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

Abstract

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.

Parathyroid Carcinoma: Incidence, Survival Analysis, and Management: A Study from the SEER Database and Insights into Future Therapeutic Perspectives

“…Small next-generation sequencing (NGS) studies with < 20 patients have reported actionable genetic alterations in approximately one half to two thirds of the cases [40]. Notably, NTRK1 was present in 5% and a high tumor mutational burden in approximately 20% [24,40].…”

“…Small next-generation sequencing (NGS) studies with < 20 patients have reported actionable genetic alterations in approximately one half to two thirds of the cases [40]. Notably, NTRK1 was present in 5% and a high tumor mutational burden in approximately 20% [24,40]. The inclusion of standardized reporting systems, such as the AJCC 8th edition of the International Collaboration on Cancer Reporting (ICCR), is expected to yield useful data for establishing prognostic stages.…”

Technological Innovations in Thyroid Cancer Surgery

“…The recommended dose for PG visualization is 0.2-0.5 mg/kg, which may be repeated as required without exceeding the maximal daily dose of 5 mg/kg [56][57][58]. Both techniques have shown promising results in several studies in the literature [46][47][48]54,59,60].…”

Application of Indocyanine Green Angiography in Bilateral Axillo-Breast Approach Robotic Thyroidectomy for Papillary Thyroid Cancer

“…Over the years, the mainstays of parathyroid protection have been visual detection of PGs, capsular dissection technique, and autotransplantation of nonperfused glands ( 3 , 5 , 6 ). Recently, near-infrared fluorescence imaging (autofluorescence and indocyanine green angiography(ICGA)) has emerged as a novel intraoperative tool to help detect, identify, and preserve the PGs during thyroid surgery ( 7 ). Near-infrared autofluorescence is based on the endogenous fluorophore in PGs and facilitates the identification and preservation of PGs, thereby reducing the rate of postoperative hypoparathyroidism ( 7 ).…”

“…Recently, near-infrared fluorescence imaging (autofluorescence and indocyanine green angiography(ICGA)) has emerged as a novel intraoperative tool to help detect, identify, and preserve the PGs during thyroid surgery ( 7 ). Near-infrared autofluorescence is based on the endogenous fluorophore in PGs and facilitates the identification and preservation of PGs, thereby reducing the rate of postoperative hypoparathyroidism ( 7 ). However, the adoption of autofluorescence has certain drawbacks ( 8 ): Thyroid tissue might present similar autofluorescence intensities with the parathyroid tissue in some cases; False positives signals may also occur from colloid nodules, brown fat, and metastatic lymph nodes; most importantly, autofluorescence is unable to assess the perfusion status and vitality of PGs.…”