Pathological evaluation of the accuracy of a fluorescence spectroscopy system for detecting parathyroid glands
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Pathological evaluation of the accuracy of a fluorescence spectroscopy system for detecting parathyroid glands Hiroshi Idogawa1 · Tomohiro Sakashita1 · Takeki Yagi1 · Keiko Segawa2 · Akihiro Homma3 Received: 4 March 2020 / Accepted: 24 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose A fluorescence-based technique for the detection of parathyroid glands (PGs) intraoperatively was previously reported. The technique was based on the phenomenon in which PGs emit autofluorescence when exposed to near-infrared light and we undertook an evaluation to consider the pathological accuracy of the method. Methods The study comprised 17 patients (18 specimens) who underwent thyroid surgery at Kushiro City General Hospital between November 2018 and June 2019. We searched for PGs intraoperatively using a fluorescence spectroscopy system and evaluated the pathological accuracy of the system. We statistically evaluated the clinical factors associated with the accuracy of the system, including age, gender, body mass index, laterality, disease state, renal function, and comorbidity. Results Eighteen specimens were evaluated pathologically, with 13 specimens confirmed as PGs. These were evaluated as “true positive,” giving a positive predictive value of 72.2% (13/18). Among the false-negative cases, one specimen was a metastatic lymph node in a patient with papillary thyroid carcinoma. There was a significant difference in the true-positive rates between malignant (25%) and benign (85.7%) disease (P = 0.044). Conclusion We consider that this technique is useful, however, we have to exercise care in malignant cases as the truepositive rate may be low. Keywords Parathyroid glands · Autofluorescence · Near-infrared light · Pathological accuracy
Introduction Iatrogenic injury of the parathyroid glands (PGs) is the most common complication after total thyroidectomy. It can cause postoperative hypoparathyroidism resulting in severe symptoms and force patients to take calcium and vitamin D on a permanent basis. PGs are often difficult to distinguish from the surrounding tissues as they are small, look like fat tissue, and vary widely in their location. Therefore, several methods for identifying PGs intraoperatively have been reported. In * Tomohiro Sakashita [email protected] 1
Department of Otolaryngology‑Head and Neck Surgery, Kushiro City General Hospital, 1‑12, Shunkodai, Kushiro 085‑0822, Japan
2
Department of Surgical Pathology, Kushiro City General Hospital, 1‑12, Shunkodai, Kushiro 085‑0822, Japan
3
Department of Otolaryngology‑Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita‑Ku, Sapporo 060‑8638, Japan
2011, Paras et al. first reported that PGs emit autofluorescence when exposed to near-infrared light [1]. Since then, there have been a number of reports related to techniques based on the use of fluorescence to detect PGs intraoperatively. These reports indicated that the method was effective clinical
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