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Akgun E, Uysal M, Avci SN, Berber E. The use of artificial intelligence to detect parathyroid tissue on ex vivo specimens during thyroidectomy and parathyroidectomy procedures using near-infrared autofluorescence signals. Surgery 2024:S0039-6060(24)00494-X. [PMID: 39147664 DOI: 10.1016/j.surg.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/17/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND In thyroidectomy and parathyroidectomy procedures, diagnostic dilemmas related to whether an index tissue is of parathyroid or nonparathyroid origin frequently arise. Current options of frozen section and parathyroid aspiration are time-consuming. Parathyroid glands appear brighter than surrounding tissues on near-infrared autofluorescence imaging. The aim of this study was to develop an artificial intelligence model differentiating parathyroid tissue on surgical specimens based on near-infrared autofluorescence. METHODS With institutional review board approval, an image library of ex vivo specimens obtained in thyroidectomy and parathyroidectomy procedures was created between November 2019 and April 2023 at a single academic center. Ex vivo autofluorescence images of surgically removed parathyroid glands, thyroid glands, lymph nodes, and thymic tissue were uploaded into an artificial intelligence platform. Two different models were trained, with the first model using autofluorescence images from all specimens, including thyroid, and the second model excluding thyroid, to prevent the effect of specimen size on the results. Deep-learning models were trained to detect autofluorescence signals specific to parathyroid glands. Randomly chosen 80% of data were used for training, 10% for validation, and 10% for testing. Recall, precision, and area under the curve of models were calculated. RESULTS Surgical procedures included 377 parathyroidectomies, 239 total thyroidectomies, 97 thyroid lobectomies, and 32 central neck dissections. For the development of the model, 1151 images from a total of 678 procedures were used. The dataset comprised 648 parathyroid, 379 thyroid, 104 lymph node, and 20 thymic tissue images. The overall precision, recall, and area under the curve of the model to detect parathyroid tissue were 96.5%, 96.5%, and 0.985, respectively. False negatives were related to dark and large parathyroid glands. CONCLUSION The visual deep-learning model developed to identify parathyroid tissue in ex vivo specimens during thyroidectomy and parathyroidectomy demonstrated a high sensitivity and positive predictive value. This suggests potential utility of near-infrared autofluorescence imaging to improve intraoperative efficiency by reducing the need for frozen sections and parathyroid hormone aspirations to confirm parathyroid tissue.
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Affiliation(s)
- Ege Akgun
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, OH
| | - Melis Uysal
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, OH
| | - Seyma Nazli Avci
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, OH
| | - Eren Berber
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, OH.
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Wang B, Yu JF, Lin SY, Li YJ, Huang WY, Yan SY, Wang SS, Zhang LY, Cai SJ, Wu SB, Li MY, Wang TY, Abdelhamid Ahmed AH, Randolph GW, Chen F, Zhao WX. Intraoperative AI-assisted early prediction of parathyroid and ischemia alert in endoscopic thyroid surgery. Head Neck 2024; 46:1975-1987. [PMID: 38348564 DOI: 10.1002/hed.27629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND The preservation of parathyroid glands is crucial in endoscopic thyroid surgery to prevent hypocalcemia and related complications. However, current methods for identifying and protecting these glands have limitations. We propose a novel technique that has the potential to improve the safety and efficacy of endoscopic thyroid surgery. PURPOSE Our study aims to develop a deep learning model called PTAIR 2.0 (Parathyroid gland Artificial Intelligence Recognition) to enhance parathyroid gland recognition during endoscopic thyroidectomy. We compare its performance against traditional surgeon-based identification methods. MATERIALS AND METHODS Parathyroid tissues were annotated in 32 428 images extracted from 838 endoscopic thyroidectomy videos, forming the internal training cohort. An external validation cohort comprised 54 full-length videos. Six candidate algorithms were evaluated to select the optimal one. We assessed the model's performance in terms of initial recognition time, identification duration, and recognition rate and compared it with the performance of surgeons. RESULTS Utilizing the YOLOX algorithm, we developed PTAIR 2.0, which demonstrated superior performance with an AP50 score of 92.1%. The YOLOX algorithm achieved a frame rate of 25.14 Hz, meeting real-time requirements. In the internal training cohort, PTAIR 2.0 achieved AP50 values of 94.1%, 98.9%, and 92.1% for parathyroid gland early prediction, identification, and ischemia alert, respectively. Additionally, in the external validation cohort, PTAIR outperformed both junior and senior surgeons in identifying and tracking parathyroid glands (p < 0.001). CONCLUSION The AI-driven PTAIR 2.0 model significantly outperforms both senior and junior surgeons in parathyroid gland identification and ischemia alert during endoscopic thyroid surgery, offering potential for enhanced surgical precision and patient outcomes.
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Affiliation(s)
- Bo Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Fan Yu
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Si-Ying Lin
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yi-Jian Li
- College of Computer and Data Science, Fuzhou University, Fuzhou, China
| | - Wen-Yu Huang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shou-Yi Yan
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Si-Si Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Li-Yong Zhang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shao-Jun Cai
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Si-Bin Wu
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Meng-Yao Li
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ting-Yi Wang
- Department of Leading Cadre, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Amr H Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fei Chen
- College of Computer and Data Science, Fuzhou University, Fuzhou, China
| | - Wen-Xin Zhao
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Clinical Research Center for Precision Management of Thyroid Cancer of Fujian Province, Fuzhou, China
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Morales-Conde S, Navarro-Morales L, Moreno-Suero F, Balla A, Licardie E. Fluorescence and tracers in surgery: the coming future. Cir Esp 2024; 102 Suppl 1:S45-S60. [PMID: 38851317 DOI: 10.1016/j.cireng.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 06/10/2024]
Abstract
The revolution that we are seeing in the world of surgery will determine the way we understand surgical approaches in coming years. Since the implementation of minimally invasive surgery, innovations have constantly been developed to allow the laparoscopic approach to go further and be applied to more and more procedures. In recent years, we have been in the middle of another revolutionary era, with robotic surgery, the application of artificial intelligence and image-guided surgery. The latter includes 3D reconstructions for surgical planning, virtual reality, holograms or tracer-guided surgery, where ICG-guided fluorescence has provided a different perspective on surgery. ICG has been used to identify anatomical structures, assess tissue perfusion, and identify tumors or tumor lymphatic drainage. But the most important thing is that this technology has come hand in hand with the potential to develop other types of tracers that will facilitate the identification of tumor cells and ureters, as well as different light beams to identify anatomical structures. These will lead to other types of systems to assess tissue perfusion without the use of tracers, such as hyperspectral imaging. Combined with the upcoming introduction of ICG quantification, these developments represent a real revolution in the surgical world. With the imminent implementation of these technological advances, a review of their clinical application in general surgery is timely, and this review serves that aim.
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Affiliation(s)
- Salvador Morales-Conde
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Laura Navarro-Morales
- Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Francisco Moreno-Suero
- Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Andrea Balla
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Eugenio Licardie
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
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Sarioglu AG, Akgun E, Uysal M, Osman M, Berber E. The utility of fluorescence imaging in detecting primary and metastatic small bowel carcinoid tumors. Am J Surg 2024; 232:3-7. [PMID: 37945469 DOI: 10.1016/j.amjsurg.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Our aim was to investigate utility of indocyanine green (ICG) and autofluorescence (AF) imaging in detection of small bowel primary and metastatic carcinoids. METHODS Using Institutional Review Board approval, ICG and AF imaging of small bowel carcinoids was performed. Imaging findings were prospectively recorded in operating room and compared with conventional imaging, surgical exploration and pathologic findings. RESULTS There were 16 patients with 23 primary small bowel tumors, 27 mesenteric lymph nodes, 36 liver metastases and 2 peritoneal nodules. Carcinoid tumors exhibited brighter AF signals compared to background. AF imaging was superior to both DOTATATE PET and surgeon inspection/palpation in demonstrating small bowel primaries. Utility for metastatic lymph nodes and peritoneal metastases was limited. Superficial liver metastases exhibited brighter fluorescence compared to background on both ICG and AF imaging. CONCLUSIONS This is the largest study assessing utility of near-infrared fluorescence imaging in detection of small bowel carcinoids. Our results show promise in the utilization fluorescence imaging to detect occult primary tumors and superficial liver metastases.
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Affiliation(s)
| | - Ege Akgun
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Melis Uysal
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Mohammed Osman
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA; Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Shi X, Lv G, Qin J, Li Y, Zheng L, Ding H, Sang J. The application of autofluorescence system contributes to the preservation of parathyroid function during thyroid surgery. Langenbecks Arch Surg 2024; 409:96. [PMID: 38483607 PMCID: PMC10940390 DOI: 10.1007/s00423-024-03256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The purpose of this study was to investigate the impact of autofluorescence technology on postoperative parathyroid function and short-term outcomes in patients undergoing thyroid surgery. METHODS A total of 546 patients were included in the study, with 287 in the conventional treatment group and 259 in the autofluorescence group. Both groups underwent central lymph node dissection, which is known to affect parathyroid function. Short-term outcomes, including rates of postoperative hypocalcemia and parathyroid dysfunction, serum calcium and PTH levels on the first postoperative day, as well as the need for calcium supplementation, were analyzed. A multivariable analysis was also conducted to assess the impact of autofluorescence on postoperative parathyroid dysfunction, considering factors such as age, BMI, and preoperative calcium levels. RESULTS The autofluorescence group demonstrated significantly lower rates of postoperative hypocalcemia and parathyroid dysfunction compared to the conventional treatment group. The autofluorescence group also had better serum calcium and PTH levels on the first postoperative day, and a reduced need for calcium supplementation. Surprisingly, the use of autofluorescence technology did not prolong surgical time; instead, it led to a shorter hospitalization duration. The multivariable analysis showed that autofluorescence significantly reduced the risk of postoperative parathyroid dysfunction, while factors such as age, BMI, and preoperative calcium levels did not show a significant correlation. CONCLUSION This study provides evidence that autofluorescence technology can improve the preservation of parathyroid function during thyroid surgery, leading to better short-term outcomes and reduced postoperative complications. The findings highlight the potential of autofluorescence as a valuable tool in the management of parathyroid hypofunction. Further research and validation are needed to establish the routine use of autofluorescence technology in the thyroid.
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Affiliation(s)
| | - Guan Lv
- Nanjing Medical University, Nanjing, China
| | - JiaBo Qin
- Nanjing Medical University, Nanjing, China
| | | | - Lulu Zheng
- Nanjing Medical University, Nanjing, China
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Yu F, Sang T, Kang J, Deng X, Guo B, Yang H, Chen X, Fan Y, Ding X, Wu B. An automatic parathyroid recognition and segmentation model based on deep learning of near-infrared autofluorescence imaging. Cancer Med 2024; 13:e7065. [PMID: 38457206 PMCID: PMC10923035 DOI: 10.1002/cam4.7065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/18/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Near-infrared autofluorescence imaging (NIFI) can be used to identify parathyroid gland (PG) during surgery. The purpose of the study is to establish a new model, help surgeons better identify, and protect PGs. METHODS Five hundred and twenty three NIFI images were selected. The PGs were recorded by NIFI and marked with artificial intelligence (AI) model. The recognition rate for PGs was calculated. Analyze the differences between surgeons of different years of experience and AI recognition, and evaluate the diagnostic and therapeutic efficacy of AI model. RESULTS Our model achieved 83.5% precision and 57.8% recall in the internal validation set. The visual recognition rate of AI model was 85.2% and 82.4% on internal and external sets. The PG recognition rate of AI model is higher than that of junior surgeons (p < 0.05). CONCLUSIONS This AI model will help surgeons identify PGs, and develop their learning ability and self-confidence.
