Table 2:
Recent studies using near-infrared autofluorescence (NIRAF) imaging for parathyroid glands (PGs) identification during thyroidectomy.
| Author, year | Study design | Sample size | Identified PGs, % | Other main findings |
|---|---|---|---|---|
| McWade, 2014 [42] | Case series | 6 | 100% | NIRAF showed 2.4–8.5 times higher emission intensity from the PGs than surrounding tissue. |
| McWade, 2016 [44] | Clinical trial | 137 | 97% | BMI, disease state, vitamin D, and calcium levels account significantly for variability in signal intensity. Age, gender, PTH, and ethnicity had no effect. |
| De Leeuw, 2016 [4] | Case series | 35 | 98.8% | PGs fluorescence was 2.93 ± 1.59 times greater than thyroid fluorescence in vivo. |
| Falco, 2016 [45] | Case series | 28 | 100% | NIRAF allows high rates of PG identification and is a safe, feasible, and noninvasive method for real-time intraoperative identification of PGs. No postoperative hypocalcemia or other complications related to the surgery were registered. |
| Kim, 2016 [73] | Case series | 8 | 100% | PGs that were exposed or even covered by connective tissues or blood vessels could be detected with strong emission. |
| Falco, 2017 [74] | Case series | 74 | 100% | The number of PGs identified was significantly increased by the use of NIRAF. The differences in fluorescent intensity among PGs, thyroid glands, and background were not affected by age, sex, and histopathological diagnosis. |
| Ladurner, 2017 [75] | Prospective trial | 30 | 80.9% | NIRAF can be used to distinguish PGs from other cervical tissues. There were no noticeable differences between parathyroid adenomas, hyperplasia, and normal PGs. |
| Kahramangil, 2017 [76] | Clinical trial | 22 | 98% | Autofluorescence detects more frequently PGs before recognition with the naked eye compared to indocyanine green fluorescence. No differences in postoperative hypocalcemia were detected. |
| Kahramangil, 2018 [52] | Retrospective cohort | 210 | 98% | NIRAF facilitated PG identification before conventional recognition by the surgeon, 37–67% of the time. NIRAF alongside conventional visual cues to aid identification of PGs during neck operations. |
| Ladurner, 2018 [77] | Case series | 20 | 90.2% | Neither lymph nodes nor thyroid revealed substantial autofluorescence and nor did adipose tissue NIRAF can be used to identify and preserve PGs during thyroidectomy. |
| Benmiloud, 2018 [78] | Before and after controlled study | 93 | 76.3% | NIRAF reduced postoperative hypocalcemia and PGs autotransplantation rate. |
| Kim, 2018 [50] | Prospective trial | 38 | 92.8% | NIRAF PG mapping has an excellent accuracy rate. This technique may be helpful for the early identification of PGs during thyroidectomy. |
| Alesina, 2018 [69] | Prospective trial | 5 | 68.8% | NIRAF allows for enhanced visualization of the parathyroid tissue during video-assisted thyroidectomy with neither intraoperative nor postoperative complications. |
| DiMarco, 2019 [79] | Prospective cohort | 269 | 85.8% | NIRAF doesn't reduce the incidence of missed inadvertent parathyroidectomy. There was no significant difference in serum calcium or PTH between NIRAF and control groups. |
| Dip, 2019 [80] | Randomized controlled trial | 170 | NR (increased from a mean of 2.6–3.5) | NIRAF increases intraoperative identification of PGs and decreases the incidence of postoperative hypocalcemia. |
| Benmiloud, 2019 [60] | Randomized clinical trial | 241 | 75.9% | NIRAF increases parathyroid preservation after total thyroidectomy and helps to improve the early postoperative hypocalcemia rate significantly. |
PGs, parathyroid glands; NIRAF, near-infrared autofluorescence; BMI, body mass index; PTH, parathyroid hormone; NR, not reported.