Giju Thomas1, Malcolm H Squires2, Tyler Metcalf2, Anita Mahadevan-Jansen1, John E Phay3. 1. Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN. 2. Division of Surgical Oncology, Ohio State University Comprehensive Cancer Center and Ohio State University Wexner Medical Center, Columbus, OH. 3. Division of Surgical Oncology, Ohio State University Comprehensive Cancer Center and Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: john.phay@osumc.edu.
Abstract
BACKGROUND: Near infrared autofluorescence (NIRAF) can guide intraoperative parathyroid gland (PG) identification. NIRAF detection devices typically rely on imaging and fiber probe-based approaches. Imaging modalities provide NIRAF pictures on adjacent display monitors, and fiber probe-based systems measure tissue NIRAF and provide real-time quantitative information to objectively aid PG identification. Both device types recently gained FDA approval for PG identification but have never been compared directly. STUDY DESIGN: Patients undergoing thyroidectomy and/or parathyroidectomy were recruited prospectively. Target tissues were intraoperatively visualized with PDE-Neo II (imaging-based) and concurrently assessed with PTeye (fiber probe-based). For PDE-Neo II, NIRAF images were collected from in situ or excised tissues, alongside the surgeon's interpretation of visualized tissues, and retrospectively analyzed in a blinded fashion. The PTeye was concomitantly used to record NIRAF intensities and ratios from the same tissues in real time. RESULTS: Twenty patients were enrolled for concurrent evaluation with both systems, which included 33 PGs and 19 nonparathyroid sites. NIRAF imaging demonstrated 90.9% sensitivity, 73.7% specificity, and 84.6% accuracy for PG identification when interpreted in real time by the surgeon compared with 81.8% sensitivity, 73.7% specificity, and 78.8% accuracy where images were quantitatively analyzed post hoc by an independent observer. In parallel, NIRAF detection with PTeye yielded 97.0% sensitivity, 84.2% specificity, and 92.3% accuracy in real time for the same specimens. CONCLUSIONS: Both NIRAF-based systems were beneficial for identifying PGs intraoperatively. Although NIRAF imaging provides valuable spatial information to localize PGs, NIRAF detection with fiber probe provides real-time quantitative information to identify PGs in presence of ambient room lights.
BACKGROUND: Near infrared autofluorescence (NIRAF) can guide intraoperative parathyroid gland (PG) identification. NIRAF detection devices typically rely on imaging and fiber probe-based approaches. Imaging modalities provide NIRAF pictures on adjacent display monitors, and fiber probe-based systems measure tissue NIRAF and provide real-time quantitative information to objectively aid PG identification. Both device types recently gained FDA approval for PG identification but have never been compared directly. STUDY DESIGN:Patients undergoing thyroidectomy and/or parathyroidectomy were recruited prospectively. Target tissues were intraoperatively visualized with PDE-Neo II (imaging-based) and concurrently assessed with PTeye (fiber probe-based). For PDE-Neo II, NIRAF images were collected from in situ or excised tissues, alongside the surgeon's interpretation of visualized tissues, and retrospectively analyzed in a blinded fashion. The PTeye was concomitantly used to record NIRAF intensities and ratios from the same tissues in real time. RESULTS: Twenty patients were enrolled for concurrent evaluation with both systems, which included 33 PGs and 19 nonparathyroid sites. NIRAF imaging demonstrated 90.9% sensitivity, 73.7% specificity, and 84.6% accuracy for PG identification when interpreted in real time by the surgeon compared with 81.8% sensitivity, 73.7% specificity, and 78.8% accuracy where images were quantitatively analyzed post hoc by an independent observer. In parallel, NIRAF detection with PTeye yielded 97.0% sensitivity, 84.2% specificity, and 92.3% accuracy in real time for the same specimens. CONCLUSIONS: Both NIRAF-based systems were beneficial for identifying PGs intraoperatively. Although NIRAF imaging provides valuable spatial information to localize PGs, NIRAF detection with fiber probe provides real-time quantitative information to identify PGs in presence of ambient room lights.
Authors: Aimee DiMarco; Ravi Chotalia; Ruth Bloxham; Charlotte McIntyre; Neil Tolley; F Fausto Palazzo Journal: World J Surg Date: 2019-06 Impact factor: 3.352
Authors: Fares Benmiloud; Stanislas Rebaudet; Arthur Varoquaux; Guillaume Penaranda; Marie Bannier; Anne Denizot Journal: Surgery Date: 2017-11-06 Impact factor: 3.982
Authors: Roland Ladurner; Sandra Sommerey; Nora Al Arabi; Klaus K J Hallfeldt; Herbert Stepp; Julia K S Gallwas Journal: Surg Endosc Date: 2016-11-14 Impact factor: 4.584
Authors: Melanie A McWade; Constantine Paras; Lisa M White; John E Phay; Anita Mahadevan-Jansen; James T Broome Journal: Surgery Date: 2013-12 Impact factor: 3.982
Authors: Giju Thomas; Melanie A McWade; Constantine Paras; Emmanuel A Mannoh; Melinda E Sanders; Lisa M White; James T Broome; John E Phay; Naira Baregamian; Carmen C Solórzano; Anita Mahadevan-Jansen Journal: Thyroid Date: 2018-09-11 Impact factor: 6.568
Authors: Giju Thomas; Carmen C Solórzano; Naira Baregamian; Emmanuel A Mannoh; Rekha Gautam; Rebecca T Irlmeier; Fei Ye; Jon A Nelson; Samuel E Long; Paul G Gauger; Alexa Magner; Tyler Metcalf; Lawrence A Shirley; John E Phay; Anita Mahadevan-Jansen Journal: Am J Surg Date: 2021-05-13 Impact factor: 2.565
Authors: Paweł Domosławski; Marcin Adamiecki; Łukasz Antkowiak; Krzysztof Paśko; Mariusz Chabowski; Jędrzej Grzegrzółka; Michał Zrąbkowski; Jacek Białecki; Ryszard Antkowiak Journal: Int J Med Sci Date: 2022-07-18 Impact factor: 3.642
Authors: Emmanuel A Mannoh; Giju Thomas; Naira Baregamian; Sarah L Rohde; Carmen C Solórzano; Anita Mahadevan-Jansen Journal: Thyroid Date: 2021-08-18 Impact factor: 6.506
Authors: Eline A Feitsma; Hugo M Schouw; Milou E Noltes; Wido Heeman; Wendy Kelder; Gooitzen M van Dam; Schelto Kruijff Journal: Life (Basel) Date: 2022-03-08