Prognostic value of intraoperative neural monitoring of the recurrent laryngeal nerve in thyroid surgery
PurposeThe diagnostic accuracy of intraoperative recurrent laryngeal nerve (RLN) monitoring (IONM) remains controversial. The aim of this study was to evaluate IONM diagnostic accuracy in prognostication of postoperative nerve function in thyroid surgery.MethodsThis prospective study was conducted in 2011 2013. Five hundred consenting patients qualified for total thyroidectomy with IONM (1000 nerves at risk) using NIM 3.0 Response equipment were included. Laryngoscopy was used to evaluate and follow up RLN injury. The primary outcome was diagnostic accuracy of IONM. The receiver operating characteristics (ROC) were used for evaluation of IONM diagnostic accuracy.ResultsLoss of signal (LOS) occurred in 31 cases, including 25 patients with LOS and corresponding vocal fold paresis found in postoperative laryngoscopy (2.5 including 20 (2.0 temporary and 5 (0.5 permanent nerve lesions. The following diagnostic accuracy values were calculated for the criterion recommended by INMSG (V2 amplitude 100 mV) sensitivity 92.0 specificity 99.3 positive predictive value (PPV) 76.7 and negative predictive value (NPV) 99.8 The ROC curve analysis allowed for calculation of the most optimal criterion in prognostication of postoperative vocal fold paresis, namely, V2 amplitude 189 mV. For this criterion, PPV was 77.4 while NPV was 99.9 .ConclusionsAdherence to the standardized protocol recommended by the International Neural Monitoring Study Group allows for optimizing predictive values of IONM in prognostication of postoperative RLN function. Any changes in the cutoff values for the definition of LOS only marginally improve PPV and NPV of IONM and need to be carefully assessed in multicenter studies.
Langenbeck's Archives of Surgery