Skip to content

Near Infrared Autofluorescence (NIRAF) Detection for Identifying Parathyroid Glands During Parathyroidectomy

Evaluating Impact of Near Infrared Autofluorescence (NIRAF) Detection for Identifying Parathyroid Glands During Parathyroidectomy

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT05152927
Enrollment
79
Registered
2021-12-10
Start date
2022-01-10
Completion date
2024-11-30
Last updated
2025-12-15

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Adenoma, Endocrine Gland Neoplasms, Hypercalcemia, Hyperparathyroidism, Hyperparathyroidism, Primary, Neoplasms, Glandular and Epithelial, Parathyroid Adenoma, Parathyroid Diseases, Parathyroid Dysfunction, Parathyroid Neoplasms

Keywords

Near Infrared Autofluorescence, Parathyroidectomy, Intraoperative Parathyroid Identification, Persistent Hyperparathyroidism, Persistent Hypercalcemia, Failed Parathyroidectomy, Repeat Parathyroidectomy

Brief summary

The goal of this study is to assess whether using PTeye (AiBiomed, Santa Barbara, CA) - a NIRAF detection modality - can improve patient outcomes and reduce healthcare associated costs after parathyroid surgeries. By being able to quickly and definitively locate parathyroid glands while in the operating room, the duration of surgical procedure could be further reduced. In addition, the number of frozen section biopsy and associated costs can be minimized. Furthermore, repeat surgeries as a result of missing a diseased parathyroid gland at the time of the initial parathyroidectomy for hyperparathyroidism could potentially be avoided.

Detailed description

This is a prospective, single-blinded, randomized study comparing the use of PTeye during parathyroidectomy to usual standard practice. PRIMARY OBJECTIVES: I. Assess the impact of PTeye on intra-operative identification of parathyroid tissues. II. Assess the impact of PTeye on improving efficiency of parathyroid surgeries. III. Assess the impact of PTeye on minimizing risk of post-surgical complications. Participants will be randomized to either the experimental or control arm. The surgeon will first take 5 baseline NIRAF measurements on the thyroid gland (or neck muscles, if thyroid is absent) using the disposable sterile fiber probe that is connected to the PTeye console, as per device functionality requirements. The subsequent step would involve touching the target tissue in the neck with the fiber optic probe, following which the PTeye will indicate to the surgeon if the tissue is likely parathyroid or not. For patients assigned to the control arm, the surgeon will not use the PTeye and will proceed with the parathyroid surgery as usual, while relying solely on her/his surgical experience in identifying the parathyroid glands during the operations. Participants will be follow-ed up for up to 6 months after surgery.

Interventions

DEVICEParathyroid Eye (PTeye)

Intraoperative Tool

Sponsors

Vanderbilt University Medical Center
CollaboratorOTHER
National Cancer Institute (NCI)
CollaboratorNIH
University of California, San Francisco
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)

Masking description

Only participants will be masked to the intervention

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* All adults \>=18 years old) patients with primary hyperparathyroidism who will be undergoing parathyroid surgery * All adult (\>=18 years old) patients with persistent primary hyperparathyroidism after having undergone a failed prior parathyroid surgery who will be undergoing repeat parathyroid surgery

Exclusion criteria

* Children and minors * Pregnant women * Patients with concurrent parathyroid and thyroid disease that require total thyroidectomy * Patients with secondary or tertiary hyperparathyroidism

Design outcomes

Primary

MeasureTime frameDescription
Median Number of Frozen Sections (or Parathyroid Aspirate) Sent for AnalysisAt the end of the parathyroidectomy, up to 5 hoursMedian number of frozen sections (or aspirate) sent for analysis during the parathyroidectomy (PTx) procedure to confirm potential parathyroid tissue

