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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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Zhang Y, Tang N, Zhou H, Zhu Y. Surface engineered multifunctional nano-systems for localised drug delivery against thyroid cancer: A review of current practices. Biomed Pharmacother 2024; 176:116840. [PMID: 38820975 DOI: 10.1016/j.biopha.2024.116840] [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: 02/09/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024] Open
Abstract
Thyroid cancer, the most prevalent cancer of the endocrine system and cervical region, has experienced a significant increase in incidence over recent decades. Nanomedicine has fundamentally revolutionized cancer treatment, particularly through the development of multifunctional nano-therapeutics. The progress in this field has been facilitated by the distinctive properties of nanomaterials, such as their capacity to perform several functions, be modified, and offer various detection methods. These features allow for non-invasive and practical diagnostic techniques through versatile imaging. Surface engineering plays a pivotal role in the design of multifunctional nano-systems for localized drug delivery against thyroid cancer. Nano-systems can be customized via surface modification techniques, such as functionalization with targeting ligands and inclusion of therapeutic drugs. This customization allows the nano-systems to specifically target cancer cells while reducing the impact on non-target cells. As a result, bovine serum albumin-coated nanostructures have emerged as powerful diagnostic and targeting nanosystems for thyroid cancer. This targeted strategy enhances the effectiveness of cancer treatment while reducing overall body toxicity. This comprehensive review aims to provide an extensive overview of the latest advancements in surface-engineered nanoparticle-based approaches for both diagnosing and treating thyroid cancer. It highlights the promising research endeavors aimed at creating novel and effective multifunctional nanomedicine for localized delivery to thyroid cancer sites. The review examines different nanomedicines that have been developed for cancer treatment and diagnosis. It also analyzes the current trends, future possibilities, and obstacles in this rapidly advancing sector. By synthesizing the current state of knowledge on surface-engineered multifunctional nano-systems, this review contributes to a better understanding of their potential applications in thyroid cancer treatment and paves the way for future research directions in this promising field of nanomedicine.
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Affiliation(s)
- Yiyi Zhang
- Department of Endocrinology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China.
| | - Nie Tang
- Department of Endocrinology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China.
| | - Hui Zhou
- Department of Endocrinology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China.
| | - Ying Zhu
- Department of Endocrinology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China.
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He J, Sun P, Lin J, Shen J, Lin H, Jiang H, Qiu R, Lin E, Lu Y. Application of carbon nanoparticles in endoscopic thyroid cancer surgery: a systematic review and meta-analysis. Front Surg 2024; 10:1283573. [PMID: 38259977 PMCID: PMC10800958 DOI: 10.3389/fsurg.2023.1283573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Background There has been a substantial increase in incidence of thyroid cancer globally over the past three decades, emphasizing the necessity for efficient surgical management. Surgical intervention requires meticulous lymphatic dissection; however, it is challenging to both accurately identify lymph nodes and preserve the surrounding structures. We investigated the role of carbon nanoparticles in endoscopic thyroid cancer surgery to improve surgical effects and reduce postoperative complications. Methods Chinese and English literature databases from inception to May 2023 were searched based on inclusion criteria, and data were extracted independently by two investigators. STATA software was used for data analysis. Results A comprehensive systematic review and meta-analysis were conducted with 13 publications (9 randomized and 4 non-randomized controlled trials). The results demonstrated that the application of carbon nanoparticles in thyroid surgery led to an increase in the number of retrieved lymph nodes and identification of metastatic lymph nodes. Furthermore, it considerably reduced the rate of improper parathyroidectomy and the incidence of postoperative hypocalcemia. Conclusion The application of carbon nanoparticles can effectively improve the effects of surgical treatment, can enhance the identification of intraoperative lymph nodes, reduce postoperative complications, and protect the integrity and function of the parathyroid gland. Systematic Review Registration www.crd.york.ac.uk/PROSPERO, identifier, CRD42023420504.