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Affiliation(s)
- Fan Yu
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Sang
- School of Computer Engineering and Science, Shanghai University, Shanghai, China
| | - Jie Kang
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianzhao Deng
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Guo
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hangzhou Yang
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Chen
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Youben Fan
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuehai Ding
- School of Computer Engineering and Science, Shanghai University, Shanghai, China
| | - Bo Wu
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Uysal M, Akgun E, Sarioglu AG, Berber E. Comparison of Perioperative Outcomes in Patients with Graves' Disease Undergoing Total Thyroidectomy With or Without Near Infrared Autofluorescence Imaging. Thyroid 2024; 34:64-69. [PMID: 37897089 DOI: 10.1089/thy.2023.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Background: The impact of near-infrared autofluorescence (NIRAF) imaging on postthyroidectomy hypocalcemia is controversial. As patients with Graves' disease are at increased risk, our aim was to compare postoperative parathyroid function in these patients undergoing total thyroidectomy (TT) with or without NIRAF imaging. Methods: This was a retrospective "before and after" study, comparing outcomes of patients who underwent TT without or with NIRAF imaging at a single center. Primary outcome was the incidence of temporary hypocalcemia and secondary outcomes, rates of incidental parathyroidectomy on final specimens and permanent hypocalcemia. Analyses were performed using Mann-Whitney U and chi-Square tests. Continuous data are expressed as median (interquartile range). Results: There were 85 patients in NIRAF and 100 patients in non-NIRAF group. Groups were comparable regarding age, gender, body-mass index, and thyroid weight. Number of parathyroid glands identified intraoperatively was 3 in both groups (p = 0.47). Intraoperative parathyroid implantation rate was 16.5% in NIRAF and 6% in non-NIRAF group (p = 0.02). Incidental parathyroidectomy rate on final pathology was 12.9% in NIRAF and 32% in non-NIRAF group (p = 0.002). The rates of temporary (11.7% vs. 16%) and permanent hypocalcemia (2.4% vs. 2%) were similar between the two groups, respectively (p = 0.66). Conclusion: To our knowledge, this is the first comparative study investigating the impact of NIRAF on postoperative parathyroid function after thyroidectomy for Graves' disease. The rate of incidental parathyroidectomy on final pathology was lower with use of NIRAF, without an impact on temporary or permanent hypocalcemia rates compared to conventional technique.
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Affiliation(s)
- Melis Uysal
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ege Akgun
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ali Gunduz Sarioglu
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eren Berber
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Romero-Velez G, Avci SN, Isiktas G, Ergun O, Akgun E, Muraveika L, Jin J, Heiden K, Krishnamurthy VD, Shin J, Siperstein A, Berber E. Comparison of incidental parathyroid tissue detection rates on pathology after total thyroidectomy performed with or without near-infrared autofluorescence imaging. Surgery 2024; 175:128-133. [PMID: 37867101 DOI: 10.1016/j.surg.2023.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Near-infrared autofluorescence imaging is an adjunct to parathyroid identification. As it does not show perfusion, it is important to study its impact during thyroidectomy by measuring quantifiable data on parathyroid detection rather than function. The aim of this study was to compare incidental parathyroidectomy rates in patients undergoing total thyroidectomy with or without near-infrared autofluorescence. METHODS Retrospective study of patients who underwent total thyroidectomy between 2014 and 2022 at one center. Clinical parameters, including rates of incidental parathyroid tissue on pathology reports, were compared between near-infrared autofluorescence and non-near-infrared autofluorescence groups. Near-infrared autofluorescence was used to guide dissection (identification) and/or to confirm tissue as parathyroid (confirmation). Statistical analysis was done with Wilcoxon rank sum test and χ2 analysis. RESULTS There were 300 patients in the near-infrared autofluorescence and 750 patients in the non-near-infrared autofluorescence group. The rate of incidental parathyroid tissue detection on final pathology was 13.3% (n = 40) in the near-infrared autofluorescence and 23.2% (n = 174) in the non-near-infrared autofluorescence group (P < .001). The rate of incidental parathyroid tissue detected on pathology with near-infrared autofluorescence decreased when used for identification and confirmation of parathyroid tissue (30.0% to 13.4%, P < .001), but not when used for confirmation only (19.6% to 18.5%, P = .89). Impact of near-infra red autofluorescence in decreasing the rate of incidental parathyroid tissue was more profound for early (38.5% to 17.1%) versus mid-late career surgeons (20% to 13%). CONCLUSION Our results suggest that the use of near-infrared autofluorescence may help decrease the rate of incidental parathyroid tissue detected on final pathology if used for both identification and confirmation of parathyroid glands during thyroidectomy.
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Affiliation(s)
- Gustavo Romero-Velez
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Seyma Nazli Avci
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL
| | - Gizem Isiktas
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Onuralp Ergun
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Ege Akgun
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Liudmila Muraveika
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Judy Jin
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Katherine Heiden
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Vikram D Krishnamurthy
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Joyce Shin
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Allan Siperstein
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH
| | - Eren Berber
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH.
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Pannu AY, O’Connor-Manson MR, Wyld L, Balasubramanian SP. Near-infrared fluorescent imaging for parathyroid identification and/or preservation in surgery for primary hyperparathyroidism. Front Endocrinol (Lausanne) 2023; 14:1240024. [PMID: 38111703 PMCID: PMC10726132 DOI: 10.3389/fendo.2023.1240024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/03/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Near infrared autofluorescence (NIRAF) is a novel intraoperative technology that has shown promising results in the localisation of parathyroid glands (PGs) over the last decade. This study aimed to assess the potential utility of NIRAF in first time surgery for primary hyperparathyroidism (PHPT). Methods An observational study over a period of 3 years in patients who underwent surgery for PHPT was designed. Data on the use of NIRAF and fluorescent patterns in different organs (thyroid and parathyroid) and parathyroid pathology (single versus multi-gland disease) were explored. In addition, cure rates and operating times were compared between the NIRAF and no-NIRAF groups to determine the potential value of NIRAF in this cohort. Results In 230 patients undergoing first time surgery for PHPT, NIRAF was used in 50 patients. Of these 50 patients, NIRAF was considered to aid parathyroid identification in 9 patients (18%). The overall cure rate at 6 months of follow-up was 96.5% (98% in NIRAF and 96.1% without NIRAF; p=1.0). The median (interquartile range) operating time was longer in the NIRAF arm at 102 minutes (74-120 minutes) compared to the no-NIRAF arm at 75 minutes (75-109 minutes); however, this difference was not statistically significant (p=0.542). Although the median parathyroid to thyroid (P/T) auto-fluorescence (AF) ratio was similar between single gland and multi gland disease (2.5 vs to 2.76; p=1.0), the P/T AF ratio correlated negatively with increasing gland weight (p=0.038). Conclusion The use of NIRAF resulted in some potential "surgeon-perceived" benefit but did not lead to improvements in cure rates. The negative correlation between fluorescent intensity and gland weight suggests loss of fluorescence with pathology, which needs further investigation. Further studies on larger cohorts of patients, in depth analysis of fluorescence patterns between normal, adenomatous, and hyperplastic glands and evaluation of user experience are needed. Primary hyperparathyroidism, hyperparathyroidism, autofluorescence, near-infrared fluorescence, parathyroid glands, endocrine, surgery.
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Affiliation(s)
- Arslan Y. Pannu
- University of Sheffield, Sheffield, United Kingdom
- Chesterfield Royal Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Lynda Wyld
- University of Sheffield, Sheffield, United Kingdom
| | - Saba P. Balasubramanian
- University of Sheffield, Sheffield, United Kingdom
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
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Ali KM, Wolfe SA, Nagururu NV, Seo S, Han SM, Kim Y, Oh E, Kim DY, Ning B, Lee SY, Cha RJ, Tufano RP, Russell JO. Parathyroid gland detection using an intraoperative autofluorescence handheld imager - early feasibility study. Front Endocrinol (Lausanne) 2023; 14:1190282. [PMID: 37554762 PMCID: PMC10405624 DOI: 10.3389/fendo.2023.1190282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/30/2023] [Indexed: 08/10/2023] Open
Abstract
Introduction Parathyroid glands may be compromised during thyroid surgery which can lead to hypoparathyroidism and hypocalcemia. Identifying the parathyroid glands relies on the surgeon's experience and the only way to confirm their presence was through tissue biopsy. Near infrared autofluorescence technology offers an opportunity for real-time, non-invasive identification of the parathyroid glands. Methods We used a new research prototype (hANDY-I) developed by Optosurgical, LLC. It offers coaxial excitation light and a dual-Red Green Blue/Near Infrared sensor that guides anatomical landmarks and can aid in identification of parathyroid glands by showing a combined autofluorescence and colored image simultaneously. Results We tested the imager during 23 thyroid surgery cases, where initial clinical feasibility data showed that out of 75 parathyroid glands inspected, 71 showed strong autofluorescence signal and were correctly identified (95% accuracy) by the imager. Conclusions The hANDY-I prototype demonstrated promising results in this feasibility study by aiding in real-time visualization of the parathyroid glands. However, further testing by conducting randomized clinical trials with a bigger sample size is required to study the effect on levels of hypoparathyroidism and hypocalcemia.
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Affiliation(s)
- Khalid Mohamed Ali
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Samantha A. Wolfe
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Nimesh V. Nagururu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Stefanie Seo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Yoseph Kim
- Department of Research and Development, Optosurgical, LLC, Columbia, MD, United States
| | - Eugene Oh
- Department of Research and Development, Optosurgical, LLC, Columbia, MD, United States
| | - Dong-Yun Kim
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Bo Ning
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, United States
| | - Seung Yup Lee
- Department of Electrical and Computer Engineering, Kennesaw State University, Marietta, GA, United States
| | - Richard Jaepyeong Cha
- Department of Research and Development, Optosurgical, LLC, Columbia, MD, United States
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, United States
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, FL, United States
| | - Jonathon O. Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
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11
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Chen W, Zhang R, Yang R, Hu J, Phay JE, Liu P, Ma X, Xu RX. Converting a probe-based fluorescence system into an easy-to-use adjunct for the detection of parathyroid glands accidentally resected intraoperatively. Langenbecks Arch Surg 2023; 408:262. [PMID: 37393198 DOI: 10.1007/s00423-023-02985-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE The reported threshold of a near-infrared fluorescence detection probe (FDP) for judging parathyroid glands (PGs) is based on the autofluorescence intensity relative to other non-PG tissues, making it unreliable when not enough reference tissues are measured. We aim to convert FDP into a more convenient tool for identifying accidentally resected PGs by quantitative measurements of autofluorescence in resected tissues. METHODS It was a prospective study approved by the Institutional Review Board. The research was divided into two stages: (1) In order to calibrate the novel FDP system, autofluorescence intensity of different in / ex vivo tissues was measured and the optimal threshold was obtained using receiver operating characteristic (ROC) curve. (2) To further validate the effectiveness of the new system, detection rates of incidental resected PGs by pathology in the control group and by FDP in the experimental group were compared. RESULTS Autofluorescence of PGs was significantly higher than that of non-PG tissue (43 patients, Mann-Whitney U test, p < 0.0001). An optimal threshold of sensitivity / specificity (78.8% and 85.1%) for discriminating PGs was obtained. The detection rates of experimental group (20 patients) and control group (33 patients) are 5.0% and 6.1% respectively (one-tailed Fisher's exact test, p = 0.6837), indicating the novel FDP system can achieve a similar proportion of PG detection compared with pathological examinations. CONCLUSIONS The novel FDP system can be used as an easy-to-use adjunct for detecting PG accidentally resected intraoperatively before the tissues are sent for frozen sections during thyroidectomy surgeries. TRIAL REGISTRATION Registration number: ChiCTR2200057957.
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Affiliation(s)
- Wei Chen
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026, China
| | - Ru Zhang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026, China
| | - Ruijie Yang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026, China
| | - Jie Hu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026, China
| | - John E Phay
- Department of Surgery, Ohio State University Comprehensive Cancer Center and Ohio State University Wexner Medical Center, 410 W 10Th Ave, Columbus, OH, 43210, USA
| | - Peng Liu
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Renai Road. NO. 188, Suzhou Industrial Park, Suzhou, 215123, Jiangsu Province, China
| | - Xiaopeng Ma
- First Affiliated Hospital, University of Science and Technology of China, Hefei, 230031, China
| | - Ronald X Xu
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, 230026, China.
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Renai Road. NO. 188, Suzhou Industrial Park, Suzhou, 215123, Jiangsu Province, China.
