-
The Laryngoscope Dec 2022We aimed to establish an artificial intelligence (AI) model to identify parathyroid glands during endoscopic approaches and compare it with senior and junior surgeons'...
OBJECTIVE
We aimed to establish an artificial intelligence (AI) model to identify parathyroid glands during endoscopic approaches and compare it with senior and junior surgeons' visual estimation.
METHODS
A total of 1,700 images of parathyroid glands from 166 endoscopic thyroidectomy videos were labeled. Data from 20 additional full-length videos were used as an independent external cohort. The YOLO V3, Faster R-CNN, and Cascade algorithms were used for deep learning, and the optimal algorithm was selected for independent external cohort analysis. Finally, the identification rate, initial recognition time, and tracking periods of PTAIR (Artificial Intelligence model for Parathyroid gland Recognition), junior surgeons, and senior surgeons were compared.
RESULTS
The Faster R-CNN algorithm showed the best balance after optimizing the hyperparameters of each algorithm and was updated as PTAIR. The precision, recall rate, and F1 score of the PTAIR were 88.7%, 92.3%, and 90.5%, respectively. In the independent external cohort, the parathyroid identification rates of PTAIR, senior surgeons, and junior surgeons were 96.9%, 87.5%, and 71.9%, respectively. In addition, PTAIR recognized parathyroid glands 3.83 s ahead of the senior surgeons (p = 0.008), with a tracking period 62.82 s longer than the senior surgeons (p = 0.006).
CONCLUSIONS
PTAIR can achieve earlier identification and full-time tracing under a particular training strategy. The identification rate of PTAIR is higher than that of junior surgeons and similar to that of senior surgeons. Such systems may have utility in improving surgical outcomes and also in accelerating the education of junior surgeons.
LEVEL OF EVIDENCE
3 Laryngoscope, 132:2516-2523, 2022.
Topics: Humans; Parathyroid Glands; Thyroid Gland; Artificial Intelligence; Thyroidectomy; Endoscopy
PubMed: 35638245
DOI: 10.1002/lary.30173 -
Surgical Oncology Mar 2019Meticulous capsular dissection can preserve the function of the parathyroid gland in most patients, but it is difficult to identify and preserve the subcapsular...
PURPOSE
Meticulous capsular dissection can preserve the function of the parathyroid gland in most patients, but it is difficult to identify and preserve the subcapsular parathyroid gland. We performed in-situ preservation of the subcapsular parathyroid gland during robotic radical thyroidectomy using super-meticulous capsular dissection, and evaluated its effect on postoperative parathyroid function.
METHODS
A 45-year-old woman was admitted with bilateral thyroid nodules. Color Doppler ultrasound demonstrated a 7 × 7 × 6 mm hypoechoic area in the middle and inferior part of the right lobe and 3 × 3 × 3 mm hypoechoic nodule in the middle part of the left lobe. She was diagnosed with right thyroid papillary cancer by fine-needle aspiration. Robotic bilateral thyroidectomy plus right central lymph node dissection was performed. During the left thyroidectomy, we found that the left inferior parathyroid gland was just under the true capsule. Subsequently, the super-meticulous capsular dissection was performed for in-situ preservation of the parathyroid gland.
RESULTS
The patient's serum parathyroid hormone concentration was 43.77 pg/ml before and 37.98 pg/ml after surgery (normal: 15-65 pg/ml). Her blood calcium level was 2.21 mmol/l before and 2.18 mol/l after surgery (normal: 2.10-2.65 mmol/l).
CONCLUSIONS
The super-meticulous capsular dissection, which could cut through the true capsule to identify subcapsular parathyroid and protect its anatomic structure as well as blood supply, is recommend for in-situ preservation of subcapsular parathyroid gland during robotic radical thyroidectomy.
Topics: Carcinoma, Papillary; Female; Humans; Middle Aged; Neck Dissection; Organ Sparing Treatments; Parathyroid Glands; Prognosis; Robotic Surgical Procedures; Thyroid Neoplasms; Thyroidectomy
PubMed: 30851920
DOI: 10.1016/j.suronc.2018.10.009 -
Otolaryngology--head and Neck Surgery :... Jul 2023Devices for near-infrared light stimulation of autofluorescence (NIRAF) allow for intraoperative identification of parathyroid glands with high sensitivity in adults....