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Affiliation(s)
- Jiaxi He
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Pengfei Sun
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jianhuang Lin
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Jiali Shen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Huihui Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Hongzhan Jiang
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Rongliang Qiu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Ende Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yizhuo Lu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
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Chen PP, Zhang X, Li JG, Chen G. Predictors of impaired effectiveness of carbon nanoparticle-based central lymph node tracing in patients who underwent surgery for papillary thyroid cancer: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e31257. [PMID: 36253990 PMCID: PMC9575759 DOI: 10.1097/md.0000000000031257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Carbon nanoparticles (CNs) are used in papillary thyroid cancer (PTC) surgery to facilitate central lymph node dissection (CLND) and protect the parathyroid glands (PGs). However, some cases develop hypoparathyroidism after using CNs. This cohort study was undertaken to explore the predictors of the reduced effectiveness of CNs. Data on patients with PTC who underwent surgery wherein CNs were used during CLND were reviewed retrospectively. Patients who did not develop hypoparathyroidism and developed hypoparathyroidism were classified into Group A and B, respectively. Demographic and clinical characteristics were compared between the 2 groups. Univariate and multivariate logistic regression analysis were performed on related variables. The receiver operating characteristic curve was used to evaluate the predictors of the binary logistic model and the cutoff value of each predictor was obtained. A total of 265 patients were included. Compared with Group A, the patients in Group B had a higher body mass index (BMI) (P = .003), were more frequently associated with Hashimoto thyroiditis (HT) (P = .001), and tumors were larger in size (P = .026). Multivariate logistic regression analyses were performed on these variables and showed that HT (P = .001) and tumor size (P = .001) predicted the impaired role of CNs. CNs are not always useful in protecting PG function in patients who undergo CLND for PTC. In patients with coexisting HT (blood thyroid peroxidase antibody [TPOAb] level higher than 44.0 IU/mL or blood anti-thyroglobulin antibody [ATG] level higher than 125.0 IU/mL) or a tumor size exceeding 1.1 cm in diameter, the protective role of CNs may be impaired.
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Affiliation(s)
- Ping-Ping Chen
- Department of Thyroid and Breast Surgery, the Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
- *Correspondence: Ping-Ping Chen, Department of Thyroid and Breast Surgery, the Affiliated People’s Hospital of Ningbo University, Ningbo 315040, Zhejiang, China (e-mail: )
| | - Xing Zhang
- Department of Thyroid and Breast Surgery, the Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Jia-Gen Li
- Department of Thyroid and Breast Surgery, the Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Gun Chen
- Department of Pathology, the Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, China
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Koimtzis G, Stefanopoulos L, Alexandrou V, Tteralli N, Brooker V, Alawad AA, Carrington-Windo E, Karakasis N, Geropoulos G, Papavramidis T. The Role of Carbon Nanoparticles in Lymph Node Dissection and Parathyroid Gland Preservation during Surgery for Thyroid Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:4016. [PMID: 36011009 PMCID: PMC9407010 DOI: 10.3390/cancers14164016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 12/07/2022] Open
Abstract
Thyroid cancer is the most common endocrine malignancy with an increasing incidence over the past few years. Surgery is considered the primary therapeutic option, which often involves lymph node dissection. The aim of this study was to assess the role of carbon nanoparticles, a novel agent, in thyroid cancer surgery. For that purpose, we conducted a systematic review of the literature on MEDLINE, EMBASE, Scopus, Cochrane and Google Scholar databases from 1 January 2002 to 31 January 2022. Ultimately, 20 articles with a total number of 2920 patients were included in the analysis. The outcome of the analysis showed that the use of carbon nanoparticles is associated with a higher number of harvested lymph nodes (WMD, 1.47, 95% CI, 1.13 to 1.82, p < 0.001) and a lower rate of accidental parathyroid gland removal (OR 0.34, CI 95% 0.24 to 0.50, p < 0.001). Based on these results, we suggest that carbon nanoparticles are applied in thyroid cancer surgery on a wider scale, so that these findings can be confirmed by future research on the subject.
