Negative and positive predictive values of nerve monitoring in thyroidectomy

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorCERNEA, Claudio R.
dc.contributor.authorBRANDAO, Lenine G.
dc.contributor.authorHOJAIJ, Flavio C.
dc.contributor.authorCARLUCCI JR., Dorival De
dc.contributor.authorBRANDAO, Jose
dc.contributor.authorCAVALHEIRO, Beatriz
dc.contributor.authorSONDERMANN, Adriana
dc.date.accessioned2013-07-30T14:39:08Z
dc.date.available2013-07-30T14:39:08Z
dc.date.issued2012
dc.description.abstractBackground Recurrent nerve injury is 1 of the most important complications of thyroidectomy. During the last decade, nerve monitoring has gained increasing acceptance in several centers as a method to predict and to document nerve function at the end of the operation. We evaluated the efficacy of a nerve monitoring system in a series of patients who underwent thyroidectomy and critically analyzed the negative predictive value (NPV) and positive predictive value (PPV) of the method. Methods. NIM System efficacy was prospectively analyzed in 447 patients who underwent thyroidectomy between 2001 and 2008 (366 female/81 male; 420 white/47 nonwhite; 11 to 82 years of age; median, 43 years old). There were 421 total thyroidectomies and 26 partial thyroidectomies, leading to 868 nerves at risk. The gold standard to evaluate inferior laryngeal nerve function was early postoperative videolaryngoscopy, which was repeated after 4 to 6 months in all patients with abnormal endoscopic findings. Results. At the early evaluation, 858 nerves (98.8%) presented normal videolaryngoscopic features after surgery. Ten paretic/paralyzed nerves (1.2%) were detected (2 unexpected unilateral paresis, 2 unexpected bilateral paresis, 1 unexpected unilateral paralysis, 1 unexpected bilateral paralyses, and 1 expected unilateral paralysis). At the late videolaryngoscopy, only 2 permanent nerve paralyses were noted (0.2%), with an ultimate result of 99.8% functioning nerves. Nerve monitoring showed absent or markedly reduced electrical activity at the end of the operations in 25/868 nerves (2.9%), including all 10 endoscopically compromised nerves, with 15 false-positive results. There were no false-negative results. Therefore, the PPV was 40.0%, and the NPV was 100%. Conclusions. In the present series, nerve monitoring had a very high PPV but a low NPV for the detection of recurrent nerve injury. (C) 2011 Wiley Periodicals, Inc. Head Neck 34: 175-179, 2012
dc.description.indexMEDLINE
dc.identifier.citationHEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK, v.34, n.2, p.175-179, 2012
dc.identifier.doi10.1002/hed.21695
dc.identifier.issn1043-3074
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/360
dc.language.isoeng
dc.publisherWILEY-BLACKWELL
dc.relation.ispartofHead and Neck-Journal for the Sciences and Specialties of the Head and Neck
dc.rightsrestrictedAccess
dc.rights.holderCopyright WILEY-BLACKWELL
dc.subjectthyroidectomy
dc.subjectnerve monitoring
dc.subjectlaryngeal nerves
dc.subjectrecurrent nerve
dc.subjectlaryngeal paralysis
dc.subject.otherrecurrent laryngeal nerve
dc.subject.otherintraoperative identification
dc.subject.otherinjury
dc.subject.otherrisk
dc.subject.wosOtorhinolaryngology
dc.subject.wosSurgery
dc.titleNegative and positive predictive values of nerve monitoring in thyroidectomy
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalHOJAIJ, Flavio C.:Dept Head & Neck Surg, Sao Paulo, Brazil; Albert Einstein Jewish Hosp, Sao Paulo, Brazil
hcfmusp.author.externalBRANDAO, Jose:Univ Sao Paulo, Sch Med, Sao Paulo, Brazil; Dept Head & Neck Surg, Sao Paulo, Brazil; Albert Einstein Jewish Hosp, Sao Paulo, Brazil
hcfmusp.citation.scopus30
hcfmusp.contributor.author-fmusphcCLAUDIO ROBERTO CERNEA
hcfmusp.contributor.author-fmusphcLENINE GARCIA BRANDAO
hcfmusp.contributor.author-fmusphcDORIVAL DE CARLUCCI JUNIOR
hcfmusp.contributor.author-fmusphcBEATRIZ GODOI CAVALHEIRO
hcfmusp.contributor.author-fmusphcADRIANA SONDERMANN DE AFONSECA
hcfmusp.description.beginpage175
hcfmusp.description.endpage179
hcfmusp.description.issue2
hcfmusp.description.volume34
hcfmusp.lim.ref2012
hcfmusp.origemWOS
hcfmusp.origem.pubmed21413099
hcfmusp.origem.scopus2-s2.0-84855691032
hcfmusp.origem.wosWOS:000298881300006
hcfmusp.publisher.cityMALDEN
hcfmusp.publisher.countryUSA
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