Devices for near-infrared light stimulation of autofluorescence (NIRAF) allow for intraoperative identification of parathyroid glands with high sensitivity in adults. However, their performance in the pediatric population is unknown. In this case series with chart review at a tertiary academic children's hospital, we investigated pediatric patients undergoing thyroid surgery and concurrent use of a probe-based NIRAF device. Thirteen patients (ages 6-18 years) underwent thyroid and/or neck dissection procedures, and 2 patients had revision procedures for a total of 15 cases with the NIRAF device. Eight cases had NIRAF values that matched surgeon opinion of parathyroid tissue or histology when available. Six cases had false positive NIRAF readings (40.0%) and 1 case had false negative readings (6.7%). Compared with surgeon opinion or histology, the NIRAF device confirmed 26 of 34 parathyroid gland candidates (76.5%). These devices need further investigation in pediatric patients, whose tissues may have different autofluorescence characteristics.
Topics: Adult; Humans; Child; Parathyroid Glands; Thyroid Gland; Parathyroidectomy; Thyroidectomy; Optical Imaging
PubMed: 36939554
DOI: 10.1002/ohn.272 -
International Journal of Hyperthermia :... 2022Hyperparathyroidism (HPT) is classified into primary HPT (PHPT), secondary HPT (SHPT), tertiary HPT (THPT), and pseudohyperparathyroidism. Parathyroid surgery is... (Review)
Review
BACKGROUND
Hyperparathyroidism (HPT) is classified into primary HPT (PHPT), secondary HPT (SHPT), tertiary HPT (THPT), and pseudohyperparathyroidism. Parathyroid surgery is generally reserved for patients with symptomatic PHPT and asymptomatic patients who meet the surgical guideline criteria. However, the risk of complications and mortality after parathyroid gland surgery increases with increasing patient age.
AIM
This study aimed to review existing research on laser ablation, radiofrequency ablation, microwave ablation, and high-intensity focused ultrasound in the treatment of HPT and analyze its application prospects.
CONCLUSIONS
Thermal ablation is a good alternative treatment for patients with parathyroid hyperplasia who do not meet the criteria or decline surgery. Being a type of minimally invasive treatment, ultrasound-guided thermal ablation has the advantages of easy operation, rapid recovery, and reusability and is used widely.
Topics: Humans; Hyperparathyroidism, Primary; Hyperparathyroidism, Secondary; Parathyroid Glands; Ultrasonography; Ultrasonography, Interventional
PubMed: 35271788
DOI: 10.1080/02656736.2022.2028907 -
Surgery Oct 2022Intraoperative parathyroid gland identification can be challenging. Parathyroid glands have an intrinsic autofluorescence when excited by wavelengths in the...
BACKGROUND
Intraoperative parathyroid gland identification can be challenging. Parathyroid glands have an intrinsic autofluorescence when excited by wavelengths in the near-infrared region. Studies using near-infrared cameras to detect parathyroid gland near-infrared autofluorescence have suggested improved identification. The pathologic parathyroid glands in primary hyperparathyroidism have variable near-infrared autofluorescence intensity, but how this correlates with different characteristics of hyperparathyroidism is unknown. Our objective was to correlate the fluorescent intensity of excited glands with clinical variables to enhance a surgeon's ability to identify parathyroid glands.
METHODS
The data on patients undergoing surgery for primary hyperparathyroidism were collected. The images were collected intraoperatively with a handheld near-infrared device and analyzed. The data consisted of the ratio of mean parathyroid gland near-infrared autofluorescence over background (white gauze) near-infrared autofluorescence. The variables assessed for correlation with autofluorescence intensity were gland volume and weight, preoperative serum calcium and parathyroid hormone, age, body mass index, and sex. The images were quantified by Image J software (National Institutes of Health, Bethesda, MD). The lasso regression was analyzed by R version 4.1.3 to calculate adjusted P values (R Foundation for Statistical Computing, Vienna, Austria).
