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Comparing intraoperative parathyroid identification based on surgeon experience versus near infrared autofluorescence detection – A surgeon-blinded multi-centric study - 29/11/21

Doi : 10.1016/j.amjsurg.2021.05.001 
Giju Thomas a, b, Carmen C. Solórzano c, Naira Baregamian c, Emmanuel A. Mannoh a, b, Rekha Gautam a, b, Rebecca T. Irlmeier d, Fei Ye d, Jon A. Nelson e, Samuel E. Long f, Paul G. Gauger e, Alexa Magner g, Tyler Metcalf h, Lawrence A. Shirley i, John E. Phay h, Anita Mahadevan-Jansen a, b,
a Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37235, USA 
b Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA 
c Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA 
d Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA 
e Division of Endocrine Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, 48109, USA 
f Department of General Surgery, Austin Regional Clinic South 1st, Austin, TX, 78704, USA 
g West Virginia University School of Medicine, Morgantown, WV, 26506, USA 
h Division of Surgical Oncology, Ohio State University Comprehensive Cancer Center and Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA 
i Lexington Surgical Specialists, Lexington, KY, 40503, USA 

Corresponding author. Orrin H. Ingram Professor of Biomedical Engineering Vanderbilt University, Station B, Box 351631, Nashville, TN, 37235, USA.Orrin H. Ingram Professor of Biomedical Engineering Vanderbilt UniversityStation BBox 351631NashvilleTN37235USA

Abstract

Background

Near infrared autofluorescence (NIRAF) detection has previously demonstrated significant potential for real-time parathyroid gland identification. However, the performance of a NIRAF detection device - PTeye® - remains to be evaluated relative to a surgeon's own ability to identify parathyroid glands.

Methods

Patients eligible for thyroidectomy and/or parathyroidectomy were enrolled under 6 endocrine surgeons at 3 high-volume institutions. Participating surgeons were categorized based on years of experience. All surgeons were blinded to output of PTeye® when identifying tissues. The surgeon's performance for parathyroid discrimination was then compared with PTeye®. Histology served as gold standard for excised specimens, while expert surgeon's opinion was used to validate in-situ tissues.

Results

PTeye® achieved 92.7% accuracy across 167 patients recruited. Junior surgeons (<5 years of experience) were found to have lower confidence in parathyroid identification and higher tissue misclassification rate per specimen when compared to PTeye® and senior surgeons (>10 years of experience).

Conclusions

NIRAF detection with PTeye® can be a valuable intraoperative adjunct technology to aid in parathyroid identification for surgeons.

Il testo completo di questo articolo è disponibile in PDF.

Highlights

Identifying parathyroid glands (PGs) during neck operations can be challenging.
This study compared the surgeons' ability in identifying PGs to a device PTeye®.
PTeye® achieved 92.7% accuracy across 167 patients recruited.
Junior surgeons had higher error rate in identifying PGs than seniors and PTeye®.
PTeye® can be a useful adjunct tool to intraoperatively identify PGs in real-time.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Parathyroid glands, Surgical guidance, Thyroidectomy, Parathyroidectomy, Near infrared autofluorescence


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Vol 222 - N° 5

P. 944-951 - novembre 2021 Ritorno al numero
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