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Fluorescent Imaging in Thyroid Surgery to Preserve Parathyroid Function: A Systematic Review and Meta-Analysis
Matthew H Cheung1,2, Megan T Nguyen1,3, Shaun A Nguyen1
1Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Objective:
Hypoparathyroidism and postoperative hypocalcemia are rare but dreaded complications of thyroid surgery, often requiring increased follow-up and contributing to financial and quality-of-life burdens. This systematic review evaluates the effectiveness of intraoperative fluorescent imaging of parathyroid glands (PGs) in improving PG identification and reducing iatrogenic complications during thyroid surgery.
Data Source:
Pubmed, Scopus, CINAHL.
Review Methods:
A systematic search of PubMed, Scopus, CINAHL, and Cochrane databases was conducted per PRISMA guidelines. Studies using intraoperative fluorescent imaging for PG identification and reporting postoperative calcium and parathyroid hormone (PTH) levels were included. Data on patient demographics, surgical technique, imaging modality, PG identification rates, incidental parathyroidectomy, autotransplantation, and postoperative calcium/PTH outcomes were extracted. Meta-analyses of proportions, odds ratios, and mean differences were performed using MedCalc and Cochrane Review Manager.
Results:
Twenty-eight studies (n = 3876) were included. Fluorescent imaging significantly improved PG identification rates (86.4% vs 70.6%, P < .0001) and reduced incidental parathyroidectomy (5.3% vs 9.5%, P = .0017). Short-term hypoparathyroidism (16.7% vs 27.0%, P = .0004) and postoperative hypocalcemia rates on Day 1 (10.6% vs 18.1%, P = .0016) and in the short term (5.7% vs 11.5%, P = .0001) were significantly lower in the fluorescent imaging group. Odds of transient hypocalcemia were also reduced (OR 0.37, P < .00001).
Conclusion:
Fluorescent imaging in thyroid surgery significantly improves PG identification rates and reduces the incidence of postoperative hypocalcemia and hypoparathyroidism. Integrating intraoperative fluorescent imaging into the intraoperative thyroid surgery paradigm may enhance patient outcomes by minimizing the frequency of PG-associated complications.
