Is the indocyanine green score an accurate predictor of postoperative parathyroid hormone level?

Demarchi, M.; Baccaro, María E.; Karenovicŝ, Wolfram; Bédat, Benoît; Triponez, Frédéric

doi:10.1016/j.surg.2021.12.036

Cited by 6 publications

(8 citation statements)

References 24 publications

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“…The most frequently reported scoring system is the 3-grade ICG score (0 = devascularized; 1 = moderately well vascularized; 2 = well vascularized), though other systems exist . Current imaging systems are not designed to provide quantification; Demarchi et al, however, reported that a global ICG score of greater than 3.75 out of total possible score of 8 (whereby each PG was identified and scored on a scale of 0-2) excluded temporary postoperative hypoparathyroidism with a 98% true negative value.…”

Section: Discussionmentioning

confidence: 99%

Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Karcioglu

Triponez

Solórzano

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceIdentification and preservation of parathyroid glands (PGs) remain challenging despite advances in surgical techniques. Considerable morbidity and even mortality result from hypoparathyroidism caused by devascularization or inadvertent removal of PGs. Emerging imaging technologies hold promise to improve identification and preservation of PGs during thyroid surgery.ObservationThis narrative review (1) comprehensively reviews PG identification and vascular assessment using near-infrared autofluorescence (NIRAF)—both label free and in combination with indocyanine green—based on a comprehensive literature review and (2) offers a manual for possible implementation these emerging technologies in thyroid surgery.Conclusions and RelevanceEmerging technologies hold promise to improve PG identification and preservation during thyroidectomy. Future research should address variables affecting the degree of fluorescence in NIRAF, standardization of signal quantification, definitions and standardization of parameters of indocyanine green injection that correlate with postoperative PG function, the financial effect of these emerging technologies on near-term and longer-term costs, the adoption learning curve and effect on surgical training, and long-term outcomes of key quality metrics in adequately powered randomized clinical trials evaluating PG preservation.

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Section: Discussionmentioning

confidence: 99%

Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Karcioglu

Triponez

Solórzano

et al. 2023

JAMA Otolaryngol Head Neck Surg

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“…Many surgeons still rely on their experience to preserve function even after PG mapping. ICG angiography has been used as a method to assess the perfusion status of PGs at the end of surgery ( 25 – 27 ). Furthermore, intraoperative mapping angiography of the PGs (iMAP) has recently been introduced as a way to evaluate PG vascularity through intravenous ICG injection ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Detectable depth of unexposed parathyroid glands using near-infrared autofluorescence imaging in thyroid surgery

et al. 2023

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BackgroundNear-infrared light can penetrate the fat or connective tissues overlying the parathyroid gland (PG), enabling early localization of the PG by near-infrared autofluorescence (NIRAF) imaging. However, the depth at which the PG can be detected has not been reported. In this study, we investigated the detectable depth of unexposed PGs using NIRAF during thyroidectomy.Materials and methodsFifty-one unexposed PGs from 30 consecutive thyroidectomy patients, mapped by an experienced surgeon (K.D. Lee) with the use of NIRAF imaging, were included. For NIRAF detection of PGs, a lab-built camera imaging system was used. Detectable depths of the unexposed PGs were measured using a Vernier caliper. The NIRAF images were classified as faint or bright depending on whether a novice could successfully interpret the image as showing the PG. Data on variables that may affect detectable depth and NIRAF intensity were collected.ResultsDetectable depth ranged between 0.35 and 3.05 mm, with a mean of 1.23 ± 0.73 mm. The average NIRAF intensity of unexposed PGs was 3.13 au. After dissection of the overlying tissue, the intensity of the exposed PG increased to 4.88 au (p < 0.001). No difference in NIRAF intensity between fat-covered (3.27 ± 0.90 au) and connective tissue-covered PGs (3.00 ± 1.23 au) was observed (p = 0.369). PGs covered by fat tissue (depth: 1.77 ± 0.67 mm) were found at deeper locations than those covered by connective tissue (depth: 0.70 ± 0.21 mm) (p < 0.001). The brightness of images of the faint group (2.14 ± 0.48 au) was on average 1.24 au lower than that of the bright group (3.38 ± 1.04 au) (p = 0.001). A novice successfully localized 80.4% of the unexposed PGs. Other variables did not significantly affect detectable depth.ConclusionUnexposed PGs could be mapped using NIRAF imaging at a maximum depth of 3.05 mm and an average depth of 1.23 mm. A novice was able to localize the PGs before they were visible to the naked eye at a high rate. These results can be used as reference data for localization of unexposed PGs in thyroid surgery.

