Related Experiment Video
Updated: Sep 20, 2026
Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging
Published on: August 17, 2022
Visual Parathyroid Identification in Thyroidectomy: A Decision Curve Analysis of Gland Preservation
Paveena Pithuksurachai1, Warut Pongsapich1, Noppadon Triprateepsilp2
1Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Objective:
To evaluate the clinical utility and net benefit of intraoperative visual identification for parathyroid preservation during thyroidectomy using decision curve analysis (DCA).
Methods:
Suspected parathyroid tissues (n = 50) were identified intraoperatively by junior staff and residents and photographed for independent consensus review by three expert otolaryngologists. Fine-needle aspiration parathyroid hormone washout (electrochemiluminescence immunoassay; ≥ 100 pg/mL) served as the surrogate biochemical reference standard. Diagnostic performance was assessed using contingency tables, logistic regression, receiver operating characteristic analysis, and DCA.
Results:
Expert visual identification achieved 84.0% sensitivity, 44.0% specificity, and 64.0% accuracy. Positive predictive values were 60.0% for experts, 51.5% for junior staff, and 47.1% for residents (p = 0.632). Logistic regression yielded odds ratios of 1.69 for experts (p = 0.380) and 1.20 for junior staff (p = 0.765); model AUC was 0.56. DCA showed greater net benefit than "Treat All" and "Treat None" strategies at a clinically relevant threshold probability of 27%.
Conclusion:
Visual identification demonstrates limited diagnostic accuracy that did not differ significantly across experience levels, although this comparison is constrained by differing assessment conditions. The low specificity underscores the need for objective adjunctive confirmation and supports evaluating biochemical and optical adjuncts in future prospective studies.
