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DeHoog RJ, King ME, Keating MF, Zhang J, Sans M, Feider CL, Garza KY, Bensussan A, Krieger A, Lin JQ, Badal S, Alore E, Pirko C, Brahmbhatt K, Yu W, Grogan R, Eberlin LS, Suliburk J. Intraoperative Identification of Thyroid and Parathyroid Tissues During Human Endocrine Surgery Using the MasSpec Pen. JAMA Surg 2023; 158:1050-1059. [PMID: 37531134 PMCID: PMC10398548 DOI: 10.1001/jamasurg.2023.3229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/08/2023] [Indexed: 08/03/2023]
Abstract
Importance Intraoperative identification of tissues through gross inspection during thyroid and parathyroid surgery is challenging yet essential for preserving healthy tissue and improving outcomes for patients. Objective To evaluate the performance and clinical applicability of the MasSpec Pen (MSPen) technology for discriminating thyroid, parathyroid, and lymph node tissues intraoperatively. Design, Setting, and Participants In this diagnostic/prognostic study, the MSPen was used to analyze 184 fresh-frozen thyroid, parathyroid, and lymph node tissues in the laboratory and translated to the operating room to enable in vivo and ex vivo tissue analysis by endocrine surgeons in 102 patients undergoing thyroidectomy and parathyroidectomy procedures. This diagnostic study was conducted between August 2017 and March 2020. Fresh-frozen tissues were analyzed in a laboratory. Clinical analyses occurred in an operating room at an academic medical center. Of the analyses performed on 184 fresh-frozen tissues, 131 were included based on sufficient signal and postanalysis pathologic diagnosis. From clinical tests, 102 patients undergoing surgery were included. A total of 1015 intraoperative analyses were performed, with 269 analyses subject to statistical classification. Statistical classifiers for discriminating thyroid, parathyroid, and lymph node tissues were generated using training sets comprising both laboratory and intraoperative data and evaluated on an independent test set of intraoperative data. Data were analyzed from July to December 2022. Main Outcomes and Measures Accuracy for each tissue type was measured for classification models discriminating thyroid, parathyroid, and lymph node tissues using MSPen data compared to gross analysis and final pathology results. Results Of the 102 patients in the intraoperative study, 80 were female (78%) and the median (IQR) age was 52 (42-66) years. For discriminating thyroid and parathyroid tissues, an overall accuracy, defined as agreement with pathology, of 92.4% (95% CI, 87.7-95.4) was achieved using MSPen data, with 82.6% (95% CI, 76.5-87.4) accuracy achieved for the independent test set. For distinguishing thyroid from lymph node and parathyroid from lymph node, overall training set accuracies of 97.5% (95% CI, 92.8-99.1) and 96.1% (95% CI, 91.2-98.3), respectively, were achieved. Conclusions and Relevance In this study, the MSPen showed high performance for discriminating thyroid, parathyroid, and lymph node tissues intraoperatively, suggesting this technology may be useful for providing near real-time feedback on tissue type to aid in surgical decision-making.
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Affiliation(s)
- Rachel J. DeHoog
- Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Mary E. King
- Department of Surgery, Baylor College of Medicine, Houston, Texas
- Department of Chemistry, The University of Texas at Austin, Austin
| | | | - Jialing Zhang
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Marta Sans
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Clara L. Feider
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Kyana Y. Garza
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Alena Bensussan
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Anna Krieger
- Department of Chemistry, The University of Texas at Austin, Austin
| | - John Q. Lin
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Sunil Badal
- Department of Chemistry, The University of Texas at Austin, Austin
| | - Elizabeth Alore
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | | | - Wendong Yu
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Raymon Grogan
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Livia S. Eberlin
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - James Suliburk
- Department of Surgery, Baylor College of Medicine, Houston, Texas
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Mechera R, Maréchal-Ross I, Sidhu SB, Campbell P, Sywak MS. A Nod to the Nodes: An Overview of the Role of Central Neck Dissection in the Management of Papillary Thyroid Carcinoma. Surg Oncol Clin N Am 2023; 32:383-398. [PMID: 36925192 DOI: 10.1016/j.soc.2022.10.012] [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: 03/15/2023]
Abstract
Lymph node metastasis in thyroid cancer is common and associated with an increased risk of locoregional recurrence (LRR). Although therapeutic central neck dissection is well established, prophylactic central node dissection (pCND) for microscopic occult nodal involvement is controversial and recommendations are based on low-level evidence. The potential benefits of pCND such as reducing LRR and re-operation, refining staging, and improving surveillance are enthusiastically debated and the decision to perform pCND must be weighed up against the increased risks of complications.
