Abstract
BackgroundNear-infrared autofluorescence imaging has potentially great value for assisting endocrine surgeons in identifying parathyroid glands and may dramatically change the surgical strategy of endocrine surgeons in thyroid surgery. This study is designed to objectively evaluate the role of near-infrared autofluorescence imaging in identifying parathyroid glands during thyroid surgery by measuring intraoperative parathyroid hormone in fine-needle aspiration biopsy washings.MethodsThis study was conducted at a tertiary referral teaching hospital in China from February 2020 to June 2020. Patients undergoing total thyroidectomy with or without neck lymph node dissection were consecutively included. The surgeon used near-infrared autofluorescence imaging to identify parathyroid glands during thyroid surgery and confirmed suspicious parathyroid tissues by measuring their intraoperative parathyroid hormone. Nanocarbon was injected into the thyroid gland if the thyroid autofluorescence intensity was too strong. The sensitivity and accuracy of near-infrared autofluorescence imaging and vision for identifying parathyroid glands, and the difference in autofluorescence intensity in various tissues were the main outcomes.ResultsOverall, 238 patients completed the trial. Based on the pathological and aIOPTH results, the sensitivity of near-infrared autofluorescence imaging for detecting parathyroid glands (568 of 596 parathyroid glands; 95.30%)was significantly higher than that of vision (517 of 596 parathyroid glands; 86.74%, P<.001). The accuracy of near-infrared autofluorescence imaging (764 of 841 tissues; 90.84%) was significantly higher than that of vision (567 of 841 tissues; 67.42%, P<.001) when the evaluations of certain tissues were inconsistent. There was a significant difference between the autofluorescence intensity of the parathyroid glands and that of the lymph nodes (74.19 ± 17.82 vs 33.97 ± 10.64, P<.001).ConclusionThe use of near-infrared autofluorescence imaging, along with intraoperative parathyroid hormone and nanocarbon for the identification of parathyroid glands in thyroid surgery may increase the number of confirmed parathyroid glands. Using near-infrared autofluorescence imaging can effectively distinguish lymph nodes and parathyroid glands during lymph node dissection.
Highlights
Hypocalcemia after thyroid surgery is a problem that has long plagued endocrine surgeons
250 patients were enrolled in this study, 122 patients used nanocarbon tracers due to strong thyroid autofluorescence during initial imaging, of whom 12 patients had contaminated the surgical field after injecting nanocarbon into the thyroid gland, which made subsequent near infrared-induced autofluorescence (NIRAF) difficult to perform and were excluded from the study
Our study included a higher proportion of patients with malignant tumors (83.2% vs 25.6%), and lymph node dissection was performed in most patients (186 of 238 patients, 78%), which led to a higher rate of postoperative hypocalcemia
Summary
Hypocalcemia after thyroid surgery is a problem that has long plagued endocrine surgeons. Accurate identification of parathyroid glands (PGs) is the first step to reduce postoperative hypocalcemia. The recognition of PGs mainly depends on visual identification by the surgeon. Due to their small size and unstable location, as well as the difficulty in distinguishing them in color and shape from lymph nodes and adipose tissue, highly subjective visual identification is often unreliable. Near-infrared autofluorescence imaging has potentially great value for assisting endocrine surgeons in identifying parathyroid glands and may dramatically change the surgical strategy of endocrine surgeons in thyroid surgery. This study is designed to objectively evaluate the role of near-infrared autofluorescence imaging in identifying parathyroid glands during thyroid surgery by measuring intraoperative parathyroid hormone in fine-needle aspiration biopsy washings
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