Identifying Parathyroids in Pediatric Thyroid/Parathyroid Surgery by Near Infrared Autofluorescence.
adolescent
autofluorescence
infrared
parathyroid
pediatric
thyroid
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
09
02
2023
received:
19
10
2022
accepted:
11
02
2023
pmc-release:
01
11
2024
medline:
23
10
2023
pubmed:
4
3
2023
entrez:
3
3
2023
Statut:
ppublish
Résumé
Compared to adult patients undergoing thyroid surgery, pediatric patients have higher rates of hypoparathyroidism often related to parathyroid gland (PG) inadvertent injury or devascularization. Previous studies have shown that near-infrared-autofluorescence (NIRAF) can be reliably used intraoperatively for label-free parathyroid identification, but all prior studies have been performed in adult patients. In this study, we assess the utility and accuracy of NIRAF with a fiber-optic probe-based system to identify PGs in pediatric patients undergoing thyroidectomy or parathyroidectomy. All pediatric patients (under 18 years of age) undergoing thyroidectomy or parathyroidectomy were enrolled in this IRB-approved study. The surgeon's visual assessment of tissues was first noted and the surgeon's confidence level in the tissue identified was recorded. A fiber-optic probe was then used to illuminate tissues-of-interest with a wavelength of 785 nm and resulting NIRAF intensities from these tissues were measured while the surgeon was blinded to results. NIRAF intensities were measured intraoperatively in 19 pediatric patients. Normalized NIRAF intensities for PGs (3.63 ± 2.47) were significantly higher than that of thyroid (0.99 ± 0.36, p < 0.001) and other surrounding soft tissues (0.86 ± 0.40, p < 0.001). Based on the PG identification ratio threshold of 1.2, NIRAF yielded a detection rate of 95.8% (46/48 pediatric PGs). Our findings indicate that NIRAF detection can potentially be a valuable and non-invasive technique to identify PGs during neck operations in the pediatric population. To our knowledge, this is the first study in children to assess the accuracy of probe-based NIRAF detection for intraoperative parathyroid identification. Level 4 Laryngoscope, 133:3208-3215, 2023.
Identifiants
pubmed: 36866696
doi: 10.1002/lary.30633
pmc: PMC10475145
mid: NIHMS1876134
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
3208-3215Subventions
Organisme : NCI NIH HHS
ID : R01 CA212147
Pays : United States
Informations de copyright
© 2023 The American Laryngological, Rhinological and Otological Society, Inc.
Références
Sosa JA, Tuggle CT, Wang TS, et al. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metabol. 2008;93:3058-3065.
Baumgarten HD, Bauer AJ, Isaza A, Mostoufi-Moab S, Kazahaya K, Adzick NS. Surgical management of pediatric thyroid disease: complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume pediatric thyroid center. J Pediatr Surg. 2019;54:1969-1975.
Kao K-T, Ferguson EC, Blair G, Chadha NK, Chanoine J-P. Risk factors for the development of hypocalcemia in pediatric patients after total thyroidectomy - a systematic review. Int J Pediatr Otorhinolaryngol. 2021;143:110666.
Scholz S, Smith JR, Chaignaud B, Shamberger RC, Huang SA. Thyroid surgery at Children's hospital Boston: a 35-year single-institution experience. J Pediatr Surg. 2011;46:437-442.
Freire AV, Ropelato MG, Ballerini MG, et al. Predicting hypocalcemia after thyroidectomy in children. Surgery. 2014;156:130-136.
Kundel A, Thompson GB, Richards ML, et al. Pediatric endocrine surgery: a 20-year experience at the Mayo Clinic. J Clin Endocrinol Metabol. 2014;99:399-406.
Francis GL, Waguespack SG, Bauer AJ, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid. 2015;25:716-759.
Chen Y, Masiakos PT, Gaz RD, et al. Pediatric thyroidectomy in a high volume thyroid surgery center: risk factors for postoperative hypocalcemia. J Pediatr Surg. 2015;50:1316-1319.
Hanba C, Svider PF, Siegel B, et al. Pediatric thyroidectomy: hospital course and perioperative complications. Otolaryngol Head Neck Surg. 2017;156:360-367.
Yu YR, Fallon SC, Carpenter JL, et al. Perioperative determinants of transient hypocalcemia after pediatric total thyroidectomy. J Pediatr Surg. 2017;52:684-688.