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Affiliation(s)
- Georgios Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Department of Electrical and Computer Engineering, Technological Institute, Robert R. McCormick School of Engineering and Applied Science, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
| | - Vyron Alexandrou
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 54634 Thessaloniki, Greece
| | - Nikos Tteralli
- Department of General Surgery, North Hampshire NHS Foundation Trust, Basingstoke RG24 9NA, UK
| | - Verity Brooker
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Awad Ali Alawad
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Eliot Carrington-Windo
- Emergency Department, Grafton Base Hospital, Northern NSW Local Health District, Grafton, NSW 2460, Australia
| | - Nikolaos Karakasis
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 54634 Thessaloniki, Greece
| | - Georgios Geropoulos
- Department of Academic Surgery, The Royal Marsden Hospital Foundation Trust, 203 Fulham Rd., London SW3 6JJ, UK
| | - Theodosios Papavramidis
- 1st Propedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
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He J, Zhang C, Zhang Z, Xia F. Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer. World J Surg Oncol 2021; 19:320. [PMID: 34736481 PMCID: PMC8570033 DOI: 10.1186/s12957-021-02427-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/22/2021] [Indexed: 12/07/2022] Open
Abstract
Background Carbon nanoparticles (CNs) are tracers used in thyroid surgery of patients with thyroid cancer (TC) to help remove lymph nodes and protect the parathyroid gland. The facilitative effect of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection (pCND) has not been reported. Methods The protective effect on parathyroid gland (PG) function and the numbers of identified parathyroid glands and central lymph nodes in endoscopic thyroid surgery through the total mammary areolas approach were compared between the CN and control groups. Results All endoscopic thyroidectomies were successfully completed. No difference was found in either group regarding the general characteristics or operative complications. The mean number of superior PGs and inferior PGs identified in situ or in the dissected central lymph tissues was not different between the groups. The mean number of lymph nodes removed by unilateral CND was greater in the CN group than in the control group. However, there was no difference in the number of harvested lymph nodes when excluding the LNs less than 5 mm, which exhibit an extremely low metastatic rate. Conclusion Carbon nanoparticles do not improve the protective effect on the parathyroid gland, especially the inferior glands, in endoscopic thyroid surgery through the total mammary areolas approach. There is no need to use CNs to facilitate the lymph node harvest in endoscopic prophylactic unilateral CND.
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Affiliation(s)
- Jie He
- Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), Changsha, 410005, Hunan, China.,Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China
| | - Chaojie Zhang
- Department of Breast and Thyroid Surgery, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), Changsha, 410005, Hunan, China
| | - Zeyu Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China
| | - Fada Xia
- Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China.
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Fröhlich E, Wahl R. Nanoparticles: Promising Auxiliary Agents for Diagnosis and Therapy of Thyroid Cancers. Cancers (Basel) 2021; 13:cancers13164063. [PMID: 34439219 PMCID: PMC8393380 DOI: 10.3390/cancers13164063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Thyroid cancer (TC) is rare relative to cancers of many other organs (breast, prostate, lung, and colon). The majority of TCs are differentiated tumors that are relatively easy to treat and have a good prognosis. However, for anaplastic TC, a rapidly growing and aggressive tumor, treatment is suboptimal because the effective drugs cause severe adverse effects. Drug delivery by nanocarriers can improve treatment by reducing side effects. This can either be mediated through better retention in the tumor tissue due to size (passive targeting) or through the attachment of specific molecules that zero in on the cancer cells (active targeting). Nanoparticles are already used for diagnosis and imaging of TC. For unresectable anaplastic TC, nanoparticle-based treatments, less suitable for deeply located cancers, could be useful, based on low-intensity focused ultrasound and near-infrared irradiation. All potential applications of nanoparticles in TC are still in the preclinical phase. Abstract Cancers of the endocrine system are rare. The majority are not highly malignant tumors. Thyroid cancer (TC) is the most common endocrine cancer, with differentiated papillary and follicular tumors occurring more frequently than the more aggressive poorly differentiated and anaplastic TC. Nanoparticles (NP) (mainly mesoporous silica, gold, carbon, or liposomes) have been developed to improve the detection of biomarkers and routine laboratory parameters (e.g., thyroid stimulating hormone, thyroglobulin, and calcitonin), tumor imaging, and drug delivery in TC. The majority of drug-loaded nanocarriers to be used for treatment was developed for anaplastic tumors because current treatments are suboptimal. Further, doxorubicin, sorafenib, and gemcitabine treatment can be improved by nanotherapy due to decreased adverse effects. Selective delivery of retinoic acid to TC cells might improve the re-differentiation of de-differentiated TC. The use of carbon NPs for the prevention of parathyroid damage during TC surgery does not show a clear benefit. Certain technologies less suitable for the treatment of deeply located cancers may have some potential for unresectable anaplastic carcinomas, namely those based on low-intensity focused ultrasound and near-infrared irradiation. Although some of these approaches yielded promising results in animal studies, results from clinical trials are currently lacking.
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Affiliation(s)
- Eleonore Fröhlich
- Center for Medical Research, Medical University Graz, 8036 Graz, Austria;
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Richard Wahl
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-7071-2983136
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