研究目的
To evaluate the performance of a simple quantitative score based on ICG angiography of the parathyroid glands (4-ICG score) for predicting postoperative hypocalcemia in patients undergoing total thyroidectomy for multinodular goiter.
研究成果
The 4-ICG score effectively predicts postoperative hypocalcemia and correlates with parathyroid function, with a high negative predictive value for scores above 3. It could be a useful tool for intraoperative assessment and guiding patient management, such as early discharge for low-risk patients. However, larger studies are needed to confirm these findings.
研究不足
The main limitation is the small sample size. Only patients with multinodular goiter were included, so results may not generalize to other conditions. Parathyroid glands were identified visually without biopsy, which could affect accuracy. The assessment of ICG angiography was subjective due to lack of specialized equipment for fluorescence quantification.
1：Experimental Design and Method Selection:
A prospective study design was used to evaluate the 4-ICG score. The score was calculated by summing the viability values (0, 1, or 2) of all four parathyroid glands based on ICG angiography findings. Discrimination and correlation analyses were performed using statistical methods.
2：Sample Selection and Data Sources:
Consecutive patients undergoing total thyroidectomy for multinodular goiter were included from two tertiary hospitals. Exclusion criteria included allergy to ICG, renal or hepatic impairment, concurrent parathyroid disease, previous thyroid/parathyroid surgery, or iodine 131 treatment.
3：List of Experimental Equipment and Materials:
Indocyanine green (ICG) dye, laparoscopic PinPoint camera (Nodadaq, Ontario, Canada), sterile water for dilution, peripheral venous access equipment, and standard surgical tools for thyroidectomy.
4：Experimental Procedures and Operational Workflow:
Total thyroidectomy was performed with attention to preserve parathyroid glands. After thyroid removal, ICG angiography was conducted by administering ICG intravenously and imaging with the PinPoint camera. Black and white images were recorded for later analysis by trained observers to assign viability scores. The 4-ICG score was calculated for each patient. Postoperative calcium and PTH levels were measured at specified times.
5：Data Analysis Methods:
Statistical analysis included Kolmogorov-Smirnov test for normality, Student t-test or Mann-Whitney U test for continuous variables, chi-square test for categorical variables, ROC curve analysis for discrimination, Hosmer-Lemeshow test for calibration, and Spearman's correlation for associations. SPSS version 22.0 was used.
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