ASPO074 - Label-free parathyroid identification during pediatric neck surgeries with near infrared autofluorescence detection
Sunday, May 1, 2022
8:55 AM – 9:55 AM CT
Location: Landmark C
Ryan H. Belcher, M.D., MPH1, Parker A. Willmon, BS2, Giju Thomas, Ph.D.3, Naira Baregamian, MD4, Monica Lopez, MD4, Harold Lovvorn, III, MD4, Carmen Solorzano, MD4, Anita Mahadevan-Jansen, MS, PhD3;
1Otolaryngology-Head and Neck Surgery, Vanderbilt Univ., Nashville, TN, 2Vanderbilt Univ., Nashville, TN, 3School of Engineering, Vanderbilt Univ., Nashville, TN, 4Section of Surgical Sciences, Vanderbilt Univ. Med. Ctr., Nashville, TN.
Assistant Professor Vanderbilt University Medical Center/Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Tennessee
Introduction: Compared to adult patients undergoing thyroid surgery, pediatric patients are at higher risk of parathyroid gland (PG) damage and subsequent transient or permanent hypoparathyroidism. Previous studies have shown near infrared autofluorescence (NIRAF) can be reliably used intraoperatively for label-free parathyroid identification, but all of these studies have only been in adult patients. In our study, we investigate the accuracy and scope of NIRAF detection of PGs in pediatric patients undergoing thyroidectomy using a fiber-optic probe-based system.
Methods: All pediatric patients (under 18 years of age) undergoing thyroidectomy was enrolled for this study that was IRB-approved. 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.
Results: NIRAF intensities were measured across different neck structures in 8 pediatric patients (Ages: 6 - 16 years) who underwent total thyroidectomy or hemithyroidectomy. Normalized NIRAF intensity (expressed as mean ± standard error) for PGs (3.9 ± 0.8) was significantly higher than that of thyroid (1.2 ± 0.1, p=0.002) and other soft tissues (0.7 ± 0.1, p=0.0005). Keeping an arbitrary threshold of 1.3, this technique yielded a detection rate of 94.7% (18/19 PGs).
Conclusion: Our findings indicate that NIRAF detection can potentially be a valuable and non-invasive technique to identify PGs during neck surgeries 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.