Detection of Parathyroid Autofluorescence Using Near-Infrared Imaging: A Multicenter Analysis of Concordance Between Different Surgeons

Kahramangil, Bora; Dip, Fernando; Benmiloud, Fares; Falcó, Jorge; Fuente, Martin De La; Verna, Silvina; Rosenthal, Raúl J.; Berber, Eren

doi:10.1245/s10434-018-6364-2

Cited by 109 publications

(119 citation statements)

References 15 publications

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“…[8][9][10][11][12][13][14][15] Our previous study for localization of the parathyroid glands using autofluorescence imaging techniques has been used to photograph the entire area of the surgical field to show where the parathyroid glands are located. Localization technologies were developed rapidly since Paras et al published the autofluorescence characteristics of the parathyroid glands.…”

Section: Introductionmentioning

confidence: 99%

“…Localization technologies were developed rapidly since Paras et al published the autofluorescence characteristics of the parathyroid glands. [8][9][10][11][12][13][14][15] Our previous study for localization of the parathyroid glands using autofluorescence imaging techniques has been used to photograph the entire area of the surgical field to show where the parathyroid glands are located. [16][17][18][19] However, this technique has three limitations.…”

Section: Introductionmentioning

confidence: 99%

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Phase‐sensitive fluorescence detector for parathyroid glands during thyroidectomy: A preliminary report

Kim

Lee

et al. 2019

Journal of Biophotonics

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Despite advances in medical technology, the parathyroid glands are still damaged during thyroid surgery. Our previous studies exploring methods for locating the parathyroid glands using autofluorescence have limitations, such as turning off the surgical light or requiring additional matching between the autofluorescence image and realsurgical field-of-view. We developed a probe-type parathyroid autofluorescence detector using a phase-sensitive process and optical filtering to overcome these limitations. A preliminary clinical trial was performed on eight parathyroid glands in four patients. The normalized mean signal of the normal parathyroid glands was 332% stronger than that of the thyroid, and 384%, 459% and 286% stronger than the signal of the muscle, trachea and fat, respectively. Additionally, the device also detected fluorescence from indocyanine green. K E Y W O R D Sautofluorescence, clinical, optical filter, parathyroid gland, phase-sensitive Abbreviations: FOV, field-of-view; ICG, indocyanine green; P/T ratio, parathyroid/thyroid intensity ratio; SNR, signal-to-noise ratio.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Phase‐sensitive fluorescence detector for parathyroid glands during thyroidectomy: A preliminary report

Kim

Lee

et al. 2019

Journal of Biophotonics

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“…More recently, fluorescence imaging technology has been proposed: parathyroid tissue fluoresces in NIR. This poorly understood phenomena, that happens without the use of any contrast or dyes, takes the name of autofluorescence . Parathyroid glands manifest the strongest autofluorescence intensity in the body, followed by much lower intensity of the thyroid.…”

mentioning

confidence: 99%

“…The use of autofluorescence for identification of parathyroid tissue is an emerging technology and was reported for the first time in 2014 . The overall sensitivity of autofluorescence under NIR for detecting parathyroid autofluorescence is between 90% and 100% . Interestingly, a negative correlation has been found between the degree of fluorescence and preoperative serum calcium, but not between gland weight and Sestamibi positivity .…”

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On the use of autofluorescence for detection of intrathyroidal parathyroid adenoma

Henegan

McGrath

Shah

et al. 2019

ANZ Journal of Surgery

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Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions

Abood,

Rolighed,

Triponez

et al. 2024

JAMA Netw Open

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ImportanceHypoparathyroidism following thyroid surgery is a serious complication that occurs frequently when surgery is performed by low-volume thyroid surgeons without experience in parathyroid surgery.ObjectiveTo evaluate the occurrence of hypoparathyroidism following total thyroidectomy after the introduction of autofluorescence in low-volume, nonparathyroid institutions.Design, Setting, and ParticipantsThis prospective, multicenter cohort study, with a follow-up period of up to 1 year, was conducted in Denmark at 2 low-volume nonparathyroid institutions between January 2021 and November 2023. All adult patients referred for total thyroidectomy were assessed for eligibility (n = 90). Only patients with no history of thyroid surgery were considered (n = 89). Patients who only underwent lobectomy (n = 6) or declined to participate (n = 5) were excluded. All included patients completed follow-up. The prospective cohort was compared with a historical cohort of successive patients undergoing primary total thyroidectomy from 2016 to 2020 (before autofluorescence was available).InterventionIncluded patients underwent autofluorescence-guided total thyroidectomy.Main outcomes and MeasuresRate of hypoparathyroidism. Immediate hypoparathyroidism was defined as the need for active vitamin D postoperatively, whereas permanent hypoparathyroidism was considered when there still was a need for active vitamin D 1 year after surgery.ResultsSeventy-eight patients underwent autofluorescence-guided surgery (mean [SD] age, 55.6 [13.1] years; 67 [86%] female) and were compared with 89 patients in the historical cohort (mean [SD] age, 49.7 [12.8] years; 78 [88%] female). The rate of immediate hypoparathyroidism decreased from 37% (95% CI, 27%-48%) to 19% (95% CI, 11%-30%) after the introduction of autofluorescence (P = .02). Permanent hypoparathyroidism rates decreased from 32% (95% CI, 22%-42%) to 6% (95% CI, 2%-14%) (P &lt; .001), reaching 0% at the end of the study. More parathyroid glands were identified with autofluorescence (75% [95% CI, 70%-80%] vs 61% [95% CI, 56%-66%]) (P &lt; .001) and less parathyroid glands were inadvertently excised (4% [95% CI, 1%-11%] vs 21% [95% CI, 13%-31%]) (P = .001).Conclusions and RelevanceIn this cohort study of autofluorescence-guided thyroid surgery in low-volume, nonparathyroid institutions, the use of autofluorescence was associated with a significant decrease in both immediate and permanent hypoparathyroidism. When autofluorescence was used, hypoparathyroidism rates were comparable with those of high-volume surgeons who also perform parathyroid surgery.

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Detection of Parathyroid Autofluorescence Using Near-Infrared Imaging: A Multicenter Analysis of Concordance Between Different Surgeons

Cited by 109 publications

References 15 publications

Phase‐sensitive fluorescence detector for parathyroid glands during thyroidectomy: A preliminary report

Phase‐sensitive fluorescence detector for parathyroid glands during thyroidectomy: A preliminary report

On the use of autofluorescence for detection of intrathyroidal parathyroid adenoma

Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions

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