Nordenström E, Bergenfelz A, Almquist M. Permanent hypoparathyroidism after Total thyroidectomy in children: results from a National Registry. World J Surg. 2018;42:2858-2863.
Wesson DE, Johnson BL, Barclay C, et al. Thyroid surgery outcomes at a children's hospital: the value of a multidisciplinary team approach. J Pediatr Surg. 2022;57:622-629.
Stack BC, Twining C, Rastatter J, et al. Consensus statement by the American Association of Clinical Endocrinology (AACE) and the American head and neck society endocrine surgery section (AHNS) on pediatric benign and malignant thyroid surgery. Endocr Pract. 2021;27:174-184.
Wang TS, Roman SA, Sosa JA. Predictors of outcomes following pediatric thyroid and parathyroid surgery. Curr Opin Oncol. 2009;21:23-28.
Hartl D, Obongo R, Guerlain J, Breuskin I, Abbaci M, Laplace-Builhé C. Intraoperative parathyroid gland identification using autofluorescence: pearls and pitfalls. World J Surg Surgical Res. 2019;2:1166.
Solórzano CC, Thomas G, Berber E, et al. Current state of intraoperative use of near infrared fluorescence for parathyroid identification and preservation. Surgery. 2021;169:868-878.
Paras C, Keller M, Mahadevan-Jansen A, White L, Phay J. Near-infrared autofluorescence for the detection of parathyroid glands. J Biomed Opt. 2011;16:067012.
Falco J, Dip F, Quadri P, de la Fuente M, Rosenthal R. Cutting edge in thyroid surgery: autofluorescence of parathyroid glands. J Am Coll Surg. 2016;223:374-380.
McWade MA, Sanders ME, Broome JT, Solórzano CC, Mahadevan-Jansen A. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery. 2016;159:193-203.
Kim SW, Song SH, Lee HS, et al. Intraoperative real-time localization of Normal parathyroid glands with autofluorescence imaging. J Clin Endocrinol Metabol. 2016;101:4646-4652.
Kahramangil B, Dip F, Benmiloud F, et al. Detection of parathyroid autofluorescence using near-infrared imaging: a multicenter analysis of concordance between different surgeons. Ann Surg Oncol. 2018;25:957-962.
The United States Food and Drug Administration. FDA permits marketing of two devices that detect parathyroid tissue in real-time during surgery. 2018 https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm624982.htm.
Voelker R. Devices help surgeons see parathyroid tissue. JAMA. 2018;320:2193.
Thomas G, McWade MA, Paras C, et al. Developing a clinical prototype to guide surgeons for intraoperative label-free identification of parathyroid glands in real time. Thyroid. 2018;28:1517-1531.
Abbaci M, De Leeuw F, Breuskin I, et al. Parathyroid gland management using optical technologies during thyroidectomy or parathyroidectomy: a systematic review. Oral Oncol. 2018;87:186-196.
Solórzano CC, Thomas G, Baregamian N, Mahadevan-Jansen A. Detecting the near infrared autofluorescence of the human parathyroid: hype or opportunity? Ann Surg. 2020;272:973-985.
Kiernan CM, Thomas G, Baregamian N, Solόrzano CC. Initial clinical experiences using the intraoperative probe-based parathyroid autofluorescence identification system-PTeye™ during thyroid and parathyroid procedures. J Surg Oncol. 2021;124:271-281.
Thomas G, Squires MH, Metcalf T, Mahadevan-Jansen A, Phay JE. Imaging or fiber probe-based approach? Assessing different methods to detect near infrared autofluorescence for intraoperative parathyroid identification. J Am Coll Surg. 2019;229:596-608.e593.
Ziai H, Dixon P, Berman G, Campisi P, Wasserman JD. Incidental parathyroidectomy among pediatric patients undergoing thyroid surgery. Laryngoscope. 2022;132(11):2262-2269.
Thomas G, Solorzano CC, Baregamian N, et al. Comparing intraoperative parathyroid identification based on surgeon experience versus near infrared autofluorescence detection - a surgeon-blinded multi-centric study. Am J Surg. 2021;222(5):944-951.
Taubitz T, Fang Y, Biesemeier A, Julien-Schraermeyer S, Schraermeyer U. Age, lipofuscin and melanin oxidation affect fundus near-infrared autofluorescence. EBioMedicine. 2019;48:592-604.
Munger BL, Roth SI. The cytology of the normal parathyroid glands of man and Virginia deer: a light and electron microscopic study with morphologic evidence of secretory activity. J Cell Biol. 1963;16:379-400.