Secondary

MeasureTime frameDescription
Number of Participants With Persistent Hyperparathyroidism or Hypercalcemia (Transient)5-14 days after PTx procedureElevated blood calcium levels (total blood calcium level \> 10.5 mg/dL or 2.6 mmol/L) with/without elevated parathyroid hormone (PTH) (serum intact PTH \> 65 pg/ml or 6.9 pmol/L) at first postoperative visit. Participants will be categorized as having persistent hyperparathyroidism or hypercalcemia (transient) Yes or No.
Number of Participants Persistent Hyperparathyroidism or Hypercalcemia (Failed Parathyroidectomy)Up to 6 months after PTx procedureIf blood calcium with/without parathyroid hormone (PTH) has not normalized at 1st post-operative visit, calcium and/or PTH is subsequently measured as necessary. Patient is defined to have a failed parathyroidectomy if hypercalcemia/hyperparathyroidism (defined as total blood calcium level \> 10.5 mg/dL or 2.6 mmol/L, with/without elevated serum intact PTH \> 65 pg/ml or 6.9 pmol/L) persists at or after the 6th postoperative month. Participants will be categorized has having persistent hyperparathyroidism or hypercalcemia (failed parathyroidectomy), Yes or No.
Number of Parathyroid Glands (PG) IdentifiedAt the end of the parathyroidectomy, up to 5 hoursOverall number of parathyroid glands identified (Combined both the experimental Group (Glands identified with naked eye + NIRAF) and Control Group (Glands identified with naked eye)
Median Number of Parathyroid Glands Identified With NIRAF (PTeye Group Only)At the end of the parathyroidectomy, up to 5 hoursMedian number of parathyroid glands identified with NIRAF, which was not seen with surgeon's naked eye during bilateral neck explorations (where the surgeon is looking for more than 1 parathyroid gland)
Median Number of Diseased Parathyroid Glands Identified Versus Preoperatively Localized GlandsAt the end of the parathyroidectomy, up to 5 hoursMedian number of diseased parathyroid glands identified intra-operatively versus glands localized preoperatively using sestamibi, Computerized tomography (CT) or ultrasound
Median Number of Intra-operative Parathyroid Hormone (PTH) Assays SentAt the end of the parathyroidectomy, up to 5 hoursThe median number of intra-operative parathyroid hormone assays (per person) sent during the procedure to the lab
Median Duration Taken to Identify First Parathyroid GlandDuring parathyroidectomy, up to 5 hoursMedian duration in minutes taken to identify 1st parathyroid gland in PTx procedure - timed from skin incision to finding PG
Number of Participants With Persistent Hyperparathyroidism (Immediate)5-14 days after PTx procedureFailure of intra-operative parathyroid hormone (PTH) to normalize (defined as failure of PTH to drop \> 50% of its baseline value at final intra-operative PTH assay and/or failure of PTH to drop \< 65 pg/ml or 6.9 pmol/L). Participants will be categorized as having persistent hyperparathyroidism (Immediate) Yes or No.
Median Duration of Parathyroidectomy (PTx) ProcedureUp to 5 hoursMedian duration of PTx procedure - timed from skin incision until the surgeon notifies the anesthesia team to awaken the patient in minutes
Median Duration for Intraoperative Parathyroid Hormone (PTH) to NormalizeAt the end of the parathyroidectomy, up to 5 hoursMedian time in minutes taken for PTH to attain cure criteria or normalize - timed from skin incision until the PTH levels drops \> 50% of its baseline value and/or PTH drops \< 65 pg/ml or 6.9 pmol/L
Median Number of Nights in the Hospital After Parathyroidectomy0-72 hours after PTx procedureMedian number of nights spent in the hospital post-surgery is defined as having spent \<= 23 hours (0 nights) or \> 23 hours (1 night) at the hospital for postoperative recovery after the surgical procedure. Participants who had surgery scheduled for later in the day will be counted as spending one night in the hospital due to the minimum required observation period post-surgery and followed institutional standards for discharge; discharged the next day. Participants who had surgery scheduled for earlier in the day were discharged on the same day of surgery.
Median Number of 'False Positive' Tissue Samples Excised by SurgeonUp to 10 days after PTx procedureThe median number of tissues per person that were excised by surgeon assumed to be parathyroid tissue, but is later validated as non-parathyroid tissue (false positive) by histology
Number of Participants With Reported Doctor Visits/Emergency Department Visits or Hospital AdmissionsUp to 6 months after PTx procedureNumber of participants who required a doctor visit/emergency department visit and/or hospital admission due to persistent hypercalcemia and/or associated symptoms after the parathyroidectomy procedure will be categorized as binary (yes or no) if any follow-up visits or admissions occurred.
Number of Participants Who Have Had Repeat Parathyroidectomy (PTx) ProcedureFrom 6 - 12 months after PTx procedureNumber of participants with an indication that repeat PTx procedure may need to be performed after the current procedure will be categorized as binary (yes or no)
Median Duration Taken to Identify Last Parathyroid GlandAt the end of the parathyroidectomy, up to 5 hoursMedian duration taken to identify last parathyroid gland in PTx procedure - timed from skin incision to finding the last PG

