OP55 – Developing a clinical prototype for label-free rapid intra-operative parathyroid identification during thyroid cancer surgeries

      Thomas, Giju1; Sanders, Melinda E.2; Solórzano, Carmen C.3; Mahadevan-Jansen, Anita1 1 Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA 2 Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA 3 Department of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA   Background: Difficulty in identifying parathyroids during thyroid cancer surgeries, often leads to accidental parathyroid excisions and eventual post-surgical hypocalcemia1. This necessitates time-consuming frozen section examinations for parathyroid identification. This study aims to translate a near-infrared fluorescence detection lab-built system into a clinical prototype for label-free intraoperative parathyroid identification. Method: A lab-built system was first tested for parathyroid identification across 20 patients undergoing thyroidectomy and/or parathyroidectomy with 134 parathyroid, 106 thyroid, 53 muscle, 57 fat and 53 tracheal measurements to validate earlier studies2, 3.  A clinical prototype called PTEye was subsequently designed with a user-friendly interface to function with operation room (OR) lights turned on. PTEye was then tested across 20 patients with 120 parathyroid, 109 thyroid, 40 muscle, 40 fat and 40 tracheal measurements. Accuracy was determined and compared between both systems by correlating the acquired data with visual confirmation by surgeon for unexcised parathyroids or histology reports for excised parathyroids. Results: Both systems provided results in real-time and neither required fluorescent dye/label injections. For in vivo parathyroid identification, the lab-built system had a sensitivity of 96.3% and specificity of 94.2% with OR lights necessarily switched off. In comparison, PTEye could identify parathyroids with a sensitivity of 100% and specificity of 96.1% in spite of OR lights remaining on.  Conclusion: PTEye demonstrated high accuracy for label-free intraoperative parathyroid identification. The intuitive interface of PTEye and its ability to rapidly identify parathyroid with ambient OR lights ensures easy usability for surgeons. Eventual clinical translation would require multi-centric testing of PTEye.   References:
    1. Sitges-Serra A, Gallego-Otaegui L, Suárez S, Lorente-Poch L, Munné A, Sancho JJ. Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma. Surgery. 2017 Mar;161(3):712-719
    2. McWade MA, Paras C, White LM, Phay JE, Mahadevan-Jansen A, Broome JT. A novel optical approach to intraoperative detection of parathyroid glands. Surgery 2013; 154(6):1371-1377
    3. McWade MA, Sanders ME, Broome JT, Solórzano CC, Mahadevan-Jansen A. Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery 2016; 159(1):193-203


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