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12
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Ludwig B, Ludwig M, Dziekiewicz A, Mikuła A, Cisek J, Biernat S, Kaliszewski K. Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications. Cancers (Basel) 2023; 15:cancers15112931. [PMID: 37296896 DOI: 10.3390/cancers15112931] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Thyroid cancer is the most common cancer of the endocrine system, and, in recent years, there has been a phenomenon of overdiagnosis followed by subsequent overtreatment. This results in an increasing number of thyroidectomy complications being faced in clinical practice. In this paper, we present the current state of knowledge and the latest findings in the fields of modern surgical techniques, thermal ablation, the identification and assessment of parathyroid function, recurrent laryngeal nerve monitoring and treatment and perioperative bleeding. We reviewed 485 papers, from which we selected 125 papers that are the most relevant. The main merit of this article is its comprehensive view of the subject under discussion-both general, concerning the selection of the appropriate method of surgery, and particular, concerning the selection of the appropriate method of prevention or treatment of selected perioperative complications.
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Affiliation(s)
- Bartłomiej Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Maksymilian Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Anna Dziekiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Agnieszka Mikuła
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Jakub Cisek
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Szymon Biernat
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
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13
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Yuan Y, Li X, Bao X, Huangfu M, Zhang H. The magic mirror: a novel intraoperative monitoring method for parathyroid glands. Front Endocrinol (Lausanne) 2023; 14:1160902. [PMID: 37284221 PMCID: PMC10239973 DOI: 10.3389/fendo.2023.1160902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future.
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14
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Shaphaba K, Thakar A, Sakthivel P, Sikka K, Singh CA, Kumar R, Chandran A, Goswami R. Incremental value of magnification and indocyanine green for parathyroid preservation in thyroid surgery. Head Neck 2023. [PMID: 37144335 DOI: 10.1002/hed.27387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND To assess the promise of surgical magnification and of intraoperative indocyanine green (ICG) assisted near-infrared fluorescence (NIRF) in improving parathyroid identification and viability assessment during thyroidectomy. METHODS Prospective comparative study. Parathyroid gland identification sequentially assessed by naked eye, surgical microscopy, and by NIRF imaging following ICG administration (5 mgIV). Parathyroid perfusion/vitality reassessed end-surgery by ICG-NIRF. RESULTS An expected total of 104 parathyroid glands were assessed in 35 patients (17 total-thyroidectomy, 18 hemi-thyroidectomy). 54/104 (51.9%) were identified by naked eye, and sequentially greater numbers identified by microscope magnification (n = 61; 58.7%; p = 0.33), and by ICG-NIRF (n = 72; 69.2%; p = 0.01). ICG-NIRF detected additional parathyroid glands in 16/35 patients (45.7%). Confident identification of at least one parathyroid remained unachieved in 5/35 by naked eye, in 4/35 by microscopic magnification, and in no patient by ICG-NIRF. ICG-NIRF indicated end-of-surgery devascularization in 12/72 glands and informed decisions regarding gland implantation. CONCLUSION Significantly greater parathyroid glands are identified and preserved with surgical magnification and with ICG-NIRF. Both techniques merit routine adoption for thyroidectomy.
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Affiliation(s)
- Konthoujam Shaphaba
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pirabu Sakthivel
- Department of Otorhinolaryngology & Head and Neck Surgery, Kovai Medical Center Hospital, Coimbatore, Tamil Nadu, India
| | - Kapil Sikka
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwin Chandran
- Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ravinder Goswami
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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15
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Tjahjono R, Phung D, Elliott MS, Riffat F, Palme CE. The Utility of Near-Infrared Autofluorescence for Parathyroid Gland Identification During Thyroid Surgery: A Single-Center Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:121-125. [PMID: 37007878 PMCID: PMC10050657 DOI: 10.1007/s12070-022-03309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
Parathyroid gland injury during thyroid surgery is common and can lead to postoperative hypocalcemia. This study aims to determine the utility of near-infrared autofluorescence (NIRAF) technology for parathyroid gland identification in thyroid surgery. A prospective case series of patients who underwent thyroid surgery between March and June 2021 were examined. Following intra-operative visualisation, parathyroid glands and surrounding tissues were exposed to near-infrared light with a wavelength of approximately 800 nm using the Storz® Near-Infrared Range/Indocyanine Green (NIR/ICG) endoscopic system. Parathyroid glands were expected to show autofluorescence following exposure. Twenty patients who underwent thyroid surgery were included. Eighteen patients (90%) were female, with a median age of 50.0 (IQR 41.0 - 62.5). Surgeries performed include hemithyroidectomy (9 patients; 45.0%), total thyroidectomy (8 patients; 40.0%), completion thyroidectomy (2 patients; 10.0%) and right inferior parathyroidectomy (1 patient; 5.0%). Attempts were made to identify 56 parathyroid glands in this case series. There were 46/56 (82.1%) surgeon-identified parathyroid glands through direct visualisation. Using NIRAF technology, 39/46 (84.8%) were identified as parathyroid glands. There was no inadvertent resection of parathyroid glands or post-operative hypocalcaemia. NIRAF technology has the potential to be a useful tool in confirming the presence of parathyroid glands following direct visualisation intra-operatively.
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Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Daniel Phung
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
| | - Michael S. Elliott
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Chris O’Brien Lifehouse, University of Sydney, 119-143 Missenden Rd, Camperdown, NSW 2050 Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
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16
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Silver Karcioglu AL, Triponez F, Solórzano CC, Iwata AJ, Abdelhamid Ahmed AH, Almquist M, Angelos P, Benmiloud F, Berber E, Bergenfelz A, Cha J, Colaianni CA, Davies L, Duh QY, Hartl D, Kandil E, Kim WW, Kopp PA, Liddy W, Mahadevan-Jansen A, Lee KD, Mannstadt M, McMullen CP, Shonka DC, Shin JJ, Singer MC, Slough CM, Stack BC, Tearney G, Thomas G, Tolley N, Vidal-Fortuny J, Randolph GW. Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery: A Review From the American Head and Neck Society Endocrine Surgery Section. JAMA Otolaryngol Head Neck Surg 2023; 149:253-260. [PMID: 36633855 DOI: 10.1001/jamaoto.2022.4421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Identification and preservation of parathyroid glands (PGs) remain challenging despite advances in surgical techniques. Considerable morbidity and even mortality result from hypoparathyroidism caused by devascularization or inadvertent removal of PGs. Emerging imaging technologies hold promise to improve identification and preservation of PGs during thyroid surgery. Observation This narrative review (1) comprehensively reviews PG identification and vascular assessment using near-infrared autofluorescence (NIRAF)-both label free and in combination with indocyanine green-based on a comprehensive literature review and (2) offers a manual for possible implementation these emerging technologies in thyroid surgery. Conclusions and Relevance Emerging technologies hold promise to improve PG identification and preservation during thyroidectomy. Future research should address variables affecting the degree of fluorescence in NIRAF, standardization of signal quantification, definitions and standardization of parameters of indocyanine green injection that correlate with postoperative PG function, the financial effect of these emerging technologies on near-term and longer-term costs, the adoption learning curve and effect on surgical training, and long-term outcomes of key quality metrics in adequately powered randomized clinical trials evaluating PG preservation.
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Affiliation(s)
- Amanda L Silver Karcioglu
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,The University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Frédéric Triponez
- Thoracic and Endocrine Surgery, Department of Surgery, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ayaka J Iwata
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Santa Clara, California
| | - Amr H Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Martin Almquist
- Department of Surgery, Skane University Hospital, Lund, Sweden, Institution for Clinical Sciences, Lund University, Lund, Sweden
| | - Peter Angelos
- MacLean Center for Clinical Medical Ethics, Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Fares Benmiloud
- Endocrine Surgery Unit, Hôpital Européen Marseille, Marseille, France
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Jaepyeong Cha
- Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - C Alessandra Colaianni
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Louise Davies
- The VA Outcomes Group, White River Junction, Vermont.,Section for Otolaryngology-Head & Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Quan-Yang Duh
- Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco.,VA Medical Center, San Francisco, California
| | - Dana Hartl
- Department of Surgery, Thyroid Surgery Unit, Gustave Roussy Cancer Campus and University Paris-Saclay, Paris, France
| | - Emad Kandil
- Endocrine and Oncological Surgery Tulane University School of Medicine, New Orleans, Louisiana
| | - Wan Wook Kim
- Department of Surgery, Breast and Thyroid Division, Kyungpook National University, South Korea
| | - Peter A Kopp
- Division of Endocrinology, Diabetology and Metabolism, University of Lausanne, Lausanne, Switzerland.,Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Whitney Liddy
- Thyroid and Parathyroid Surgery, Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, Illinois
| | - Anita Mahadevan-Jansen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Surgery, Otolaryngology and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kang-Dae Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Caitlin P McMullen
- Moffitt Cancer Center, Department of Head & Neck-Endocrine Oncology, Tampa, Florida
| | - David C Shonka
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael C Singer
- Division of Thyroid & Parathyroid Surgery, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Cristian M Slough
- Department of Otolaryngology-Head and Neck Surgery, Hawke's Bay Fallen Soldiers' Memorial Hospital, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Brendan C Stack
- Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Guillermo Tearney
- Department of Pathology and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Neil Tolley
- Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Jordi Vidal-Fortuny
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland.,Department of Thoracic and Endocrine Surgery, Geneva, Switzerland
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
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17
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Indocyanine green fluorescence and near-infrared autofluorescence may improve post-thyroidectomy parathyroid function. Surgery 2023; 173:124-131. [PMID: 36244813 DOI: 10.1016/j.surg.2022.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/12/2022] [Accepted: 06/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Near-infrared autofluorescence and indocyanine green fluorescence are 2 recent tools introduced to improve postoperative parathyroid function during thyroid surgery. METHODS We conducted a randomized prospective study. Patients undergoing total thyroidectomy were randomly assigned either to the fluorescence group, in which near-infrared autofluorescence and indocyanine green fluorescence were used, or to the control group. The primary outcomes of the study were the rate of postoperative transient and symptomatic hypocalcemia. RESULTS A significantly higher number of parathyroid glands were identified in the fluorescence group (3.83 vs 3.64, P = .028). The rate of postoperative symptomatic hypocalcemia was significantly lower in the fluorescence group (6% vs 17%, P = .015), as was the dosage (1.53 vs 1.91 g, P = .007) and the duration of calcium therapy (32.30 vs 45.66 days, P = .003). Having at least 2 well-vascularized parathyroid glands correlates to lower rates of transient hypocalcemia (7.4% vs 21.9%, P = .037) as well as to higher serum calcium (8.70 vs 8.42 mg/dL, P = .027) and parathyroid hormone levels (19.15 vs 11.4 pg/mL, P = .0002) on postoperative day 1. CONCLUSION Near-infrared autofluorescence and indocyanine green fluorescence are novel tools that may support the endocrine surgeon in preserving and predicting post-thyroidectomy parathyroid gland function.
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18
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A multicenter evaluation of near-infrared autofluorescence imaging of parathyroid glands in thyroid and parathyroid surgery. Surgery 2023; 173:132-137. [PMID: 36511281 DOI: 10.1016/j.surg.2022.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/24/2022] [Accepted: 07/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The usefulness of incorporating near-infrared autofluorescence into the surgical workflow of endocrine surgeons is unclear. Our aim was to develop a prospective registry and gather expert opinion on appropriate use of this technology. METHODS This was a prospective multicenter collaborative study of patients undergoing thyroidectomy and parathyroidectomy at 7 academic centers. A questionnaire was disseminated among 24 participating surgeons. RESULTS Overall, 827 thyroidectomy and parathyroidectomy procedures were entered into registry: 42% of surgeons found near-infrared autofluorescence useful in identifying parathyroid glands before they became apparent; 67% correlated near-infrared autofluorescence pattern to normal and abnormal glands; 38% of surgeons used near-infrared autofluorescence, rather than frozen section, to confirm parathyroid tissue; and 87% and 78% of surgeons reported near-infrared autofluorescence did not improve the success rate after parathyroidectomy or the ability to find ectopic glands, respectively. During thyroidectomy, 66% of surgeons routinely used near-infrared autofluorescence to rule out inadvertent parathyroidectomy. However, only 36% and 45% felt near-infrared autofluorescence decreased inadvertent parathyroidectomy rates and improved ability to preserve parathyroid glands during central neck dissections, respectively. CONCLUSION This survey study identified areas of greatest potential use for near-infrared autofluorescence, which can form the basis of future objective trials to document the usefulness of this technology.
