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Near-infrared autofluorescence in thyroid and parathyroid surgery
Aimee N Di Marco1,2, Fausto F Palazzo1,2
1Department of Endocrine Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Gland Surgery
|March 17, 2020
Summary
Near-infrared autofluorescence (NIR-AF) can detect parathyroid glands during neck surgery, but its impact on patient outcomes like hypoparathyroidism remains unclear. More research is needed to establish its clinical value.
Area of Science:
- Surgical Technology
- Medical Imaging
- Endocrine Surgery
Background:
- Near-infrared autofluorescence (NIR-AF) allows for contrast-free visualization of parathyroid glands (PTGs) and thyroid tissue.
- PTGs exhibit brighter autofluorescence than surrounding tissues, aiding intraoperative identification.
- Over 25 reports confirm the feasibility and PTG detection capability of NIR-AF in neck endocrine surgery, with reported accuracies of 90-100%.
Purpose of the Study:
- To review the current evidence on the utility of NIR-AF in thyroidectomy and parathyroidectomy.
- To assess the impact of NIR-AF on key clinical outcomes, specifically post-operative hypoparathyroidism and hyperparathyroidism cure rates.
- To identify limitations and future research directions for NIR-AF in neck endocrine surgery.
Main Methods:
- Review of published literature on near-infrared autofluorescence in thyroid and parathyroid surgery.
- Analysis of studies reporting on the intraoperative detection of PTGs using NIR-AF devices.
- Evaluation of clinical outcome data, including post-operative hypoparathyroidism and hyperparathyroidism cure rates, from available studies.
Main Results:
- Intraoperative NIR-AF has demonstrated feasibility and high accuracy (90-100%) in detecting parathyroid glands.
- Data on the effect of NIR-AF on clinical outcomes like post-operative hypoparathyroidism is limited and shows conflicting results.
- Current evidence does not conclusively demonstrate improved clinical outcomes in thyroidectomy or parathyroidectomy due to NIR-AF.
Conclusions:
- While NIR-AF is effective for intraoperative PTG identification, its impact on clinical outcomes requires further investigation.
- Variability in AF signal and depth penetration limits its current utility in improving cure rates for hyperparathyroidism.
- Well-designed, multi-center randomized controlled trials are necessary to establish the role and cost-effectiveness of NIR-AF in routine neck endocrine surgery.
