":"3.41.2"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>During intraoperative autofluorescence, the imaging intensity of diseased parathyroid glands is often lower than that of normal parathyroid glands, and some diseased glands especially those in secondary hyperparathyroidism (HPT) show heterogeneous intensities. This study aimed to investigate the reasons for these findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>After formalin and paraffin fixation and bivalve cutting, 18 diseased glands from patients with primary HPT, 35 diseased parathyroid glands from patients with uremic HPT, and the surrounding thyroid and thymus tissues were measured using near-infrared autofluorescence with a Fluorobeam imaging system (Fluoptics, France). None of the tissues were stained with indocyanine green. Hematoxylin and eosin staining matched the intensity of the autofluorescence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Using the bright white intensity of the adult normal parathyroid gland as a reference (index score of 2), the chief cells and oxyphilic cell tissues of the diseased parathyroid had the same intensity score of 2 as that of the normal parathyroid gland, and the clear water parathyroid cell had a weaker intensity score (1\u20131.5). Their glandular architecture, including the trabecular, follicular, or solid arrangements, did not affect the level of intensity. The thymus, thyroid, fat, fibrosis, and necrosis had very low intensities (scores of 0). The red blood cell-hemorrhage appeared dark black (intensity score -1). The thickness of the fibrotic capsule varied in the diseased parathyroid glands; however, only a very thin capsule was observed in the normal parathyroid glands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Various degrees of fibrotic capsules in the diseased parathyroid gland may be the main factor contributing to the lower intensity during autofluorescence, and different cell types, necrosis, fibrosis, and hemorrhage may explain the appearance of heterogeneous intensity in the diseased parathyroid glands.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2023.1233610","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T09:24:02Z","timestamp":1693819442000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Why does diseased parathyroid appear weak or heterogenous intensity during intraoperative near-infrared autofluorescence?"],"prefix":"10.3389","volume":"14","author":[{"given":"Shih-Ming","family":"Huang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"067012","DOI":"10.1117\/1.3583571","article-title":"Near-infrared autofluorescence for the detection of parathyroid glands","volume":"16","author":"Paras","year":"2011","journal-title":"J BioMed Opt"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2017.0102","article-title":"Near-infrared autofluorescence imaging to detect parathyroid glands in thyroid surgery","volume":"100","author":"Ladurner","year":"2018","journal-title":"Ann R Coll Surg Engl"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.701253","article-title":"The accuracy of near infrared autofluorescence in identifying parathyroid gland during thyroid and parathyroid surgery: A meta-analysis","volume":"12","author":"Wang","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2017.09.04","article-title":"Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy","volume":"6","author":"Kahramangil","year":"2017","journal-title":"Gland Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2503","article-title":"Label-free intraoperative parathyroid localization with near-infrared autofluorescence imaging","volume":"99","author":"McWade","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zraa047","article-title":"Autofluorescence pattern of parathyroid adenomas","volume":"5","author":"Demarchi","year":"2021","journal-title":"BJS 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near-infrared autofluorescence imaging of parathyroid glands in thyroid and parathyroid surgery","volume":"173","author":"Sehnem","year":"2023","journal-title":"Surgery"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5424-1","article-title":"Increased identification of parathyroid glands using near infrared light during thyroid and parathyroid surgery","volume":"31","author":"Falco","year":"2017","journal-title":"Surg Endosc"},{"key":"B12","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.surg.2015.06.047","article-title":"Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection","volume":"159","author":"McWade","year":"2016","journal-title":"Surgery"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07161-w","article-title":"Intraoperative parathyroid autofluorescence detection in patients with primary hyperparathyroidism","volume":"26","author":"Squires","year":"2019","journal-title":"Ann Surg Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvac090","article-title":"Near-infrared autofluorescence features of parathyroid carcinoma","volume":"6","author":"Merrill","year":"2022","journal-title":"J Endocr Soc"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2017.05.08","article-title":"Intraoperative real-time localization of parathyroid gland with near infrared fluorescence imaging","volume":"6","author":"Kim","year":"2017","journal-title":"Gland Surg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2018.12.05","article-title":"Near-infrared imaging in re-operative parathyroid surgery: first description of autofluorescence from cryopreserved parathyroid glands","volume":"8","author":"Moore","year":"2019","journal-title":"Gland Surg"}],"container-title":["Frontiers in 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