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19
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Huang J, He Y, Wang Y, Chen X, Zhang Y, Chen X, Huang Z, Fang J, Zhong Q. Prevention of hypoparathyroidism: A step-by-step near-infrared autofluorescence parathyroid identification method. Front Endocrinol (Lausanne) 2023; 14:1086367. [PMID: 36793275 PMCID: PMC9922903 DOI: 10.3389/fendo.2023.1086367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Hypoparathyroidism is an important factor that seriously affects the quality of life of patients after thyroidectomy. This study aimed to optimize the surgical procedure for parathyroid identification using near-infrared autofluorescence (NIRAF) during thyroidectomy. METHODS This was a prospective controlled study that included 100 patients with primary papillary thyroid carcinoma diagnosed in Beijing Tongren Hospital between June 2021 and April 2022 who were awaiting total thyroidectomy and bilateral neck dissection. The patients were randomly divided into an experimental group in whom step-by-step NIRAF imaging was used to identify parathyroid glands, and a control group in whom NIRAF was not used. RESULTS The number of parathyroid glands identified in the NIRAF group was higher than that in the control group (195 vs. 161, p=0.000, Z=-5.186). The proportion of patients with parathyroid glands inadvertently removed in the NIRAF group was lower than that in the control group (2.0% vs. 18.0%, respectively; p=0.008, χ2 = 7.111). In the NIRAF group, we found that more than 95% of the superior parathyroid glands and more than 85% of the inferior parathyroid glands were identified before the dangerous phase, which was much higher than that in the control group. The incidences of temporary hypoparathyroidism, hypocalcemia, and symptomatic hypocalcemia were higher in the control group than those in the NIRAF group. On the first postoperative day, the average parathyroid hormone (PTH) level in the NIRAF group decreased to 38.1% of the preoperative level and that in the control group decreased to 20.0% of the preoperative level (p=0.000, Z=-3.547). On the third postoperative day, the PTH level in 74% of the patients in the NIRAF group recovered to normal levels, whereas it recovered in only 38% of the patients in the control group (p=0.000, χ2 = 13.149). The PTH levels in all patients in the NIRAF group had recovered within 30 days after surgery, whereas one patient in the control group failed to return to the normal level 6 months after surgery and was diagnosed with permanent parathyroidism. CONCLUSIONS The step-by-step NIRAF parathyroid identification method can effectively locate the parathyroid gland and protect its function.
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20
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Han YS, Kim Y, Lee HS, Kim Y, Ahn YC, Lee KD. Detectable depth of unexposed parathyroid glands using near-infrared autofluorescence imaging in thyroid surgery. Front Endocrinol (Lausanne) 2023; 14:1170751. [PMID: 37113485 PMCID: PMC10126413 DOI: 10.3389/fendo.2023.1170751] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background Near-infrared light can penetrate the fat or connective tissues overlying the parathyroid gland (PG), enabling early localization of the PG by near-infrared autofluorescence (NIRAF) imaging. However, the depth at which the PG can be detected has not been reported. In this study, we investigated the detectable depth of unexposed PGs using NIRAF during thyroidectomy. Materials and methods Fifty-one unexposed PGs from 30 consecutive thyroidectomy patients, mapped by an experienced surgeon (K.D. Lee) with the use of NIRAF imaging, were included. For NIRAF detection of PGs, a lab-built camera imaging system was used. Detectable depths of the unexposed PGs were measured using a Vernier caliper. The NIRAF images were classified as faint or bright depending on whether a novice could successfully interpret the image as showing the PG. Data on variables that may affect detectable depth and NIRAF intensity were collected. Results Detectable depth ranged between 0.35 and 3.05 mm, with a mean of 1.23 ± 0.73 mm. The average NIRAF intensity of unexposed PGs was 3.13 au. After dissection of the overlying tissue, the intensity of the exposed PG increased to 4.88 au (p < 0.001). No difference in NIRAF intensity between fat-covered (3.27 ± 0.90 au) and connective tissue-covered PGs (3.00 ± 1.23 au) was observed (p = 0.369). PGs covered by fat tissue (depth: 1.77 ± 0.67 mm) were found at deeper locations than those covered by connective tissue (depth: 0.70 ± 0.21 mm) (p < 0.001). The brightness of images of the faint group (2.14 ± 0.48 au) was on average 1.24 au lower than that of the bright group (3.38 ± 1.04 au) (p = 0.001). A novice successfully localized 80.4% of the unexposed PGs. Other variables did not significantly affect detectable depth. Conclusion Unexposed PGs could be mapped using NIRAF imaging at a maximum depth of 3.05 mm and an average depth of 1.23 mm. A novice was able to localize the PGs before they were visible to the naked eye at a high rate. These results can be used as reference data for localization of unexposed PGs in thyroid surgery.
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Affiliation(s)
- Young Seok Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Yikeun Kim
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, Republic of Korea
| | - Hyoung Shin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Yeongjoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Yeh-Chan Ahn
- Department of Biomedical Engineering and Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
- *Correspondence: Kang Dae Lee, ; Yeh-Chan Ahn,
| | - Kang Dae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
- *Correspondence: Kang Dae Lee, ; Yeh-Chan Ahn,
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21
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Martinez J, Zafereo M. Parathyroid Autofluorescence During Thyroid Surgery: Utility and Limitations. VideoEndocrinology 2022. [DOI: 10.1089/ve.2022.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Julian Martinez
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
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22
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Morales-Conde S, Licardie E, Alarcón I, Balla A. Indocyanine green (ICG) fluorescence guide for the use and indications in general surgery: recommendations based on the descriptive review of the literature and the analysis of experience. Cir Esp 2022; 100:534-554. [PMID: 35700889 DOI: 10.1016/j.cireng.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/26/2021] [Indexed: 06/15/2023]
Abstract
Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery. The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain.
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy.
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23
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Kim Y, Lee HC, Kim J, Oh E, Yoo J, Ning B, Lee SY, Ali KM, Tufano RP, Russell JO, Cha J. A coaxial excitation, dual-red-green-blue/near-infrared paired imaging system toward computer-aided detection of parathyroid glands in situ and ex vivo. JOURNAL OF BIOPHOTONICS 2022; 15:e202200008. [PMID: 35340114 PMCID: PMC9357067 DOI: 10.1002/jbio.202200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
Early and precise detection of parathyroid glands (PGs) is a challenging problem in thyroidectomy due to their small size and similar appearance to surrounding tissues. Near-infrared autofluorescence (NIRAF) has stimulated interest as a method to localize PGs. However, high incidence of false positives for PGs has been reported with this technique. We introduce a prototype equipped with a coaxial excitation light (785 nm) and a dual-sensor to address the issue of false positives with the NIRAF technique. We test the clinical feasibility of our prototype in situ and ex vivo using sterile drapes on 10 human subjects. Video data (1287 images) of detected PGs were collected to train, validate and compare the performance for PG detection. We achieved a mean average precision of 94.7% and a 19.5-millisecond processing time/detection. This feasibility study supports the effectiveness of the optical design and may open new doors for a deep learning-based PG detection method.
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Affiliation(s)
- Yoseph Kim
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St. Baltimore, MD 21218, USA
- Optosurgical, LLC, 11076 Birchtree Ln., Laurel, MD 20723, USA
- These authors contributed equally to this work
| | - Hun Chan Lee
- Department of Mechanical Engineering, Boston University, 44 Cummington Mall, Boston, MA 0221571, USA
- These authors contributed equally to this work
| | - Jongchan Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
- These authors contributed equally to this work
| | - Eugene Oh
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St. Baltimore, MD 21218, USA
- Optosurgical, LLC, 11076 Birchtree Ln., Laurel, MD 20723, USA
| | - Jennifer Yoo
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Bo Ning
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Seung Yup Lee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr. NE, Atlanta, GA 30322 USA
- Department of Electrical and Computer Engineering, Kennesaw State University, 840 Polytechnic Lane, Marietta, GA 30060, USA
| | - Khalid Mohamed Ali
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287, USA
| | - Ralph P. Tufano
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287, USA
| | - Jonathon O. Russell
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287, USA
| | - Jaepyeong Cha
- Optosurgical, LLC, 11076 Birchtree Ln., Laurel, MD 20723, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, 2300 Eye St. NW, Washington, DC 20052, USA
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24
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Wolf HW, Runkel N, Limberger K, Nebiker CA. Near-infrared autofluorescence of the parathyroid glands during thyroidectomy for the prevention of hypoparathyroidism: a prospective randomized clinical trial. Langenbecks Arch Surg 2022; 407:3031-3038. [PMID: 35904639 PMCID: PMC9640439 DOI: 10.1007/s00423-022-02624-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Abstract
Purpose Postoperative hypoparathyroidism remains the most often complication in thyroid surgery. Near-infrared autofluorescence (NIR-AF) is a modality to identify parathyroid glands (PG) in vivo with high accuracy, but its use in daily routine surgery is unclear so far. In this randomized controlled trial, we evaluate the ability of NIR-AF to prevent postoperative hypoparathyroidism following total thyroidectomy. Methods Patients undergoing total thyroidectomy were allocated in two groups with the use of NIR-AF in the intervention group or according to standard practice in the control group. The aim was to identify the PGs in an early most stage of the operation to prevent their devascularization or removal. Parathyroid hormone was measured pre- and postoperatively and on postoperative day (POD) 1. Serum calcium was measured on POD 1 and 2. Possible symptoms and calcium/calcitriol supplement were recorded. Results A total of 60 patients were randomized, of whom 30 underwent NIR-AF-based PG identification. Hypoparathyroidism at skin closure occurred in 7 out of 30 patients using NIR-AF, respectively, in 14 out of 30 patients in the control group (p=0.058). There was no significant difference in serum calcium and parathyroid hormone levels between both groups. Likewise, NIR-AF could not detect PGs at a higher rate. Conclusion The use of NIR-AF may help surgeons identify and preserve PGs but did not significantly reduce the incidence of postoperative hypoparathyroidism in this trial. Larger case series have to clarify whether there is a benefit in routine thyroidectomy. Trial registration number DRKS00009242 (German Clinical Trial Register). Registration date: 03.09.2015
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Affiliation(s)
- Henning Wendelin Wolf
- Schwarzwald-Baar Klinikum Villingen-Schwenningen, Klinikstrasse 11, 78052, Villingen-Schwenningen, Germany. .,Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Norbert Runkel
- Schwarzwald-Baar Klinikum Villingen-Schwenningen, Klinikstrasse 11, 78052, Villingen-Schwenningen, Germany.,AMEOS Spital Einsiedeln, Spitalstrasse 28, 8840, Einsiedeln, Switzerland
| | - Kathrin Limberger
- Schwarzwald-Baar Klinikum Villingen-Schwenningen, Klinikstrasse 11, 78052, Villingen-Schwenningen, Germany
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25
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Lu W, Chen Q, Zhang P, Su A, Zhu J. Near-Infrared Autofluorescence Imaging in Thyroid Surgery: A Systematic Review and Meta-Analysis. J INVEST SURG 2022; 35:1723-1732. [PMID: 35786292 DOI: 10.1080/08941939.2022.2095468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This meta-analysis aimed to assess the position of near-infrared autofluorescence (NIRAF) imaging in the recognition and protection of the parathyroid gland (PG) during thyroidectomy. METHODS The PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were searched up to June 2021. The primary outcome was to evaluate the rates of postoperative hypocalcemia, inadvertent PG resection, and autotransplantation of PG when adopting NIRAF imaging compared with standard naked-eye (N-E) surgery. RESULTS Eight studies with 2,889 patients were enrolled in the analysis. Our analysis showed that the incidence of transient hypocalcemia was 7.11% (60/844) in the NIRAF group and 22.40% (458/2045) in the N-E group (p < 0.0001) and the rate of transient hypoparathyroidism was 28.31% (126/445) and 33.36% (496/1487) in the NIRAF and N-E groups (p = 0.0008). The rate of inadvertent resection of PGs was 7.65% (55/719) in the NIRAF group and 14.39% (132/917) in the N-E group (p < 0.0001). No significant difference was observed in other indexes including the pooled proportion of permanent hypocalcemia and rate of PG autotransplantation. CONCLUSIONS The application of NIRAF imaging in thyroidectomy can help lower the incidence of inadvertent PG resection and reduce the risk of postoperative hypocalcemia and hypoparathyroidism compared with N-E recognition.
