8th Biennial Congress of the European Society of Endocrine Surgeons
Published online: 17 March 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
May 24-26 2018, Amsterdam, The Netherlands
Local Organising Committee:
Els Nieveen Van Dijkum, MD - General and Endocrine
Surgeon, Academic Medical Center, The Netherlands
Sam Van Slycke, MD - General and Endocrine Surgeon,
OLV Clinic Aalst, Belgium
KIT - Royal Tropical Institute
1092 AD Amsterdam
SESSION 1 - NEUROENDOCRINE AND BASIC
Enabling label-free real-time intraoperative parathyroid
identification with a clinical prototype – a multicentric study
, Magner A.
, Sanders M.E.
, Phay J.E.
, Solórzano C. C.
, Mahadevan-Jansen A.
1 Department of Biomedical Engineering, Vanderbilt
University, Nashville, USA
2 Vanderbilt Biophotonics Center, Vanderbilt University,
3 Division of Surgical Oncology, Ohio State University
Comprehensive Cancer Center and Ohio State University
Wexner Medical Center, Columbus, USA
4 Department of Pathology, Vanderbilt University Medical
Center, Nashville, USA
5 Department of Surgical Oncology and Endocrine Surgery,
Vanderbilt University Medical Center, Nashville, USA
Background: Identifying parathyroid glands during head
and neck surgeries can be challenging, resulting in acci-
dental healthy parathyroid gland excision or incomplete
removal of diseased parathyroid glands. Thus accurate
intraoperative parathyroid identification is imperative for
optimal patient outcome. Routine intraoperative tech-
niques such as frozen section biopsies or parathyroid hor-
mone assays are invasive, time consuming and costly.
Recently parathyroid glands were found to possess near-
infrared autofluorescence (NIRAF) that can be utilized for
its real-time identification during surgery.
Objective: To evaluate accuracy of a clinical prototype
called 'PTEye' that employs NIRAF detection for label-
free intraoperative parathyroid identification.
Method: The PTEye was tested across 35 patients at
Center A and 10 patients at Center B, with 245 parathy-
roid and 458 non-parathyroid (thyroid, muscle, fat, lymph
node and trachea) measurements. The PTEye was de-
signed with a user-friendly interface and can function with
operation room (OR) lights remaining on. Accuracy was
determined by correlating data with the surgeons’ visual
confirmation for unexcised parathyroids or histology re-
port of excised parathyroids.
Results: NIRAF counts were 5.5 times higher in parathy-
roid than non-parathyroid measurements (p-value<0.01).
The PTEye achieved 95.5% sensitivity and 98.1% spec-
ificity (accuracy: 97.2%) at Center A, and 97.7% sensi-
tivity and 97.0% specificity (accuracy: 97.2%) at Center
B. Overall accuracy was 97.2% (kappa=0.94) with a pos-
itive and negative predictive value of 95.9% and 97.8%
respectively. Furthermore, PTEye provided results in
real-time without needing contrast agents while OR
lights remained on.
Conclusion: The PTEye demonstrated high accuracy for
label-free intraoperative parathyroid identification. The in-
tuitive interface of PTEye and its ability to rapidly iden-
tify parathyroid glands with ambient OR lights can ensure
easy usability by surgeons.
Langenbeck's Archives of Surgery (2018) 403:403–423