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Affiliation(s)
- Robert Mechera
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Clarunis, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland; Endocrine and Breast Surgery, St. George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia.
| | - Isabella Maréchal-Ross
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia
| | - Stan B Sidhu
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Peter Campbell
- Endocrine and Breast Surgery, St. George Hospital, Gray Street, Kogarah, New South Wales 2217, Australia
| | - Mark S Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
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Dong Z, Liu W, Peng Y, Zhan X, Su Y, Diao C, Cheng R. Single inferior parathyroid autotransplantation during total thyroidectomy with bilateral central lymph node dissection for papillary thyroid carcinoma: a retrospective cohort study. World J Surg Oncol 2023; 21:102. [PMID: 36959661 PMCID: PMC10035247 DOI: 10.1186/s12957-023-02886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Management of the inferior parathyroid gland using total thyroidectomy (TT) with central lymph node dissection (CLND) is still controversial. Therefore, we evaluated the safety and effectiveness of single inferior parathyroid autotransplantation. METHODS The clinical data of patients with papillary thyroid carcinoma (PTC) who underwent TT with bilateral CLND from January 2018 to December 2020 were collected. Quality of life (QoL) was assessed using the Chinese version of the EORTC QLQ-C30 and THYCA-QOL. The patients were divided into an autotransplantation group and a preservation group according to whether a single inferior parathyroid gland was transplanted. The incidence of permanent hypoparathyroidism, the number of resected central lymph nodes (CLNs), the rate of recurrence reoperation, the rate of radioactive iodine (RAI) treatment, and the QoL score were compared between the two groups. RESULTS A total of 296 patients were included in the study; there were 99 patients in the autotransplantation group and 197 in the preservation group. The incidence of permanent hypoparathyroidism was 3.0% (3/99) and 4.6% (9/197) in the autotransplantation and preservation groups, respectively (P = 0.532). The median number of resected CLNs was 12 (8-17) and 10 (6-14) in the autotransplantation and preservation groups, respectively (P = 0.015). No reoperations were performed for patients with CLN recurrence, and the rates of lateral lymph node (LLN) recurrence reoperation were 2.0% (2/99) and 3.6% (7/197) in the autotransplantation and preservation groups, respectively (P = 0.473). The RAI treatment rates were 12.1% (12/99) and 22.3% (44/197) in the autotransplantation and preservation groups, respectively (P = 0.034). A total of 276 questionnaires were recovered, including 84 in the autotransplantation group and 192 in the preservation group. The QoL of the two groups of patients is similar (P > 0.05). CONCLUSION Single inferior parathyroid autotransplantation during thyroidectomy can be used to prevent permanent hypoparathyroidism and can enable more extensive CLND.