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Affiliation(s)
- Wei Lu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Qiang Chen
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Pei Zhang
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
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26
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Sahyouni G, Osterbauer B, Park S, Paik C, Austin J, Kwon D, Gomez G. Incidence of thymic tissue in pediatric thyroidectomy. Int J Pediatr Otorhinolaryngol 2022; 158:111168. [PMID: 35544968 DOI: 10.1016/j.ijporl.2022.111168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/30/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The nuances in the technical approach to pediatric thyroidectomy have been sparsely reported in the literature. No previous studies have reported on the rates of unintentional thymic tissue excision during pediatric thyroidectomy. In this study, we sought to describe the rates of thymic tissue excision noted on surgical specimens from pediatric thyroidectomies and investigate any correlations with preoperative factors and long-term outcomes. METHODS A retrospective chart review was conducted of patients who underwent thyroidectomy at a tertiary care children's hospital between January 2010 and October 2020. Presence of thymic tissue (PTT) was defined as any pathologist-documented evidence of thymic tissue in the surgical specimen. Patient characteristics, operative details, and disease related datapoints were investigated for any correlation with PTT. RESULTS Of the 209 patients who underwent thyroidectomy in the study period, 53 (25%) had PTT. After conducting a stepwise multivariate analysis, those with a concomitant central neck dissection had 3.3 times the odds of having PTT as compared to those with no neck dissection (p = 0.013, 95%CI: 1.3, 8.3). Additionally, patients with evidence of incidental parathyroidectomy had 8.99 times the odds of also having PTT as compared to those without IPE (p < 0.001, 95%CI: 4.0, 20.1). CONCLUSION This is the first report analyzing the rate of thymic tissue excision during pediatric thyroidectomy. Thyroid surgeons should be prepared to encounter thymic tissue during pediatric cases and be aware of its associated risk of incidental parathyroid gland excision and dissection of tissue beyond intended surgical limits.
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Affiliation(s)
- Grace Sahyouni
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.
| | - Beth Osterbauer
- Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd. MS#58, Los Angeles, CA, 90027, USA.
| | - Soyun Park
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.
| | - Connie Paik
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.
| | - Juliana Austin
- Children's Hospital Los Angeles, Department of Endocrinology, Diabetes and Metabolism, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
| | - Daniel Kwon
- Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd. MS#58, Los Angeles, CA, 90027, USA; Department of Otolaryngology - Head and Neck Surgery, University of Southern California, 9033 Wilshire Blvd #305, Beverly Hills, CA, 90211, USA.
| | - Gabriel Gomez
- Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd. MS#58, Los Angeles, CA, 90027, USA; Department of Otolaryngology - Head and Neck Surgery, University of Southern California, 9033 Wilshire Blvd #305, Beverly Hills, CA, 90211, USA.
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27
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Zheng W, Liu C, Jin J, Sun W, Zhao J, Zhao M, Yao S, Zhu B, Chen F, Shang J, Wang K, Guo P, Qin J, Cheng X. Biodegradable iron oxide nanoparticles for intraoperative parathyroid gland imaging in thyroidectomy. PNAS NEXUS 2022; 1:pgac087. [PMID: 36741464 PMCID: PMC9896913 DOI: 10.1093/pnasnexus/pgac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/08/2022] [Indexed: 02/07/2023]
Abstract
Parathyroid gland (PG) injury is the most common complication of thyroidectomy owing to the lack of approaches for surgeons to effectively distinguish PGs from surrounding thyroid glands (TGs) in the operation room. Herein, we report the development of biodegradable iron oxide nanoparticles (IONPs) as a promising contrast agent candidate for intraoperative PG visualization. We elucidated that locally administrated dark-colored IONPs readily diffuse in TGs but cannot infiltrate tissue-dense PGs, yielding a distinguishable contrast enhancement between PGs and TGs by naked eye observation. We performed unbiased and quantitative in vivo screenings to optimize particle size and concentration of IONPs for PG/TG contrast enhancement. Moreover, in vivo applications of IONPs via the local administration route demonstrate no adverse toxicities and can be biodegraded in the thyroid microenvironment within 3 months. To our knowledge, these promising findings provide the first in vivo evidence that IONPs can serve as a safe, biodegradable, and effective contrast agent candidate for improving PG visualization in thyroidectomy.
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Affiliation(s)
- Weihui Zheng
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
- The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Chun Liu
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Jiaoyue Jin
- The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Wei Sun
- The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Jianqiang Zhao
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
- The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Ming Zhao
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
- The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Shili Yao
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Bing Zhu
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Fan Chen
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Jinbiao Shang
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
- The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Kejing Wang
- Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
- The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Peng Guo
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Jiangjiang Qin
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Xiangdong Cheng
- The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
- Key Laboratory of Prevention, Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
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Qian B, Zhang X, Bing K, Hu L, Qu X, Huang T, Shi W, Zhang S. Real-time intraoperative near-infrared autofluorescence imaging to locate the parathyroid glands: A preliminary report. Biosci Trends 2022; 16:301-306. [PMID: 35768258 DOI: 10.5582/bst.2022.01256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Identification and localization of parathyroid glands (PGs) remains a challenge for surgeons. The aim of this study was to evaluate the efficiency of intraoperative near-infrared autofluorescence (NIRAF) imaging to detect PGs in thyroid and parathyroid diseases. Seventy-six patients undergoing surgery for thyroid or parathyroid diseases between July 9, 2020 and August 20, 2021 were retrospectively analyzed. Intraoperative carbon nanoparticle (CN) negative imaging and handheld NIRAF imaging were successively performed for each patient. Of 206 PGs that needed to be identified for surgery, 162 were identified by NIRAF imaging, with a theoretical rate of identification of 78.64%. This was higher than the rate of identification with CN negative imaging, which was 75.73%. The number of PGs identified by NIRAF imaging and CN negative imaging did not differ significantly in either total thyroidectomy or thyroid lobectomy. In addition, the autofluorescence (AF) intensity of secondary parathyroid adenoma was weaker than that of normal PGs. NIRAF imaging is potentially a more efficient tool for identification of PGs than CN negative imaging, with a shorter learning curve and lower risk. It may not be well-suited to secondary hyperthyroidism or adenoma, but it was more efficient at identifying excised specimens than visual identification by a surgeon.
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Affiliation(s)
- Bei Qian
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ximeng Zhang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kaijian Bing
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Longqing Hu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xincai Qu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Huang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Shi
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shoupeng Zhang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Wang B, Zheng J, Yu JF, Lin SY, Yan SY, Zhang LY, Wang SS, Cai SJ, Abdelhamid Ahmed AH, Lin LQ, Chen F, Randolph GW, Zhao WX. Development of Artificial Intelligence for Parathyroid Recognition During Endoscopic Thyroid Surgery. Laryngoscope 2022; 132:2516-2523. [PMID: 35638245 DOI: 10.1002/lary.30173] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/24/2022] [Accepted: 04/13/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to establish an artificial intelligence (AI) model to identify parathyroid glands during endoscopic approaches and compare it with senior and junior surgeons' visual estimation. METHODS A total of 1,700 images of parathyroid glands from 166 endoscopic thyroidectomy videos were labeled. Data from 20 additional full-length videos were used as an independent external cohort. The YOLO V3, Faster R-CNN, and Cascade algorithms were used for deep learning, and the optimal algorithm was selected for independent external cohort analysis. Finally, the identification rate, initial recognition time, and tracking periods of PTAIR (Artificial Intelligence model for Parathyroid gland Recognition), junior surgeons, and senior surgeons were compared. RESULTS The Faster R-CNN algorithm showed the best balance after optimizing the hyperparameters of each algorithm and was updated as PTAIR. The precision, recall rate, and F1 score of the PTAIR were 88.7%, 92.3%, and 90.5%, respectively. In the independent external cohort, the parathyroid identification rates of PTAIR, senior surgeons, and junior surgeons were 96.9%, 87.5%, and 71.9%, respectively. In addition, PTAIR recognized parathyroid glands 3.83 s ahead of the senior surgeons (p = 0.008), with a tracking period 62.82 s longer than the senior surgeons (p = 0.006). CONCLUSIONS PTAIR can achieve earlier identification and full-time tracing under a particular training strategy. The identification rate of PTAIR is higher than that of junior surgeons and similar to that of senior surgeons. Such systems may have utility in improving surgical outcomes and also in accelerating the education of junior surgeons. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Bo Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Jing Zheng
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.,Department of Thyroid Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jia-Fan Yu
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Si-Ying Lin
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Shou-Yi Yan
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Li-Yong Zhang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Si-Si Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Shao-Jun Cai
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Amr H Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Lan-Qin Lin
- Department of Operation, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Fei Chen
- College of Computer and Data Science, Fuzhou University, Fuzhou, Fujian, China
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wen-Xin Zhao
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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郭 飞, 耿 胜, 张 静. [Research progress of autofluorescence imaging of parathyroid glands]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:397-401. [PMID: 35483695 PMCID: PMC10128258 DOI: 10.13201/j.issn.2096-7993.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Indexed: 06/14/2023]
Abstract
The main causes of hypoparathyroidism are unintentional parathyroidectomy and/or impaired blood supply. Therefore, accurate identification and preservation of parathyroid glands in situ during thyroid or parathyroid surgery has become one of the problems that plague endocrine surgeons. In recent years, near-infrared autofluorescence imaging technology has gradually attracted more and more attention from surgeons because of its simplicity, safety, accuracy, real-time, no-contrast agent, and non-invasiveness. This article reviews the development history, clinical application, and application prospects of the parathyroid gland autofluorescence imaging technology in recent years.
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Affiliation(s)
- 飞跃 郭
- 河北省人民医院腺体外科(石家庄,050001)Department of Glandular Surgery, Hebei General Hospital, Shijiazhuang, 050051, China
| | - 胜杰 耿
- 河北医科大学研究生学院Graduate School of Hebei Medical University
| | - 静 张
- 河北省人民医院腺体外科(石家庄,050001)Department of Glandular Surgery, Hebei General Hospital, Shijiazhuang, 050051, China
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Avci SN, Isiktas G, Ergun O, Berber E. A visual deep learning model to predict abnormal versus normal parathyroid glands using intraoperative autofluorescence signals. J Surg Oncol 2022; 126:263-267. [PMID: 35416299 DOI: 10.1002/jso.26884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous work demonstrated that abnormal versus normal parathyroid glands (PGs) exhibit different patterns of autofluorescence, with former appearing darker and more heterogenous. Our objective was to develop a visual artificial intelligence model using intraoperative autofluorescence signals to predict whether a PG is abnormal (hypersecreting and/or hypercellular) or normal before excision during surgical exploration for primary hyperparathyroidism. METHODS A total of 906 intraoperative parathyroid autofluorescence images of 303 patients undergoing parathyroidectomy/thyroidectomy were used to develop model. Autofluorescence image of each PG was uploaded into the visual artificial intelligence platform as abnormal or normal. For deep learning, randomly chosen 80% of data was used for training, 10% for testing, 10% for validation. The area under the receiver operating characteristic (AUROC), area under the precision-recall curve (AUPRC), recall (sensitivity), and precision (positive predictive value) of the model were calculated. RESULTS AUROC and AUPRC of the model to predict normal and abnormal PGs were 0.90 and 0.93, respectively. Recall and precision of the model were 89% each. CONCLUSION Visual artificial intelligence platforms may be used to compare the autofluorescence signal of a given parathyroid gland against a large database. This may be a new adjunctive tool for intraoperative assessment of parathyroid glands during surgical exploration for primary hyperparathyroidism.
