Near-Infrared Autofluorescence-Guided Parathyroid Identification During Pediatric Thyroidectomy for Thyroid Cancer: A...

Area of Science:

• Pediatric Surgery
• Endocrine Surgery
• Surgical Imaging Technologies

Background:

• Postoperative hypoparathyroidism is a common complication following pediatric total thyroidectomy.
• Limited evidence exists on the utility of near-infrared autofluorescence (NIRAF) in pediatric thyroid surgery.
• This study introduces NIRAF imaging in pediatric thyroid cancer surgery.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of NIRAF imaging in pediatric thyroid cancer surgery.
• To compare outcomes between NIRAF-assisted and conventional thyroidectomy procedures.
• To assess the impact of NIRAF on parathyroid gland preservation and postoperative hypoparathyroidism.

Main Methods:

• A single-center study involving 40 children with thyroid cancer undergoing 45 total thyroidectomies with central lymph node dissection.
• NIRAF imaging using Fluobeam LX was applied in 31 procedures, with 14 procedures serving as controls.
• Analysis focused on rates of incidental parathyroidectomy and postoperative hypoparathyroidism.

Main Results:

• Autofluorescence was detected in 77% of NIRAF-assisted procedures, identifying an average of 2.5 parathyroid glands.
• Incidental parathyroid removal was less frequent with NIRAF (35.5%) compared to controls (57%).
• Transient hypoparathyroidism rates were 20.7% with NIRAF versus 36.4% in controls; permanent hypoparathyroidism was 3.4% vs. 7.1%.

Conclusions:

• NIRAF imaging is a feasible technology for pediatric thyroidectomy.
• NIRAF assistance is associated with a reduction in incidental parathyroid gland removal.
• The use of NIRAF correlates with lower rates of postoperative hypoparathyroidism in pediatric patients.