Efficacy of indocyanine green fluorescence in predicting parathyroid vascularization during thyroid surgery

Razavi, Alexander C.; Ibraheem, Kareem; Haddad, Antoine; Saparova, Lachin; Shalaby, Hosam; Abdelgawad, Mohamed; Kandil, Emad

doi:10.1002/hed.25837

Cited by 27 publications

(33 citation statements)

References 11 publications

(28 reference statements)

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“…Several authors [49,71] have stated that ICG angiography can guide more appropriate autotransplantation without compromising postoperative parathyroid function. This is in contrast with Razavi et al [48], who assert that ICG angiography may lead to unnecessary parathyroid autotransplantation because low-flow ICG patterns are not associated with postoperative PTH changes or transient hypocalcemia.…”

Section: Effects On the Autotransplantation Ratecontrasting

confidence: 58%

“…The fluorescence system varied from study to study, with the Fluobeam 800 system (Fluoptics, Grenoble, France) being the most common (five studies). The system was not specified in two studies [48,56] (Table 3). An image showing the autofluorescence of the PGs (Figure 2A) and the sequence of ICG angiography (ICGA) (Figure 2B,C) is provided in Figure 2.…”

Section: Type Of Fluorescence (Exogenous or Autofluorescence)mentioning

confidence: 99%

“…None of the comparative studies found a statistically significant relationship for postoperative PTH levels between study and control groups, except for [66], which found a statistically significant lower incidence of transient hypoparathyroidism in the NIRAF group (33.7% vs. 46.6%; p = 0.002). Three studies [45,48,49] demonstrated better PTH levels for fluorescence-guided surgery (Table 4).…”

Section: Postoperative Serum Parathyroid Hormonementioning

confidence: 99%

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Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism

Demarchi

Seeliger

Lifante

et al. 2021

Cancers

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Background: Hypoparathyroidism is one of the most frequent complications of thyroid surgery, especially when associated with lymph node dissection in cases of thyroid cancer. Fluorescence-guided surgery is an emerging tool that appears to help reduce the rate of this complication. The present review aims to highlight the utility of fluorescence imaging in preserving parathyroid glands during thyroid cancer surgery. Methods: We performed a systematic review of the literature according to PRISMA guidelines to identify published studies on fluorescence-guided thyroid surgery with a particular focus on thyroid cancer. Articles were selected and analyzed per indication and type of surgery, autofluorescence or exogenous dye usage, and outcomes. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included articles. Results: Twenty-five studies met the inclusion criteria, with three studies exclusively assessing patients with thyroid cancer. The remaining studies assessed mixed cohorts with thyroid cancer and other thyroid or parathyroid diseases. The majority of the papers support the potential benefit of fluorescence imaging in preserving parathyroid glands in thyroid surgery. Conclusions: Fluorescence-guided surgery is useful in the prevention of post-thyroidectomy hypoparathyroidism via enhanced early identification, visualization, and preservation of the parathyroid glands. These aspects are notably beneficial in cases of associated lymphadenectomy for thyroid cancer.

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Section: Effects On the Autotransplantation Ratecontrasting

confidence: 58%

Section: Type Of Fluorescence (Exogenous or Autofluorescence)mentioning

confidence: 99%

Section: Postoperative Serum Parathyroid Hormonementioning

confidence: 99%

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Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism

Demarchi

Seeliger

Lifante

et al. 2021

Cancers

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“…The authors declare no conflicts of interest. In contrast, some studies report fewer positive results regarding the prediction of parathyroid function using ICG angiography [34,38], although this difference could be related to the subjective visual interpretation of gray scale imaging (i.e., ICG score) [32] during angiography in the absence of a standardized numerical criterion (Table 3). Table 3.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands

Demarchi

Karenovicŝ

Bédat

et al. 2020

JCM

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Fluorescence imaging is a well-known method for both the in vivo and in vitro identification of specific cells or tissues. This imaging tool is gaining importance in the intraoperative detection and preservation of parathyroid glands during endocrine surgery owing to the intrinsic properties of parathyroid tissue. The aim of this paper is to provide an overview of the basics of the technology, its history, and the recent surgical intraoperative applications of near-infrared imaging methods. Moreover, a literature review of the utilization of fluorescence devices in thyroid surgery suggests that the use of near-infrared imaging seems to be beneficial in reducing postoperative hypoparathyroidism, which is one of the most frequent complications of thyroid surgery.

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“…A few experimental techniques have been reported for assessing parathyroid vascularity including topical application of lidocaine (35), laser Doppler flowmetry (36), intraoperative parathyroid hormone (PTH) assay (37), and confocal endomicroscopy using the dye fluorescein (38). Recently, the use of indocyanine green (ICG) angiography has gained traction (39)(40)(41)(42)(43)(44)(45). While there have been promising reports, there are a few limitations.…”

Section: Introductionmentioning

confidence: 99%

Assessing Intraoperative Laser Speckle Contrast Imaging of Parathyroid Glands in Relation to Total Thyroidectomy Patient Outcomes

Mannoh

Thomas

Baregamian

et al. 2021

Thyroid

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Background: Accurate assessment of parathyroid gland vascularity is important during thyroidectomy to preserve the function of parathyroid glands and to prevent postoperative hypocalcemia. Laser speckle contrast imaging (LSCI) has been shown to be accurate in detecting differences in parathyroid vascularity. In this surgeon-blinded prognostic study, we evaluate the relationship between intraoperative LSCI measurements and postoperative outcomes of total thyroidectomy patients. Methods: Seventy-two thyroidectomy patients were included in this study. After thyroid resection, an LSCI device was used to image all parathyroid glands identified, and a speckle contrast value was calculated for each. An average value was calculated for each patient, and the data were grouped according to whether the patient had normal (16-77 pg/mL) or low levels of parathyroid hormone (PTH) measured on postoperative day 1 (POD1). The aim of this study was to establish a speckle contrast threshold for classifying a parathyroid gland as adequately perfused and to determine how many such glands are required for normal postoperative parathyroid function. Results: A speckle contrast limit of 0.186 separated the normoparathyroid and hypoparathyroid groups with 87.5% sensitivity and 84.4% specificity: 7 of 8 patients with low PTH on POD1 had an average parathyroid speckle contrast above this limit, while 54 of 64 patients with normal postoperative PTH had an average parathyroid speckle contrast below this limit. Taking this value as the threshold for adequate parathyroid perfusion, it was determined that only one vascularized gland was needed for normal postoperative parathyroid function: 64 of 69 patients (92.8%) with at least one vascularized gland (determined by LSCI) had normal postoperative PTH, while all 3 patients (100%) with no vascularized glands had low postoperative PTH. Overall, the rates of temporary and permanent hypoparathyroidism in this study were 8.3% and 1.4%, respectively. Conclusions: LSCI is a promising technique for assessing parathyroid gland vascularity. It has the potential to help reduce the incidence of hypocalcemia after thyroidectomy by providing surgeons with additional information during surgery to aid in the preservation of parathyroid function.

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Efficacy of indocyanine green fluorescence in predicting parathyroid vascularization during thyroid surgery

Cited by 27 publications

References 11 publications

Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism

Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism

Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands

Assessing Intraoperative Laser Speckle Contrast Imaging of Parathyroid Glands in Relation to Total Thyroidectomy Patient Outcomes

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