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Affiliation(s)
- Seyma N Avci
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gizem Isiktas
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Onuralp Ergun
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Guo F, Xu L, Zhang J. Use of Near-Infrared Autofluorescence Imaging During Thyroidectomy Associated with Improved Clinical Outcomes. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03375-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Avci SN, Isiktas G, Berber E. A Visual Deep Learning Model to Localize Parathyroid-Specific Autofluorescence on Near-Infrared Imaging : Localization of Parathyroid Autofluorescence with Deep Learning. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11632-y. [PMID: 35348975 DOI: 10.1245/s10434-022-11632-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/26/2022] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE Parathyroid glands may be detected by their autofluorescence on near-infrared imaging. Nevertheless, recognition of parathyroid-specific autofluorescence requires a learning curve, with other unrelated bright signals causing confusion. The aim of this study was to find out whether machine learning could be used to facilitate identification of parathyroid-specific autofluorescence signals on intraoperative near-infrared images in patients undergoing thyroidectomy and parathyroidectomy procedures. METHODS In an institutional review board-approved study, intraoperative near-infrared images of patients who underwent thyroidectomy and/or parathyroidectomy procedures within a year were used to develop an artificial intelligence model. Parathyroid-specific autofluorescence signals were marked with rectangles on intraoperative near-infrared still images and used for training a deep learning model. A randomly chosen 80% of the data were used for training, 10% for testing, and 10% for validation. Precision and recall of the model were calculated. RESULTS A total of 466 intraoperative near-infrared images of 197 patients who underwent thyroidectomy and/or parathyroidectomy procedures were analyzed. Procedures included total thyroidectomy in 54 patients, thyroid lobectomy in 24 patients, parathyroidectomy in 108 patients, and combined thyroidectomy and parathyroidectomy procedures in 11 patients. The overall recall and precision of the model were 90.5 and 95.7%, respectively. CONCLUSIONS To our knowledge, this is the first study that describes the use of artificial intelligence tools to assist in recognition of parathyroid-specific autofluorescence signals on near-infrared imaging. The model developed may have utility in facilitating training and decreasing the learning curve associated with the use of this technology.
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Affiliation(s)
- Seyma Nazli Avci
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gizem Isiktas
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
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Noureldine SI, Nazli Avci S, Isiktas G, Ergun O, Elshamy M, Berber E. Detection of near-infrared autofluorescence from adrenal neoplasms: An initial experience. J Surg Oncol 2022; 126:257-262. [PMID: 35319103 DOI: 10.1002/jso.26863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/11/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Fluorescence from adrenal tumors can be detected with near-infrared imaging after injection with indocyanine green. However, it is unknown if adrenal tumors exhibit autofluorescence. The aim of this study was to determine whether adrenal tumors emit near-infrared autofluorescence (NIRAF). METHODS This was a prospective study of patients who underwent minimally invasive adrenalectomy at a tertiary center. Intraoperative images were analyzed to detect NIRAF with a 750 nm camera. Descriptive and comparative statistical analyses were performed. RESULTS Twenty-five adrenalectomies were examined. Only 11 tumors (44%), that originated from the cortex exhibited autofluorescence. A contrast distinction between the tumor and retroperitoneum was observed in 23 patients, whereas a contrast distinction between the tumor and normal adrenocortical tissue was seen in 12 patients. The overall fluorescence intensity of adrenal tumors was found to be variable and ranging between 0.3 and 5.6 times that of the background tissue. Pheochromocytoma, malignancy and adrenal cyst did not demonstrate NIRAF. CONCLUSION This is the first study to show that adrenocortical tissue can demonstrate NIRAF. The pattern of fluorescence was similar to that observed after indocyanine green injection in our historical experience. NIRAF has a potential to be used as an intraoperative optical adjunct during adrenalectomy.
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Affiliation(s)
- Salem I Noureldine
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Seyma Nazli Avci
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gizem Isiktas
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Onuralp Ergun
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohammed Elshamy
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eren Berber
- Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Heterogeneity in Utilization of Optical Imaging Guided Surgery for Identifying or Preserving the Parathyroid Glands—A Meta-Narrative Review. Life (Basel) 2022; 12:life12030388. [PMID: 35330139 PMCID: PMC8955594 DOI: 10.3390/life12030388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Postoperative hypoparathyroidism is the most common complication after total thyroidectomy. Over the past years, optical imaging techniques, such as parathyroid autofluorescence, indocyanine green (ICG) angiography, and laser speckle contrast imaging (LSCI) have been employed to save parathyroid glands during thyroid surgery. This study provides an overview of the utilized methods of the optical imaging techniques during total thyroidectomy for parathyroid gland identification and preservation. Methods: PUBMED, EMBASE and Web of Science were searched for studies written in the English language utilizing parathyroid autofluorescence, ICG-angiography, or LSCI during total thyroidectomy to support parathyroid gland identification or preservation. Case reports, reviews, meta-analyses, animal studies, and post-mortem studies were excluded after the title and abstract screening. The data of the studies were analyzed qualitatively, with a focus on the methodologies employed. Results: In total, 59 articles were included with a total of 6190 patients. Overall, 38 studies reported using parathyroid autofluorescence, 24 using ICG-angiography, and 2 using LSCI. The heterogeneity between the utilized methodology in the studies was large, and in particular, regarding study protocols, imaging techniques, and the standardization of the imaging protocol. Conclusion: The diverse application of optical imaging techniques and a lack of standardization and quantification leads to heterogeneous conclusions regarding their clinical value. Worldwide consensus on imaging protocols is needed to establish the clinical utility of these techniques for parathyroid gland identification and preservation.
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Oh E, Lee HC, Kim Y, Ning B, Lee SY, Cha J, Kim WW. A pilot feasibility study to assess vascularity and perfusion of parathyroid glands using a portable hand-held imager. Lasers Surg Med 2022; 54:399-406. [PMID: 34481419 PMCID: PMC8894507 DOI: 10.1002/lsm.23478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/06/2021] [Accepted: 08/21/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Intraoperative localization and preservation of parathyroid glands (PGs) are challenging during thyroid surgery. A new noninvasive technique of combined near-infrared PG autofluorescence detection and dye-free imaging angiography that allows intraoperative feedback has recently been introduced. The objective of this study was to evaluate this technique in real-time. MATERIALS AND METHODS A pilot feasibility study of a portable imaging device in four patients who underwent either thyroid lobectomy or total thyroidectomy is presented. PG autofluorescence and vascularity/tissue perfusion were monitored using a real-time screen display during the surgical procedure. RESULTS Three lobectomies and one total thyroidectomy were performed. Among the nine PGs identified by the operating surgeon, eight PGs were confirmed using the autofluorescence device. Each PG was successfully determined to be either well-perfused or devascularized, and devascularized PGs were autotransplanted. CONCLUSIONS The preliminary results suggest that the combination of PG autofluorescence detection and dye-free angiography can potentially be used to assess PG function. With further validation studies, the effectiveness of this technique in clinical practice can be further delineated.
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Affiliation(s)
- Eugene Oh
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21212 USA,Sheikh Zayed Surgical Institute, Children’s National Hospital, 111 Michigan Ave., NW Washington, DC 20010, USA
| | - Hun Chan Lee
- Dept. of Mechanical Engineering, Boston University, 110 Cummington Mall Boston, MA 02215 USA
| | - Yoseph Kim
- Department of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21212 USA
| | - Bo Ning
- Sheikh Zayed Surgical Institute, Children’s National Hospital, 111 Michigan Ave., NW Washington, DC 20010, USA
| | - Seung Yup Lee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 1760 Haygood Dr. NE, Atlanta, GA 30322 USA,Department of Electrical and Computer Engineering, Kennesaw State University, 840 Polytechnic Lane, Marietta, GA 30060, USA
| | - Jaepyeong Cha
- Sheikh Zayed Surgical Institute, Children’s National Hospital, 111 Michigan Ave., NW Washington, DC 20010, USA,George Washington University School of Medicine and Health Sciences, Department of Pediatrics, Washington DC, USA,Corresponding authors: Jaepyeong Cha, PhD, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, or , Tel: 202-476-6426; Wan Wook Kim, MD PhD, Department of Surgery, Kyungpook National University School of Medicine, 807 Hogukno, Buk-gu, Daegu 41404, South Korea, , Tel: 82-53-200-2705, Fax: 82-53-200-2027
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro Buk-gu, Daegu, South Korea, 41404,Corresponding authors: Jaepyeong Cha, PhD, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, or , Tel: 202-476-6426; Wan Wook Kim, MD PhD, Department of Surgery, Kyungpook National University School of Medicine, 807 Hogukno, Buk-gu, Daegu 41404, South Korea, , Tel: 82-53-200-2705, Fax: 82-53-200-2027
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Dip F, Bregoli P, Falco J, White KP, Rosenthal RJ. Nerve autofluorescence in near-ultraviolet light markedly enhances nerve visualization in vivo. Surg Endosc 2022; 36:1999-2005. [PMID: 33835251 DOI: 10.1007/s00464-021-08484-0/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/28/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND During surgery, surgeons must accurately localize nerves to avoid injuring them. Recently, we have discovered that nerves fluoresce in near-ultraviolet light (NUV) light. The aims of the current study were to determine the extent to which nerves fluoresce more brightly than background and vascular structures in NUV light, and identify the NUV intensity at which nerves are most distinguishable from other tissues. METHODS We exposed sciatic nerves within the posterior thigh in five 250-300 gm Wistar rats, then observed them at four different NUV intensity levels: 20%, 35%, 50%, and 100%. Brightness of fluorescence was measured by fluorescence spectroscopy, quantified as a fluorescence score using Image-J software, and statistically compared between nerves, background, and both an artery and vein by unpaired Student's t tests with Bonferroni adjustment to accommodate multiple comparisons. Sensitivity, specificity, and accuracy were calculated for each NUV intensity. RESULTS At 20, 35, 50, and 100% NUV intensity, fluorescence scores for nerves versus background tissues were 117.4 versus 40.0, 225.8 versus 88.0, 250.6 versus 121.4, and 252.8 versus 169.4, respectively (all p < 0.001). Fluorescence scores plateaued at 50% NUV intensity for nerves, but continued to rise for background. At 35%, 50%, and 100% NUV intensity, a fluorescence score of 200 was 100% sensitive, specific, and accurate identifying nerves. At 100 NUV intensity, artery and vein scores were 61.8 and 60.0, both dramatically lower than for nerves (p < 0.001). CONCLUSIONS At all NUV intensities ≥ 35%, a fluorescence score of 200 is 100% accurate distinguishing nerves from other anatomical structures in vivo.
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Affiliation(s)
- Fernando Dip
- Instituto Argentino de Diagnóstico y Tratamiento, Universidad de Buenos Aires, Buenos Aires, Argentina
- Cleveland Clinic Florida, Weston, FL, 33325, USA
| | - Pedro Bregoli
- Instituto Argentino de Diagnóstico y Tratamiento, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jorge Falco
- Instituto Argentino de Diagnóstico y Tratamiento, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Kevin P White
- ScienceRight Research Consulting, London, ON, Canada
| | - Raúl J Rosenthal
- Cleveland Clinic Florida, Weston, FL, 33325, USA.
- Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
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Guía de uso e indicaciones de la fluorescencia con verde de indocianina (ICG) en cirugía general: recomendaciones basadas en la revisión descriptiva de la literatura y el análisis de la experiencia. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Bollerslev J, Rejnmark L, Zahn A, Heck A, Appelman-Dijkstra NM, Cardoso L, Hannan FM, Cetani F, Sikjaer T, Formenti AM, Björnsdottir S, Schalin-Jäntti C, Belaya Z, Gibb F, Lapauw B, Amrein K, Wicke C, Grasemann C, Krebs M, Ryhänen E, Makay Ö, Minisola S, Gaujoux S, Bertocchio JP, Hassan-Smith Z, Linglart A, Winter EM, Kollmann M, Zmierczak HG, Tsourdi E, Pilz S, Siggelkow H, Gittoes N, Marcocci C, Kamenický P. European Expert Consensus on Practical Management of Specific Aspects of Parathyroid Disorders in Adults and in Pregnancy: Recommendations of the ESE Educational Program of Parathyroid Disorders. Eur J Endocrinol 2022; 186:R33-R63. [PMID: 34863037 PMCID: PMC8789028 DOI: 10.1530/eje-21-1044] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
This European expert consensus statement provides recommendations for the diagnosis and management of primary hyperparathyroidism (PHPT), chronic hypoparathyroidism in adults (HypoPT), and parathyroid disorders in relation to pregnancy and lactation. Specified areas of interest and unmet needs identified by experts at the second ESE Educational Program of Parathyroid Disorders (PARAT) in 2019, were discussed during two virtual workshops in 2021, and subsequently developed by working groups with interest in the specified areas. PHPT is a common endocrine disease. However, its differential diagnosing to familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represent areas of uncertainty requiring clarifications. HypoPT is an orphan disease characterized by low calcium concentrations due to insufficient PTH secretion, most often secondary to neck surgery. Prevention and prediction of surgical injury to the parathyroid glands are essential to limit the disease-related burden. Long-term treatment modalities including the place for PTH replacement therapy and the optimal biochemical monitoring and imaging surveillance for complications to treatment in chronic HypoPT, need to be refined. The physiological changes in calcium metabolism occurring during pregnancy and lactation modify the clinical presentation and management of parathyroid disorders in these periods of life. Modern interdisciplinary approaches to PHPT and HypoPT in pregnant and lactating women and their newborns children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed for a broader clinical audience, and were developed with focus on endocrinologists in training.
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Affiliation(s)
- Jens Bollerslev
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Specialized Endocrinology, Department of Endocrinology, Medical Clinic, Oslo University Hospital, Oslo, Norway
- Correspondence should be addressed to J Bollerslev Email
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Alexandra Zahn
- Schön-Klinik Hamburg, Department of Endocrine Surgery, Hamburg, Germany
| | - Ansgar Heck
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Specialized Endocrinology, Department of Endocrinology, Medical Clinic, Oslo University Hospital, Oslo, Norway
| | - Natasha M Appelman-Dijkstra
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Luis Cardoso
- Centro Hospitalar e Universitário de Coimbra, i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Fadil M Hannan
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Filomena Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sigridur Björnsdottir
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Zhanna Belaya
- The National Medical Research Centre for Endocrinology, Moscow, Russia
| | - Fraser Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Corinna Wicke
- Thyroid Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Corinna Grasemann
- Division of Rare Diseases, Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Eeva Ryhänen
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Özer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Rome, Italy
| | - Sébastien Gaujoux
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - Jean-Philippe Bertocchio
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nephrology Department, Boulevard de l’Hôpital, Paris, France
| | - Zaki Hassan-Smith
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Agnès Linglart
- Université de Paris Saclay, AP-HP, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Filière OSCAR, Service d’Endocrinologie et Diabète de l’Enfant, Hôpital Bicêtre Paris Saclay, Le Kremlin Bicêtre, France
| | - Elizabeth M Winter
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Martina Kollmann
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Hans-Georg Zmierczak
- Reference Centre for Rare Bone, Calcium and Phosphate Disorders – University Hospital Ghent, Ghent, Belgium
| | - Elena Tsourdi
- Center for Healthy Aging, Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Heide Siggelkow
- Endokrinologikum Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Neil Gittoes
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Peter Kamenický
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Le Kremlin-Bicêtre, France
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Berber E, Akbulut S, Avci S, Isiktas G. Comparison of Parathyroid Autofluorescence Signals in Different Types of Hyperparathyroidism. World J Surg 2022; 46:807-812. [PMID: 35006327 DOI: 10.1007/s00268-021-06422-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are scant data in the literature regarding whether parathyroid autofluorescence (AF) signal patterns vary based on the etiology of hyperparathyroidism. The aim of this study was to compare AF signals of parathyroid glands across different etiologies of hyperparathyroidism. METHODS As a prospective institutional review board-approved study between 2016 and 2019, AF intensities and heterogeneity indexes (HIs) of parathyroid glands in patients who underwent parathyroidectomy using AF were calculated and compared using Chi-square, Kruskal Wallis, Mann Whitney U, and logistic regression tests. RESULTS Of the total of 183 patients, 127 patients had sporadic classic primary hyperparathyroidism, 30 patients had sporadic normohormonal primary hyperparathyroidism, 10 patients had sporadic normocalcemic primary hyperparathyroidism, 12 patients had tertiary hyperparathyroidism, and 4 patients had familial primary hyperparathyroidism related to multiple endocrine neoplasia (MEN) 2A. There were no statistical differences in AF signals of abnormal parathyroid glands in classic, normohormonal or normocalcemic sporadic hyperparathyroidism. Parathyroid glands in patients with tertiary hyperparathyroidism were similar in intensity, but more homogenous compared to those in sporadic primary hyperparathyroidism. CONCLUSIONS The pattern of AF exhibited by abnormal parathyroid glands was similar across different spectrums of primary hyperparathyroidism, in accordance with observations in the literature. However, parathyroid glands in tertiary hyperparathyroidism were more homogeneous, despite exhibiting a similar intensity of AF compared to those in sporadic primary hyperparathyroidism. These differences should be kept in mind when using the AF pattern as an adjunct to visual assessment in parathyroid exploration.
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Affiliation(s)
- Eren Berber
- Departments of Endocrine, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA. .,General Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA.
| | - Serkan Akbulut
- Departments of Endocrine, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Seyma Avci
- Departments of Endocrine, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Gizem Isiktas
- Departments of Endocrine, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
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41
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Lo CY. Thyroidectomy for Papillary Thyroid Carcinoma. Methods Mol Biol 2022; 2534:39-56. [PMID: 35670967 DOI: 10.1007/978-1-0716-2505-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Papillary thyroid carcinoma is the most common endocrine malignancy and accounts for the overwhelming majority of thyroid carcinoma. This recent dramatic increase in incidence is almost exclusively attributed to the incidental detection of small papillary thyroid carcinoma or microcarcinoma. Surgical management of thyroid carcinoma has been evolving to avoid overtreating patients by adopting the appropriate risk-based approach including the recommendation of hemithyroidectomy for low-risk carcinoma, the avoidance of routine prophylactic central nodal dissections, a higher threshold in using postoperative radioiodine ablation after total thyroidectomy, and the active observation or surveillance of papillary microcarcinoma as a viable alternative option instead of immediate surgical treatment.
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Affiliation(s)
- Chung Yau Lo
- Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong.
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42
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Benmiloud F, Penaranda G, Chiche L, Rebaudet S. Intraoperative Mapping Angiograms of the Parathyroid Glands Using Indocyanine Green During Thyroid Surgery: Results of the Fluogreen Study. World J Surg 2021; 46:416-424. [PMID: 34743241 DOI: 10.1007/s00268-021-06353-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND During thyroid surgery, preservation of parathyroid gland (PG) feeding vessels is often impossible. The aim of the Fluogreen study was to determine the feasibility of using indocyanine green (ICG)-based intraoperative mapping angiograms of the PG (iMAP) to improve vascular preservation. STUDY DESIGN This prospective study enrolled all patients undergoing thyroid lobectomy or total thyroidectomy at the Hôpital Européen Marseille between September and December 2018. After exploring the thyroid lobe by autofluorescence to locate the PGs, ICG solution was injected intravenously to locate the PG feeding vessels and guide dissection. A second ICG injection was administered at the end of the lobectomy to assess perfusion of the PGs. The primary outcome was the quality of the angiogram, scaled as iMAP 0 (not informative), iMAP 1 (general vascular pattern visible but no clear vascular pedicle flowing into the PG), or iMAP 2 (clear vascular pedicle flowing into the PG). The secondary outcome was the PG perfusion score at the end of surgery, scaled from ICG 0 (no perfusion) to ICG 2 (intense uptake). RESULTS A total of 47 adult patients were analyzed, including 34 total thyroidectomies and 13 lobectomies. ICG angiography assessed 76 PGs, which were scored as iMAP 2 in 24 cases (31.6%), iMAP 1 in 46 (60.5%) and iMAP 0 in six (7.9%). At the end of dissection, the ICG perfusion score was significantly better for the PGs with informative angiography (iMAP 1 or 2), than for the PGs with uninformative angiography (iMAP 0), or the PGs not evaluated by vascular angiography (p < 0.05). CONCLUSION iMAP is feasible and provides direct vascular information in one-third of the cases. Further improvements to this technology are necessary, and the influence of this technique on patient outcomes during thyroidectomy will need to be further evaluated.
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Affiliation(s)
- Fares Benmiloud
- Endocrine Surgery Unit, Département de Chirurgie, Hôpital Européen de Marseille, 6 Rue Désirée Clary, 13003, Marseille, France.
| | | | - Laurent Chiche
- Internal Medicine and Infectious Diseases Unit, Hôpital Européen Marseille, Marseille, France
| | - Stanislas Rebaudet
- Internal Medicine and Infectious Diseases Unit, Hôpital Européen Marseille, Marseille, France
- Aix-Marseille University, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
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43
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Law RH, Larrabee KA, Van Harn M, Singer MC. Parathyroid Gland Autofluorescence Characteristics in Patients With Primary Hyperparathyroidism. Laryngoscope 2021; 132:715-721. [PMID: 34612528 DOI: 10.1002/lary.29880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/18/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Near-infrared imaging for intraoperative parathyroid gland (PG) detection has recently commanded significant attention. The PTeye (Medtronic, Minneapolis, MN) is a probe-based system for near-infrared autofluorescent evaluation of PGs. This study was designed to evaluate the capabilities of the PTeye in the setting of surgery for primary hyperparathyroidism. STUDY DESIGN Prospective, Cohort study. METHODS This single-institution, prospective cohort study included all patients undergoing parathyroidectomy for primary hyperparathyroidism with presumed single gland disease from June 2020 to December 2020. Absolute intensity and intensity ratios, with the thyroid as the control tissue, were obtained for the adenoma, ipsilateral normal PG, and adjacent tissue. The ability of the PTeye to function when not in direct contact with tissue was measured. RESULTS Twenty-two patients were included. The median intensity ratio for the in situ adenomas was 4.38 (interquartile range [IQR]: 2.03-5.87), ipsilateral normal PGs 6.17 (IQR: 3.83-7.67), strap muscle 0.47 (IQR: 0.30-0.60), and fat 0.20 (IQR: 0.17-0.47). All normal PGs and 21/22 adenomas demonstrated autofluorescence above the detection threshold. The PTeye functioned at a maximum distance of separation of 10 mm through saline medium and 6 mm through clear solid medium. CONCLUSION This study confirms the PTeye's ability to recognize PGs with a high degree of precision. The device was found to function properly even with the probe not in direct contact with the tissue. Although adenomatous PGs appear to demonstrate altered autofluorescent properties from normal PGs, additional research is required to determine if these differences are clinically useful. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Richard H Law
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Katherine A Larrabee
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Meredith Van Harn
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Michael C Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
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Wu Y, Liu Y, Huang T, Jiang Y, Wang H, He Z. Application of nanocarbon negative imaging technology in surgery for secondary hyperparathyroidism. Gland Surg 2021; 10:2455-2461. [PMID: 34527557 DOI: 10.21037/gs-21-385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/19/2021] [Indexed: 01/19/2023]
Abstract
Background Our objective is to evaluate the application values and effects of nanocarbon negative imaging technology in surgery for patients with the fifth stage of chronic kidney disease complicated with secondary hyperparathyroidism (SHPT). Methods Eighty-nine patients with SHPT in the fifth stage of chronic kidney disease admitted to the Department of Thyroid and Breast Surgery at the Affiliated Hospital of Nantong University between January 2018 and August 2020 were selected. All patients underwent total parathyroidectomy (tPTX) and were randomly divided into a group receiving nanocarbon (observation group; group A) and a control group (group B). Patients were followed up for 6 months after surgery and several observation indexes were compared and analyzed. Results Compared with the control group, the parathyroid glands in the observation group treated with nanocarbon were more clearly exposed, and better performances were seen in the operation time, blood loss, and recovery rate of bone pain (P<0.05). The postoperative follow-up blood intact parathyroid hormone level (iPTH) and recurrence rate control were also improved in the observation group and the differences were statistically significant (P<0.05). Conclusions In the fifth stage of chronic kidney disease with SHPT, the application of nanocarbon negative imaging technology can significantly reduce the recurrence rate of hyperparathyroidism, improve the surgical effect, and improve the long-term quality of life and survival rate of patients.