Countries

United States

Participant flow

Participants by arm

ArmCount
Parathyroid Eye (PTeye)
For participants assigned to the study arm, the surgeon will use the PTeye as an intraoperative tool to identify if a suspect tissue is a parathyroid or not, during the parathyroid surgery.
38
Usual Standard of Care
The surgeon will proceed with the parathyroid surgery as usual, while relying solely on her/his surgical experience in identifying the parathyroid glands during the operations.
41
Total79

Baseline characteristics

CharacteristicParathyroid Eye (PTeye)TotalUsual Standard of Care
Age, Continuous68 years67 years64 years
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants5 Participants4 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
37 Participants73 Participants36 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants1 Participants1 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
4 Participants7 Participants3 Participants
Race (NIH/OMB)
Black or African American
2 Participants4 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
1 Participants2 Participants1 Participants
Race (NIH/OMB)
Unknown or Not Reported
4 Participants12 Participants8 Participants
Race (NIH/OMB)
White
27 Participants54 Participants27 Participants
Region of Enrollment
United States
38 participants79 participants41 participants
Sex: Female, Male
Female
27 Participants57 Participants30 Participants
Sex: Female, Male
Male
11 Participants22 Participants11 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 380 / 41
other
Total, other adverse events
0 / 380 / 41
serious
Total, serious adverse events
2 / 385 / 41

Outcome results

Primary

Median Number of Frozen Sections (or Parathyroid Aspirate) Sent for Analysis

Median number of frozen sections (or aspirate) sent for analysis during the parathyroidectomy (PTx) procedure to confirm potential parathyroid tissue

Time frame: At the end of the parathyroidectomy, up to 5 hours

ArmMeasureValue (MEDIAN)
Parathyroid Eye (PTeye)Median Number of Frozen Sections (or Parathyroid Aspirate) Sent for Analysis0 frozen aspirate samples
Usual Standard of CareMedian Number of Frozen Sections (or Parathyroid Aspirate) Sent for Analysis0 frozen aspirate samples
Secondary

Median Duration for Intraoperative Parathyroid Hormone (PTH) to Normalize

Median time in minutes taken for PTH to attain cure criteria or normalize - timed from skin incision until the PTH levels drops \> 50% of its baseline value and/or PTH drops \< 65 pg/ml or 6.9 pmol/L

Time frame: At the end of the parathyroidectomy, up to 5 hours

ArmMeasureValue (MEDIAN)
Parathyroid Eye (PTeye)Median Duration for Intraoperative Parathyroid Hormone (PTH) to Normalize76 minutes
Usual Standard of CareMedian Duration for Intraoperative Parathyroid Hormone (PTH) to Normalize66 minutes
Secondary

Median Duration of Parathyroidectomy (PTx) Procedure

Median duration of PTx procedure - timed from skin incision until the surgeon notifies the anesthesia team to awaken the patient in minutes

Time frame: Up to 5 hours

ArmMeasureValue (MEDIAN)
Parathyroid Eye (PTeye)Median Duration of Parathyroidectomy (PTx) Procedure87 minutes
Usual Standard of CareMedian Duration of Parathyroidectomy (PTx) Procedure82 minutes
Secondary

Median Duration Taken to Identify First Parathyroid Gland

Median duration in minutes taken to identify 1st parathyroid gland in PTx procedure - timed from skin incision to finding PG

Time frame: During parathyroidectomy, up to 5 hours

Population: Data was not collected for one participant from each group

ArmMeasureValue (MEDIAN)
Parathyroid Eye (PTeye)Median Duration Taken to Identify First Parathyroid Gland38 minutes
Usual Standard of CareMedian Duration Taken to Identify First Parathyroid Gland31 minutes
Secondary

Median Duration Taken to Identify Last Parathyroid Gland

Median duration taken to identify last parathyroid gland in PTx procedure - timed from skin incision to finding the last PG

Time frame: At the end of the parathyroidectomy, up to 5 hours

Population: Data was not collected for one participant from each group

ArmMeasureValue (MEDIAN)
Parathyroid Eye (PTeye)Median Duration Taken to Identify Last Parathyroid Gland48 minutes
Usual Standard of CareMedian Duration Taken to Identify Last Parathyroid Gland35 minutes
Secondary

