Meta-Analysis of Image-Based Versus Probe-Based Parathyroid Near-Infrared Autofluorescence

Proper identification of parathyroid tissue is a critical component in surgery involving the thyroid and parathyroid gland (PG). In recent years, near infrared autofluorescence (NIRAF) has been investigated as a non-invasive strategy to detect PG in parathyroidectomy and in PG preservation in thyroidectomy. There are currently two FDA approved NIRAF modalities, image-based and probe-based. The aim of this meta-analysis is to evaluate the efficacy of these two NIRAF modalities. PubMed, Scopus, and MEDLINE were utilized, with 238 studies analyzed via independent, blinded review. Studies from January 2000 to February 2023, Boolean phrase "parathyroid autofluorescence", written in English, and included results found within the body of the article were the inclusion criteria used. Conference abstracts, reviews, case reports, commentary, discussion and letter, non-English, animal studies, in vitro studies, contrast enhanced fluorescence, and NIRAF with use of indocyanine green, were the exclusion criteria used. Five studies were enrolled based on inclusion and exclusion criteria. The estimated overall accuracy of image-based methods is 0.96 (95% CI of (0.87, 0.99)), while the estimated overall accuracy of probe-based methods is 0.93 (95% CI of (0.92, 0.94)). With p=0.36, there is insufficient evidence to indicate a significant difference in overall accuracy, sensitivity and specificity between image-based methods and probe-based methods. Both imaging and probe-based detection modalities offer effective, noninvasive means for identifying parathyroid glands intraoperatively. Further studies comparing the efficacy of these two modalities are needed to further differentiate their clinical performance.