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Affiliation(s)
- Zhizhong Dong
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wen Liu
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ying Peng
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiangxiang Zhan
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjun Su
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang Diao
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruochuan Cheng
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, 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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Zhang Q, Qu KP, Wang ZS, Gao JW, Zhang YP, Cao WJ. Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma. Front Oncol 2022; 12:942488. [PMID: 35992841 PMCID: PMC9386417 DOI: 10.3389/fonc.2022.942488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to examine the effect of selective inferior parathyroid gland autotransplantation on central lymph node dissection(CLND) and incidence of postoperative hypoparathyroidism in patients undergoing endoscopic radical resection of thyroid carcinoma. Methods The data of 310 patients undergoing endoscopic radical resection of thyroid carcinoma will be retrospectively analyzed. The patients will be divided into the experimental group and the control group according to whether they combined with parathyroid autotransplantation. Statistics of the incidence rate of postoperative hypoparathyroidism, the concentration of PTH and Calcium in the systemic circulation at different time points in the two groups, the concentration of PTH in the cubital fossa vein in the transplantation region in the experimental group, and the number of central lymph nodes and positive lymph nodes dissection will be carried out. Results The incidence rate of temporary and permanent hypoparathyroidism in the experimental group was 33.75% and 0.625%, respectively, and in the control group was 22% and 5%, respectively; its difference was statistically significant (X2 = 10.255, P=0.006). Parathyroid autotransplantation increased incidence of transient hypoparathyroidism (OR, 1.806; Cl, 1.088-2.998; P=0.022), and lower incidence of permanent hypoparathyroidism (OR, 0.112; Cl, 0.014-0.904; P=0.040). The diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism (OR, 0.769; Cl, 0.467-1.265; P=0.301) or permanent hypoparathyroidism (OR, 1.434; Cl, 0.316-6.515; P=0.641). Comparison of systemic circulation PTH, between the two groups showed that the PTH of patients in the experimental group was higher than that in the control group from 1 week to 12 months after the operation, and the difference was statistically significant (P<0.05). In the experimental group, from 1 week to 12 months after surgery, PTH concentrations was significantly higher in the cubital fossa of the transplantation side than in the contralateral side, and the differences were statistically significant (P<0.05). The mean number of central lymph node dissected per patient was significantly higher in the experimental group (7.94 ± 3.03 vs. 6.99 ± 2.86; P <0.05); The mean number of positive nodes per patient was significantly higher in the experimental group (3.16 ± 1.86 vs. 2.53 ± 1.59; P <0.05). Conclusions In endoscopic radical resection of thyroid carcinoma, parathyroid autotransplantation is more beneficial to postoperative parathyroid glands function recovery, effectively preventing postoperative permanent hypoparathyroidism and realizing more thorough CLND.
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Affiliation(s)
- Qi Zhang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Kun-Peng Qu
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
- *Correspondence: Kun-Peng Qu,
| | - Ze-Sheng Wang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jing-Wei Gao
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yu-Peng Zhang
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Wei-Jia Cao
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
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PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia. Diagnostics (Basel) 2021; 11:diagnostics11091733. [PMID: 34574074 PMCID: PMC8467686 DOI: 10.3390/diagnostics11091733] [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: 08/04/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022] Open
Abstract
Post-thyroidectomy hypocalcemia is a frequent complication with significant morbidity, and has been shown to increase hospital stay and readmission rates. The evaluation of serum parathyroid hormone (PTH) levels after thyroidectomy represents a reliable method to predict post-thyroidectomy hypocalcemia, but it remains infrequently used. This retrospective study investigates serum PTH values 3 h after thyroidectomy as a predictor of hypocalcemia. In this study, we enrolled 141 patients aged between 27 and 71 years eligible for total thyroidectomy who presented with multinodular goiter, suspicious nodule on cytological examination, Graves’ disease, or toxic multinodular goiter. Three hours after total thyroidectomy, 53 patients (37.6%) showed a reduction in serum PTH. Of these patients 75.5% developed hypocalcemia by 24 h after surgery and 100% were hypocalcemic after 48 h (p < 0.001). There was no significant difference attributable to the different thyroid diseases, nor to the age of the patients. PTH at 3 h after total thyroidectomy accurately predicts post-operative hypocalcemia. The early detection of patients at risk of developing post-operative hypocalcemia allows for prompt supplementation of calcium and Vitamin D in order to prevent symptoms and allows for a safe and timely discharge.
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