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“…Using NIRAF alone does not give information about the viability of the glands, but rather allows the surgeon to identify the glands. With the use of ICG, well vascularized parathyroid tissue has increased fluorescence, providing a brighter image and allows for deeper tissue imaging than NIRAF alone 25–27,40–45 . Fortuny et al demonstrated that ICG angiography can reliably predict vascularization of the parathyroid glands and obviate the need for calcium supplementation when at least one well perfused parathyroid gland is detected intraoperatively 46 .…”

Section: Methodsmentioning

confidence: 99%

“…Surgery for renal induced hyperparathyroidism where subtotal parathyroidectomy is the anticipated operation may be optimal for use of ICG to assess parathyroid gland remnant viability before removing the remaining parathyroid glands. Evidence of the usefulness and reliability of such an approach is not yet available but it holds theoretical promise 26,42 …”

Section: Methodsmentioning

confidence: 99%

“…With the use of ICG, well vascularized parathyroid tissue has increased fluorescence, providing a brighter image and allows for deeper tissue imaging than NIRAF alone. [25][26][27][40][41][42][43][44][45] Fortuny et al demonstrated that ICG angiography can reliably predict vascularization of the parathyroid glands and obviate the need for calcium supplementation when at least one well perfused parathyroid gland is detected intraoperatively. 46 Thus, one may infer parathyroid function and predict whether postoperative hypocalcemia is likely to ensue.…”

Section: The Benefits Of Icgmentioning

confidence: 99%

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The utility of parathyroid autofluorescence as an adjunct in thyroid and parathyroid surgery 2023

Pace‐Asciak,

Russell,

Solorzano

et al. 2023

Head & Neck

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Thyroid and parathyroid surgery requires careful dissection around the vascular pedicle of the parathyroid glands to avoid excessive manipulation of the tissues. If the blood supply to the parathyroid glands is disrupted, or the glands are inadvertently removed, temporary and/or permanent hypocalcemia can occur, requiring post‐operative exogenous calcium and vitamin D analogues to maintain stable levels. This can have a significant impact on the quality of life of patients, particularly if it results in permanent hypocalcemia. For over a decade, parathyroid tissue has been noted to have unique intrinsic properties known as “fluorophores,” which fluoresce when excited by an external light source. As a result, parathyroid autofluorescence has emerged as an intra‐operative technique to help with identification of parathyroid glands and to supplement direct visualization during thyroidectomy and parathyroidectomy. Due to the growing body of literature surrounding Near Infrared Autofluorescence (NIRAF), we sought to review the value of using autofluorescence technology for parathyroid detection during thyroid and parathyroid surgery. A literature review of parathyroid autofluorescence was performed using PubMED. Based on the reviewed literature and expert surgeons' opinions who have used this technology, recommendations were made. We discuss the current available technologies (image vs. probe approach) as well as their limitations. We also capture the opinions and recommendations of international high‐volume endocrine surgeons and whether this technology is of value as an intraoperative adjunct. The utility and value of this technology seems promising and needs to be further defined in different scenarios involving surgeon experience and different patient populations and conditions.

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Is the indocyanine green score an accurate predictor of postoperative parathyroid hormone level?

Cited by 6 publications

References 24 publications

Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Detectable depth of unexposed parathyroid glands using near-infrared autofluorescence imaging in thyroid surgery

The utility of parathyroid autofluorescence as an adjunct in thyroid and parathyroid surgery 2023

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