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Affiliation(s)
- Yu Wu
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Ying Liu
- Department of General Surgery, Nantong Geriatric Rehabilitation Hospital, Nantong, China
| | - Tao Huang
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Yasu Jiang
- Department of General Surgery, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Hua Wang
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhixian He
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
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45
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Gorobeiko M, Dinets A. Intraoperative detection of parathyroid glands by autofluorescence identification using image-based system: report of 15 cases. J Med Case Rep 2021; 15:414. [PMID: 34365979 PMCID: PMC8351090 DOI: 10.1186/s13256-021-03009-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background A detection of parathyroid glands by the evaluation of their autofluorescence in the near-infrared spectrum is considered as a promising tool in addition to their visual verification. The aim of this study was to evaluate the role of near-infrared autofluorescence application by using two different image-based systems for the identification of parathyroid glands during surgery of thyroid and parathyroid benign and malignant lesions. Methods Evaluation of near-infrared autofluorescence was performed in 15 patients by using two different image-based systems equipped with a near-infrared laser camera. Intravenous injection of fluorophore indocyanine green was used for the enhancement of near-infrared autofluorescence signal. Results Normal parathyroid glands were identified and mobilized after visual inspection in 12 (80%) patients, which was confirmed by near-infrared autofluorescence evaluation. Confident recognition of parathyroid glands by near-infrared autofluorescence signal and their subsequent distinction from lymph nodes was achieved in two (13%) patients with prior surgery for papillary thyroid carcinoma. In one (7%) case, parathyroid gland was identified as fragments of tissue within the postoperative scarring area by near-infrared autofluorescence evaluation, but not by visual inspection. A less intensive near-infrared autofluorescence signal was detected in the parathyroid gland owing to unintentional excision in one (7%) case. Better signal intensity from parathyroid glands was noticed after changes of the near-infrared camera in Fluobeam 800 image-based system in position to an angle of approximately 45–65° in relation to area of interest in all cases as compared with holding straight on the parathyroid gland. Fluobeam LX demonstrated a good near-infrared autofluorescence signal without any specific changes in the camera angle. Thyroid carcinoma demonstrated low-intensity signal in the case of invasion to thyroid capsule. No fluorescent signal was identified from metastatic, or from normal, lymph nodes. Conclusions The application of near-infrared autofluorescence imaging is considered as a useful, but additional, tool for the visual assessment of parathyroid gland in the case of primary neck exploration. The utility of near-infrared autofluorescence imaging for parathyroid detection is increased in the case of repeated surgical intervention owing to increased risk of unintentional parathyroid removal as well as for discrimination of parathyroids from the lymph nodes in cases of thyroid malignancy.
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Affiliation(s)
- Maksym Gorobeiko
- Department of Surgery, Taras Shevchenko National University of Kyiv, Demiїvska 13, Ukraine, Kyiv, 03039, Ukraine.,Department of Surgery, Verum Expert Clinic, Kyiv, Ukraine
| | - Andrii Dinets
- Department of Surgery, Taras Shevchenko National University of Kyiv, Demiїvska 13, Ukraine, Kyiv, 03039, Ukraine. .,Department of Surgery, Verum Expert Clinic, Kyiv, Ukraine.
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Demarchi MS, Seeliger B, Lifante JC, Alesina PF, Triponez F. Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism. Cancers (Basel) 2021; 13:cancers13153792. [PMID: 34359693 PMCID: PMC8345196 DOI: 10.3390/cancers13153792] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/08/2021] [Accepted: 07/23/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Hypoparathyroidism is one of the most frequent complications of thyroid surgery, especially when associated with lymph node dissection in cases of thyroid cancer. Fluorescence-guided surgery is an emerging tool that appears to help reduce the rate of this complication. The present review aims to highlight the utility of fluorescence imaging in preserving parathyroid glands during thyroid cancer surgery. Methods: We performed a systematic review of the literature according to PRISMA guidelines to identify published studies on fluorescence-guided thyroid surgery with a particular focus on thyroid cancer. Articles were selected and analyzed per indication and type of surgery, autofluorescence or exogenous dye usage, and outcomes. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included articles. Results: Twenty-five studies met the inclusion criteria, with three studies exclusively assessing patients with thyroid cancer. The remaining studies assessed mixed cohorts with thyroid cancer and other thyroid or parathyroid diseases. The majority of the papers support the potential benefit of fluorescence imaging in preserving parathyroid glands in thyroid surgery. Conclusions: Fluorescence-guided surgery is useful in the prevention of post-thyroidectomy hypoparathyroidism via enhanced early identification, visualization, and preservation of the parathyroid glands. These aspects are notably beneficial in cases of associated lymphadenectomy for thyroid cancer.
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Affiliation(s)
- Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;
- Department of Endocrine Surgery, Lyon Sud University Hospitals, 69310 Pierre Benite, France;
| | - Barbara Seeliger
- IHU—Strasbourg, Institute of Image-Guided Surgery, 67091 Strasbourg CEDEX, France;
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg CEDEX, France
- Department of General, Digestive, and Endocrine Surgery, Strasbourg University Hospitals, 67091 Strasbourg CEDEX, France
- Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, 45136 Essen, Germany;
| | - Jean-Christophe Lifante
- Department of Endocrine Surgery, Lyon Sud University Hospitals, 69310 Pierre Benite, France;
- Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, 69622 Lyon, France
| | - Pier Francesco Alesina
- Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, 45136 Essen, Germany;
- Department of Surgery, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;
- Correspondence: ; Tel.: +41-(0)22-372-78-62
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Near-infrared autofluorescence-based parathyroid glands identification in the thyroidectomy or parathyroidectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2021; 407:491-499. [PMID: 34322746 DOI: 10.1007/s00423-021-02269-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/06/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the diagnostic accuracy of near-infrared autofluorescence-based identification in the identification of parathyroid glands during thyroidectomy or parathyroidectomy. METHODS The clinical studies were retrieved from PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, SCOPUS, and Google Scholar. The study protocol was registered on Open Science Framework ( https://osf.io/um8rj/ ). The search period ranged from the date of each database's inception to May 2021. Cohort studies dealing with patients of whom parathyroid glands were detected by near-infrared autofluorescence and confirmed clinically or pathologically during thyroidectomy or parathyroidectomy were included. Editorials, letters, "how-I-do-it" descriptions, other site head and neck tumors, and articles with lack of diagnostic identification data were excluded. True positive, true negative, false positive, and false negative were extracted. The QUDAS ver. 2 was used to evaluate the methodological quality. RESULTS Seventeen studies with 1198 participants were evaluated in this analysis. Near-infrared autofluorescence-based identification of parathyroid glands showed a diagnostic odds ratio of 228.8759 (95% confidence interval, 134.1099; 390.6063). The area under the summary receiver operating characteristic curve was 0.967. The sensitivity, specificity, negative predictive value, and positive predictive value were 0.9693 (0.9491; 0.9816), 0.9248 (0.8885; 0.9499), 0.9517 (0.8981; 0.9778), and 0.9488 (0.9167; 0.9689), respectively. Subgroup analyses were performed to compare two autofluorescence detection methods, because there was high heterogeneity in the outcomes. The diagnostic accuracy was higher in probe-based detection than in image-based detection. CONCLUSIONS Near-infrared autofluorescence-based identification is valuable for identifying the parathyroid glands of patients during thyroidectomy or parathyroidectomy.
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48
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Berber E, Akbulut S. Can near-infrared autofluorescence imaging be used for intraoperative confirmation of parathyroid tissue? J Surg Oncol 2021; 124:1008-1013. [PMID: 34247400 DOI: 10.1002/jso.26603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Whether ex vivo autofluorescence (AF) imaging findings could be quantified to intraoperatively differentiate parathyroid tissue has not been reported. Our aim was to assess the ability of AF imaging to confirm parathyroid tissue during thyroidectomy and parathyroidectomy procedures. METHODS This was a retrospective Institutional Review Board-approved study. AF signals of specimens imaged ex vivo before submission to pathology during thyroidectomy and parathyroidectomy procedures were quantified. Using receiver operating characteristic (ROC) curves, optimal values for sensitivity/specificity to differentiate parathyroid tissue were calculated. RESULTS 166 parathyroid and 217 non-parathyroid specimens were analyzed. With surgical drapes as background, the optimal normalized AF intensity threshold to predict parathyroid tissue on ROC curve analysis was 1.72 (86.1% sensitivity, 84.8% specificity, and area under the curve [AUC]: 0.919). The cutoff for 97% sensitivity was 1.31 and for 99.1% specificity was 3.16. With Telfa as background, the optimal threshold to predict parathyroid tissue was 1.46 (88.4% sensitivity, 76.8% specificity, and AUC: 0.896). The threshold for 96.8% sensitivity was 1.18 and for 98.8% specificity was 2.44. If thresholds for highest specificity were used, 40% of frozen sections to confirm parathyroid tissue could have been avoided. CONCLUSION Quantified brightness analysis of ex vivo AF signals may have utility in intraoperative differentiation of parathyroid tissue for 40% of surgical specimens.
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Affiliation(s)
- Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serkan Akbulut
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Weng YJ, Jiang J, Min L, Ai Q, Chen DB, Chen WC, Huang ZH. Intraoperative near-infrared autofluorescence imaging for hypocalcemia risk reduction after total thyroidectomy: Evidence from a meta-analysis. Head Neck 2021; 43:2523-2533. [PMID: 33949716 DOI: 10.1002/hed.26733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/30/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022] Open
Abstract
This meta-analysis evaluates whether near-infrared autofluorescence (NIRAF) imaging reduces the risk of hypocalcemia after total thyroidectomy. A systematic literature search in PubMed, EMBASE, Web of Science, and Cochrane Library for studies from June 2011 to January 2021 comparing total thyroidectomy with NIRAF and conventional surgery (naked eye). Six eligible studies involving 2180 patients were included. The prevalence of transient hypocalcemia was 8.11% (40/493) and 25.19% (425/1687) in the NIRAF and naked eye groups (p < 0.0001), respectively. The prevalence of permanent hypocalcemia was 0% (0/493) and 2.19% (37/1687) in the NIRAF and naked eye groups (p = 0.05), respectively. NIRAF reduces the risk of transient hypocalcemia and may possibly lower the rate of permanent hypocalcemia. Nonetheless, further studies are needed to verify our results and evaluate the cost-effectiveness of NIRAF in real-world clinical practice.
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Affiliation(s)
- Yu-Jing Weng
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Jiang Jiang
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Lei Min
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Qing Ai
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - De-Biao Chen
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Wei-Chun Chen
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Zhi-Heng Huang
- Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, People's Republic of China
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50
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Spare Parathyroid Glands During Thyroid Surgery with Perioperative Autofluorescence Imaging: A Diagnostic Study. World J Surg 2021; 45:2785-2790. [PMID: 33835219 DOI: 10.1007/s00268-021-06102-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this original study was to determine the number of parathyroid glands that can be saved and reimplanted thanks to autofluorescence during thyroid surgery. Preservation of parathyroid function remains challenging during thyroid surgery. The parathyroid glands must be identified and immediately autotransplanted in the case of devascularization. Near-infrared autofluorescence of parathyroid glands has recently been proposed to help surgeons during the dissection. METHODS A total of 116 thyroid lobectomies were performed on 70 consecutive adult patients. Each lobectomy specimen was scanned in vitro with an autofluorescence imaging device. Every spot of autofluorescence was examined by the surgeon and subsequently the pathologist. The pathologist also performed a complete study of the rest of the lobe. We compared the results of the macroscopic and microscopic diagnoses. RESULTS We detected 24 fluorescent spots on the specimens: 13 were considered to be parathyroid tissue by the surgeon and 11, non-parathyroid tissue. The pathologist confirmed the surgical diagnosis but also discovered 15 additional parathyroid glands that were hidden. CONCLUSIONS Autofluorescence imaging of the thyroidectomy specimen with surgical inspection is safe, quick, noninvasive and can help detect the accidental removal of parathyroid glands. About 60% of these glands can be spared and autotransplanted during the surgery.
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