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

• Published in: The American journal of surgery Vol. 222; no. 5; pp. 944 - 951
• Main Authors: Thomas, Giju, Solórzano, Carmen C., Baregamian, Naira, Mannoh, Emmanuel A., Gautam, Rekha, Irlmeier, Rebecca T., Ye, Fei, Nelson, Jon A., Long, Samuel E., Gauger, Paul G., Magner, Alexa, Metcalf, Tyler, Shirley, Lawrence A., Phay, John E., Mahadevan-Jansen, Anita
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited
• Subjects: Accuracy; Adult; Aged; Aged, 80 and over; Clinical Competence; Female; Histology; Humans; Hypocalcemia; Identification; Intraoperative Period; Lymphatic system; Male; Middle Aged; Near infrared autofluorescence; Optical Imaging - methods; Parathyroid; Parathyroid gland; Parathyroid glands; Parathyroid Glands - anatomy & histology; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - surgery; Parathyroidectomy; Patients; Spectroscopy, Near-Infrared; Surgeons; Surgical guidance; Thymus gland; Thyroid gland; Thyroidectomy; Tissues; Variables; Young Adult; Parathyroid glands; Surgical guidance; Parathyroidectomy; Thyroidectomy; Near infrared autofluorescence
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.05.001

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