Median Number of Diseased Parathyroid Glands Identified Versus Preoperatively Localized Glands

Median number of diseased parathyroid glands identified intra-operatively versus glands localized preoperatively using sestamibi, Computerized tomography (CT) or ultrasound

Time frame: At the end of the parathyroidectomy, up to 5 hours

ArmMeasureGroupValue (MEDIAN)
Parathyroid Eye (PTeye)Median Number of Diseased Parathyroid Glands Identified Versus Preoperatively Localized GlandsIntra-operatively1 parathyroid glands
Parathyroid Eye (PTeye)Median Number of Diseased Parathyroid Glands Identified Versus Preoperatively Localized GlandsLocalized pre-operatively1 parathyroid glands
Usual Standard of CareMedian Number of Diseased Parathyroid Glands Identified Versus Preoperatively Localized GlandsIntra-operatively1 parathyroid glands
Usual Standard of CareMedian Number of Diseased Parathyroid Glands Identified Versus Preoperatively Localized GlandsLocalized pre-operatively1 parathyroid glands
Secondary

Median Number of 'False Positive' Tissue Samples Excised by Surgeon

The median number of tissues per person that were excised by surgeon assumed to be parathyroid tissue, but is later validated as non-parathyroid tissue (false positive) by histology

Time frame: Up to 10 days after PTx procedure

ArmMeasureValue (MEDIAN)
Parathyroid Eye (PTeye)Median Number of 'False Positive' Tissue Samples Excised by Surgeon0 tissue samples
Usual Standard of CareMedian Number of 'False Positive' Tissue Samples Excised by Surgeon0 tissue samples
Secondary

Median Number of Intra-operative Parathyroid Hormone (PTH) Assays Sent

The median number of intra-operative parathyroid hormone assays (per person) sent during the procedure to the lab

Time frame: At the end of the parathyroidectomy, up to 5 hours

ArmMeasureValue (MEDIAN)
Parathyroid Eye (PTeye)Median Number of Intra-operative Parathyroid Hormone (PTH) Assays Sent5 assays
Usual Standard of CareMedian Number of Intra-operative Parathyroid Hormone (PTH) Assays Sent5 assays
Secondary

Median Number of Nights in the Hospital After Parathyroidectomy

Median number of nights spent in the hospital post-surgery is defined as having spent \<= 23 hours (0 nights) or \> 23 hours (1 night) at the hospital for postoperative recovery after the surgical procedure. Participants who had surgery scheduled for later in the day will be counted as spending one night in the hospital due to the minimum required observation period post-surgery and followed institutional standards for discharge; discharged the next day. Participants who had surgery scheduled for earlier in the day were discharged on the same day of surgery.

Time frame: 0-72 hours after PTx procedure

ArmMeasureGroupValue (MEDIAN)
Parathyroid Eye (PTeye)Median Number of Nights in the Hospital After Parathyroidectomy<= 23 hours0 number of nights
Parathyroid Eye (PTeye)Median Number of Nights in the Hospital After Parathyroidectomy> 23 hours1 number of nights
Usual Standard of CareMedian Number of Nights in the Hospital After Parathyroidectomy<= 23 hours0 number of nights
Usual Standard of CareMedian Number of Nights in the Hospital After Parathyroidectomy> 23 hours1 number of nights
Secondary

Median Number of Parathyroid Glands Identified With NIRAF (PTeye Group Only)

Median number of parathyroid glands identified with NIRAF, which was not seen with surgeon's naked eye during bilateral neck explorations (where the surgeon is looking for more than 1 parathyroid gland)

Time frame: At the end of the parathyroidectomy, up to 5 hours

Population: Only 4 participants had glands identified with NIRAF, which was not seen with surgeon's naked eye

ArmMeasureValue (MEDIAN)
Parathyroid Eye (PTeye)Median Number of Parathyroid Glands Identified With NIRAF (PTeye Group Only)1 parathyroid glands
Secondary

Number of Parathyroid Glands (PG) Identified

Overall number of parathyroid glands identified (Combined both the experimental Group (Glands identified with naked eye + NIRAF) and Control Group (Glands identified with naked eye)

Time frame: At the end of the parathyroidectomy, up to 5 hours

ArmMeasureValue (NUMBER)
Parathyroid Eye (PTeye)Number of Parathyroid Glands (PG) Identified45 parathyroid glands
Usual Standard of CareNumber of Parathyroid Glands (PG) Identified45 parathyroid glands
Secondary

