Establishing a Predictive Perfusion Threshold Using SPY-PHI QP in Staged Breast Reconstruction: A Prospective Evaluation With Nitroglycerin Adjustment
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ID: 314578
2026
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Abstract
BACKGROUND: The SPY Fluorescence Imaging system enables intraoperative visualization of microvascular perfusion. Recently, SPY has been integrated with Quantitative Perfusion (QP) software to provide numerical assessment of relative tissue perfusion; however, clinically actionable perfusion thresholds predictive of mastectomy skin necrosis complications have not been clearly established. OBJECTIVES: To evaluate the predictive performance of proposed SPY-PHI QP perfusion thresholds in patients undergoing staged breast reconstruction and to explore a QP-specific cutoff while accounting for nitroglycerin ointment use as a potential confounder. METHODS: Patients undergoing staged breast reconstruction with tissue expander placement were included. SPY-PHI QP was used intraoperatively to assess relative perfusion. Diagnostic performance metrics-including sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and odds ratios-were calculated. A sub-analysis excluding patients who received nitroglycerin ointment was performed to identify a QP-specific cutoff in unmanipulated tissue. RESULTS: Fifty-eight patients (83 breasts) were included. Using a 33% perfusion threshold, SPY-PHI QP® demonstrated high sensitivity (87.5%) and negative predictive value (98.3%) for mastectomy skin flap necrosis. After adjusting for nitroglycerin use, the association between low perfusion and mastectomy skin flap necrosis was attenuated. In patients who did not receive nitroglycerin, a perfusion threshold of 30% demonstrated optimal diagnostic performance (sensitivity 100%, specificity 76.7%, AUC 0.8875). CONCLUSIONS: SPY-PHI QP provides quantitative, real-time assessment of tissue perfusion during breast reconstruction. In patients not treated with nitroglycerin, a 30% perfusion threshold may be predictive of wound complications. These findings support further investigation of QP-specific thresholds in larger, prospective studies that account for adjunctive interventions.
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| Authors | Nikki Rezania, Kelly A. Harmon, Okensama La-Anyane, A Fritsch, Helen Jeon, Michelle Seu, Quyen Diep, George Kokosis |
| Journal | Aesthetic surgery journal |
| Year | 2026 |
| DOI |
10.1093/asj/sjag099
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| URL | |
| Keywords | Keywords not found |
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