RESULTS
From 2017 to 2021, 131 patients with primary hyperparathyroidism underwent parathyroidectomies of 151 parathyroid glands. The mean near-infrared autofluorescence intensity of parathyroid glands had a negative correlation with weight with lighter glands fluorescing more (P = .019) and a positive correlation with age with glands from older patients fluorescing more (P = .013). There were no significant correlations with preoperative serum calcium and parathyroid hormone, body mass index, and sex (P > .05).
CONCLUSION
In patients with primary hyperparathyroidism, we found that autofluorescence intensity correlated with parathyroid gland weight and patient age. This suggested that near-infrared camera use may be particularly helpful in identifying smaller adenomas and in older patients.
Topics: Aged; Calcium; Humans; Hyperparathyroidism, Primary; Optical Imaging; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Spectroscopy, Near-Infrared
PubMed: 35981919
DOI: 10.1016/j.surg.2022.06.027 -
AJR. American Journal of Roentgenology Aug 2023Existing gaps in primary hyperparathyroidism (PHPT) diagnosis and treatment have prompted calls for systemic change in the approach to this disease. One proposed change...
Existing gaps in primary hyperparathyroidism (PHPT) diagnosis and treatment have prompted calls for systemic change in the approach to this disease. One proposed change is opportunistic assessment for enlarged parathyroid glands on routine CT examinations, to target biochemical testing to individuals most likely to have un-diagnosed PHPT. The purpose of our study was to assess the utility of a radiologist recommendation for biochemical testing in patients with a suspected enlarged parathyroid gland on routine CT for identifying previously undiagnosed PHPT. This retrospective study included patients without known or suspected PHPT who underwent routine CT (i.e., performed for reasons other than known or suspected parathyroid disease) between August 2019 and September 2021 in which the clinical CT report included a radiologist recommendation for biochemical testing to evaluate for possible PHPT because of a suspected enlarged parathyroid gland. Neuroradiologists at the study institution included this recommendation on the basis of individual judgment without formal criteria. The EHR was reviewed to identify patients who underwent subsequent laboratory evaluation for PHPT. An endocrine surgeon used available laboratory results and clinical data to classify patients as having PHPT, secondary hyper-parathyroidism, or no parathyroid disorder independent of the CT findings. The sample comprised 39 patients (median age, 68 years; 20 women, 19 men) who received the radiologist recommendation for biochemical evaluation. Of these patients, 13 (33.3%) received the recommended biochemical evaluation. Of the 13 tested patients, three (23.1%) were classified as having PHPT, four (30.8%) as having secondary hyperparathyroidism, and six (46.2%) as having no parathyroid disorder. Thus, the number of patients needing to receive a radiologist recommendation for biochemical testing per correct PHPT diagnosis was 13.0, and the number of patients needing to undergo laboratory testing per correct PHPT diagnosis was 4.3. One of the three patients classified as having PHPT underwent surgical resection of the lesion identified by CT, which was shown on histopathologic evaluation to represent hypercellular parathyroid tissue. Radiologist recommendations for biochemical testing in patients with suspected enlarged parathyroid glands on routine CT helped to identify individuals with undiagnosed PHPT. Opportunistic assessment for enlarged parathyroid glands on routine CT may facilitate PHPT diagnosis.
Topics: Male; Humans; Female; Aged; Parathyroid Glands; Hyperparathyroidism, Primary; Retrospective Studies; Tomography, X-Ray Computed; Parathyroidectomy
PubMed: 36946894
DOI: 10.2214/AJR.23.29049 -
Surgery Apr 1994There is considerable controversy about the arterial supply to the superior parathyroid glands. Knowledge of this blood supply should be important for the surgeon...
BACKGROUND
There is considerable controversy about the arterial supply to the superior parathyroid glands. Knowledge of this blood supply should be important for the surgeon performing thyroid and parathyroid operations. The purpose of this investigation was to document whether the superior parathyroid glands receive their blood supply from the superior thyroid artery.
METHODS
We injected contrast material into the superior thyroid artery in 52 cadavers and determined the arterial blood supply to the parathyroid glands by using a dissecting microscope.