Number of Participants Persistent Hyperparathyroidism or Hypercalcemia (Failed Parathyroidectomy)

If blood calcium with/without parathyroid hormone (PTH) has not normalized at 1st post-operative visit, calcium and/or PTH is subsequently measured as necessary. Patient is defined to have a failed parathyroidectomy if hypercalcemia/hyperparathyroidism (defined as total blood calcium level \> 10.5 mg/dL or 2.6 mmol/L, with/without elevated serum intact PTH \> 65 pg/ml or 6.9 pmol/L) persists at or after the 6th postoperative month. Participants will be categorized has having persistent hyperparathyroidism or hypercalcemia (failed parathyroidectomy), Yes or No.

Time frame: Up to 6 months after PTx procedure

Population: Participants from both groups were missing labs. Not all PTEye participants returned to the clinic for blood draws within 5-14 days to obtain lab values required to calculate this endpoint and standard clinical care does not necessitate participants returning for labs routinely at each follow-up time points.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Parathyroid Eye (PTeye)Number of Participants Persistent Hyperparathyroidism or Hypercalcemia (Failed Parathyroidectomy)0 Participants
Usual Standard of CareNumber of Participants Persistent Hyperparathyroidism or Hypercalcemia (Failed Parathyroidectomy)1 Participants
Secondary

Number of Participants Who Have Had Repeat Parathyroidectomy (PTx) Procedure

Number of participants with an indication that repeat PTx procedure may need to be performed after the current procedure will be categorized as binary (yes or no)

Time frame: From 6 - 12 months after PTx procedure

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Parathyroid Eye (PTeye)Number of Participants Who Have Had Repeat Parathyroidectomy (PTx) Procedure0 Participants
Usual Standard of CareNumber of Participants Who Have Had Repeat Parathyroidectomy (PTx) Procedure1 Participants
Secondary

Number of Participants With Persistent Hyperparathyroidism (Immediate)

Failure of intra-operative parathyroid hormone (PTH) to normalize (defined as failure of PTH to drop \> 50% of its baseline value at final intra-operative PTH assay and/or failure of PTH to drop \< 65 pg/ml or 6.9 pmol/L). Participants will be categorized as having persistent hyperparathyroidism (Immediate) Yes or No.

Time frame: 5-14 days after PTx procedure

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Parathyroid Eye (PTeye)Number of Participants With Persistent Hyperparathyroidism (Immediate)0 Participants
Usual Standard of CareNumber of Participants With Persistent Hyperparathyroidism (Immediate)1 Participants
Secondary

Number of Participants With Persistent Hyperparathyroidism or Hypercalcemia (Transient)

Elevated blood calcium levels (total blood calcium level \> 10.5 mg/dL or 2.6 mmol/L) with/without elevated parathyroid hormone (PTH) (serum intact PTH \> 65 pg/ml or 6.9 pmol/L) at first postoperative visit. Participants will be categorized as having persistent hyperparathyroidism or hypercalcemia (transient) Yes or No.

Time frame: 5-14 days after PTx procedure

Population: Participants from both groups were missing labs. Not all PTEye participants returned to the clinic for blood draws within 5-14 days to obtain lab values required to calculate this endpoint and standard clinical care does not necessitate participants returning for labs routinely at each follow-up time points.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Parathyroid Eye (PTeye)Number of Participants With Persistent Hyperparathyroidism or Hypercalcemia (Transient)0 Participants
Usual Standard of CareNumber of Participants With Persistent Hyperparathyroidism or Hypercalcemia (Transient)0 Participants
Secondary

Number of Participants With Reported Doctor Visits/Emergency Department Visits or Hospital Admissions

Number of participants who required a doctor visit/emergency department visit and/or hospital admission due to persistent hypercalcemia and/or associated symptoms after the parathyroidectomy procedure will be categorized as binary (yes or no) if any follow-up visits or admissions occurred.

Time frame: Up to 6 months after PTx procedure

ArmMeasureValue (NUMBER)
Parathyroid Eye (PTeye)Number of Participants With Reported Doctor Visits/Emergency Department Visits or Hospital Admissions5 participants
Usual Standard of CareNumber of Participants With Reported Doctor Visits/Emergency Department Visits or Hospital Admissions8 participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026