Fujian Medical University Union Hospital, Department of Thyroid Surgery, Fuzhou, China.
Fujian Clinical Research Center for Precision Management of Thyroid Cancers, Fuzhou, China.
J Biomed Opt. 2025 Jan;30(Suppl 1):S13702. doi: 10.1117/1.JBO.30.S1.S13702. Epub 2024 Jul 18.
Near-infrared autofluorescence (NIRAF) utilizes the natural autofluorescence of parathyroid glands (PGs) to improve their identification during thyroid surgeries, reducing the risk of inadvertent removal and subsequent complications such as hypoparathyroidism. This study evaluates NIRAF's effectiveness in real-world surgical settings, highlighting its potential to enhance surgical outcomes and patient safety.
We evaluate the effectiveness of NIRAF in detecting PGs during thyroidectomy and central neck dissection and investigate autofluorescence characteristics in both fresh and paraffin-embedded tissues.
We included 101 patients diagnosed with papillary thyroid cancer who underwent surgeries in 2022 and 2023. We assessed NIRAF's ability to locate PGs, confirmed via parathyroid hormone assays, and involved both junior and senior surgeons. We measured the accuracy, speed, and agreement levels of each method and analyzed autofluorescence persistence and variation over 10 years, alongside the expression of calcium-sensing receptor (CaSR) and vitamin D.
NIRAF demonstrated a sensitivity of 89.5% and a negative predictive value of 89.1%. However, its specificity and positive predictive value (PPV) were 61.2% and 62.3%, respectively, which are considered lower. The kappa statistic indicated moderate to substantial agreement (kappa = 0.478; ). Senior surgeons achieved high specificity (86.2%) and PPV (85.3%), with substantial agreement (kappa = 0.847; ). In contrast, junior surgeons displayed the lowest kappa statistic among the groups, indicating minimal agreement (kappa = 0.381; ). Common errors in NIRAF included interference from brown fat and eschar. In addition, paraffin-embedded samples retained stable autofluorescence over 10 years, showing no significant correlation with CaSR and vitamin D levels.
NIRAF is useful for PG identification in thyroid and neck surgeries, enhancing efficiency and reducing inadvertent PG removals. The stability of autofluorescence in paraffin samples suggests its long-term viability, with false positives providing insights for further improvements in NIRAF technology.
近红外自发荧光（NIRAF）利用甲状旁腺（PGs）的自然自发荧光来改善其在甲状腺手术中的识别，降低意外切除和随后发生甲状旁腺功能减退等并发症的风险。本研究评估了 NIRAF 在真实手术环境中的有效性，强调了其提高手术结果和患者安全性的潜力。
我们评估 NIRAF 在甲状腺切除术和中央颈部解剖中检测 PG 的有效性，并研究新鲜和石蜡包埋组织中的自发荧光特征。
我们纳入了 2022 年和 2023 年接受手术治疗的 101 例诊断为甲状腺乳头状癌的患者。我们评估了 NIRAF 通过甲状旁腺激素检测定位 PG 的能力，涉及初级和高级外科医生。我们测量了每种方法的准确性、速度和一致性水平，并分析了 10 年来自发荧光的持久性和变化，以及钙敏感受体（CaSR）和维生素 D 的表达。
NIRAF 显示出 89.5%的敏感性和 89.1%的阴性预测值。然而，其特异性和阳性预测值（PPV）分别为 61.2%和 62.3%，被认为较低。kappa 统计表明存在中度到高度一致性（kappa = 0.478； ）。高级外科医生具有较高的特异性（86.2%）和 PPV（85.3%），具有高度一致性（kappa = 0.847； ）。相比之下，初级外科医生在各组中表现出最低的 kappa 统计值，表明一致性最小（kappa = 0.381； ）。NIRAF 中的常见错误包括棕色脂肪和焦痂的干扰。此外，石蜡包埋样本在 10 年内保持稳定的自发荧光，与 CaSR 和维生素 D 水平无显著相关性。
NIRAF 可用于甲状腺和颈部手术中的 PG 识别，提高效率并减少意外 PG 切除。石蜡样本中自发荧光的稳定性表明其具有长期可行性，假阳性为进一步改进 NIRAF 技术提供了思路。