RESULTS
The upper parathyroid gland was identified in 51 instances and the upper and lower glands in 26 instances on the side of injection. Of 92 parathyroid glands identified, 57 glands (62%) had a single artery, 26 (28%) had two, and 9 (10%) had three or more arteries. In 9 (45%) of the 20 cases specifically examined, a distinct anastomosing branch was identified between the inferior and the superior thyroid arteries, from which the upper parathyroid artery arose.
CONCLUSIONS
Our study documented that the superior thyroid artery almost always supplies the upper parathyroid glands. Forty-five percent of the subjects had a distinct anastomosing branch between the superior and inferior thyroid arteries, which should be kept intact at operation to preserve the upper parathyroid function. One third of the parathyroid glands have two or more parathyroid arteries.
Topics: Arteries; Blood Vessels; Cadaver; Contrast Media; Humans; Parathyroid Glands; Thyroid Gland
PubMed: 8165531
DOI: No ID Found -
Acta Oto-rhino-laryngologica Belgica 2001The paper describes the histology of the normal parathyroid gland and the histopathology of parathyroid adenoma, hyperplasia and carcinoma. The possibilities and... (Review)
Review
The paper describes the histology of the normal parathyroid gland and the histopathology of parathyroid adenoma, hyperplasia and carcinoma. The possibilities and limitations of intraoperative frozen sections are discussed. Finally the use of immunochemistry and other special studies in parathyroid pathology is mentioned.
Topics: Adenoma; Carcinoma; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Hyperplasia; Male; Monitoring, Intraoperative; Parathyroid Glands; Parathyroid Neoplasms
PubMed: 11441481
DOI: No ID Found -
Surgery Jan 2020The aim of this study was to determine both the accuracy of near infrared fluorescence imaging to detect parathyroid glands and the potential indications of near...
BACKGROUND
The aim of this study was to determine both the accuracy of near infrared fluorescence imaging to detect parathyroid glands and the potential indications of near infrared fluorescence imaging in thyroid and parathyroid surgery by correlating the autofluorescence signature with the pathologic specimen.
METHODS
This was an institutional review board-approved, prospective study of patients undergoing thyroidectomy and parathyroidectomy with near infrared fluorescence imaging. Each specimen sent to pathology was inspected with near infrared fluorescence imaging and predicted to be either parathyroid or non-parathyroid tissue by its autofluorescence signature and then correlated with the pathologic findings.
RESULTS
Autofluorescence was demonstrated to be present in 98% of the parathyroid glands, with 23% identified correctly with infrared based on the autofluorescence signature before visual identification by the surgeon. There were 550 specimens that were imaged with autofluorescence and then sent to pathology. For these samples, sensitivity, specificity, and positive and negative predictive values to predict parathyroid tissue were 98.5%, 97.2%, 95.1%, and 99.1%. In 5% of the total thyroidectomy specimens, incidentally resected parathyroid glands were identified with autofluorescence, leading to their subsequent reimplantation. In patients with parathyroid disease and negative preoperative localization, 21% of abnormal glands were recognized with autofluorescence before visual identification by the surgeon.
CONCLUSION
Although the ability of infrared autofluorescence to confirm the presence of parathyroid tissue within surgical specimens was high, its power to find parathyroid glands in situ before visual recognition by surgeons was low. These advantages and limitations should be kept in mind when incorporating this technology into an endocrine surgical practice. Once a parathyroid seems to have been identified by the surgeon or tissue that looks like a parathyroid gland is identified, the autofluorescence signature is a very accurate assurance of parathyroid tissue.
Topics: Adult; Aged; Female; Humans; Hypoparathyroidism; Intraoperative Care; Male; Middle Aged; Optical Imaging; Parathyroid Glands; Parathyroidectomy; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Thyroid Gland; Thyroidectomy
PubMed: 31526579
DOI: 10.1016/j.surg.2019.04.072 -
Nihon Rinsho. Japanese Journal of... Oct 1970
Review
Topics: Adenoma; Animals; Calcium; Gastric Juice; Humans; Hyperparathyroidism; Hypoparathyroidism; Parathyroid Diseases; Parathyroid Glands; Parathyroid Neoplasms; Peptic Ulcer; Rats
PubMed: 4921453
DOI: No ID Found