Bo Wang, Chi-Peng Zhou, Wei Ao, Shao-Jun Cai, Zhi-Wen Ge, Jun Wang, Wen-Yu Huang, Jia-Fan Yu, Si-Bin Wu, Shou-Yi Yan, Li-Yong Zhang, Si-Si Wang, Zhi-hong Wang, Surong Hua, Amr H. Abdelhamid Ahmed, Gregory Randolph, Wen-Xin Zhao
Journal of Biomedical Optics, Vol. 30, Issue S1, S13702, (July 2024) https://doi.org/10.1117/1.JBO.30.S1.S13702
TOPICS: Surgery, Thyroid, Autofluorescence, Tissues, Fluorescence intensity, Lymph nodes, Fluorescence, Cancer, Neck, Visual inspection
Significance
Near-infrared autofluorescence (NIRAF) utilizes the natural autofluorescence of parathyroid glands (PGs) to improve their identification during thyroid surgeries, reducing the risk of inadvertent removal and subsequent complications such as hypoparathyroidism. This study evaluates NIRAF’s effectiveness in real-world surgical settings, highlighting its potential to enhance surgical outcomes and patient safety.
Aim
We evaluate the effectiveness of NIRAF in detecting PGs during thyroidectomy and central neck dissection and investigate autofluorescence characteristics in both fresh and paraffin-embedded tissues.
Approach
We included 101 patients diagnosed with papillary thyroid cancer who underwent surgeries in 2022 and 2023. We assessed NIRAF’s ability to locate PGs, confirmed via parathyroid hormone assays, and involved both junior and senior surgeons. We measured the accuracy, speed, and agreement levels of each method and analyzed autofluorescence persistence and variation over 10 years, alongside the expression of calcium-sensing receptor (CaSR) and vitamin D.
Results
NIRAF demonstrated a sensitivity of 89.5% and a negative predictive value of 89.1%. However, its specificity and positive predictive value (PPV) were 61.2% and 62.3%, respectively, which are considered lower. The kappa statistic indicated moderate to substantial agreement (kappa = 0.478; P<0.001). Senior surgeons achieved high specificity (86.2%) and PPV (85.3%), with substantial agreement (kappa = 0.847; P<0.001). In contrast, junior surgeons displayed the lowest kappa statistic among the groups, indicating minimal agreement (kappa = 0.381; P<0.001). Common errors in NIRAF included interference from brown fat and eschar. In addition, paraffin-embedded samples retained stable autofluorescence over 10 years, showing no significant correlation with CaSR and vitamin D levels.
Conclusions
NIRAF is useful for PG identification in thyroid and neck surgeries, enhancing efficiency and reducing inadvertent PG removals. The stability of autofluorescence in paraffin samples suggests its long-term viability, with false positives providing insights for further improvements in NIRAF technology.
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