Translating near infrared autofluorescence for guiding pediatric endocrine neck surgeries

Project Summary This proposal aims to address the rate of hypocalcemia following thyroidectomy in the pediatric population using near infrared autofluorescence (NIRAF) of parathyroid glands. Thyroid cancer is one of the most common cancers affecting adolescents and young adults and permanent hypoparathyroidism is the most frequently reported complication following thyroidectomy. Post-operative hypoparathyroidism (PoSH), resulting from damage to the parathyroid glands or their vasculature, gives rise to hypocalcemia in 30-50% of cases transiently and up to 7% permanently. We have developed an approach based on NIRAF exhibited by the parathyroid glands and demonstrated clinical utility by showing that 97% of parathyroid glands have greater autofluorescence than surrounding tissues. The lab-built system used in these studies has since been commercialized as the FDA cleared PTeye® marketed by Medtronic. However, additional work has shown the autofluorescence from other neck tissues are more variable in the pediatric population, causing a higher false positive rate. Here, we propose a rigorous evaluation of the autofluorescence of pediatric neck tissues to aid in the specific translation of this technology to pediatric neck surgeries by tailoring the metrics used for this new patient population. To achieve this, we will characterize the spectral properties of parathyroid gland tissue in children (Aim 1) at five of the nation’s high-volume centers for pediatric thyroidectomies. The variation of NIRAF over time in the pediatric population will then be interrogated using parathyroid gland organoids (Aim 2) to better understand the underpinnings of the fluorescence signal. Finally, the findings from Aims 1 and 2 will be used to modify the PTeye® before deploying it in the clinic to characterize the short- and long-term outcomes of pediatric thyroidectomy among high-volume centers (Aim 3). Because this will be the first multi-center prospective study for pediatric thyroidectomies, Aim 3 will also serve to standardize the perioperative care and clinical outcome definitions, as current practice is extrapolated from adult procedures without pediatric-specific clinical standards.