New Advances of ICG Angiography in Parathyroid Identification

Abstract

Objective: For surgeons, locating parathyroid in thyroidectomy and parathyroidectomy is critical since parathyroid plays an important role in calcium balance. The fluorescence of parathyroid has already been found by researchers and the angiography equipment detecting the fluorescence of parathyroid with indocyanine green has been widely applied. Using the indocyanine green angiography and looking at the actual fluorescence of in vivo and in vitro tissues, it was possible to identify thyroid, parathyroid, lymph nodes and fat tissues during the surgical procedure. This mini-review aims to present the application of indocyanine green angiography in parathyroid detection and discusses the safety of this method. Methods: The relevant data were searched by using the keywords “Indocyanine green,” “Parathyroid,” and “Identification” and “Protection” in “Pubmed,” “Web of Science” and “China Knowledge Resource Integrated databases”, and a manual search was done to acquire peer-reviewed articles and reports about indocyanine green. Results: Indocyanine green dye along with the intraoperative fluorescence imaging system is safe in detecting parathyroid and predicting postoperative hypoparathyroidism. Conclusion: The conclusion suggests that indocyanine green angiography is a safe, effective and easy way to detect parathyroid glands. The conclusion will be of interest to surgeons regarding thyroidectomy and parathyroidectomy.

Indocyanine green fluorescence for parathyroid gland identification and function prediction: Systematic review and meta‐analysis

“…However, high‐quality ICG imaging can be used not only during thyroid and parathyroid surgery but also in evaluating hepatic function, cardiac perfusion, and gastrointestinal anastomosis perfusion, and in performing fluorescence cholangiography and real‐time sentinel lymph node mapping. Thus, multiple departments can share the same equipment, pursuing its cost‐effectiveness 13,20,36 . Also, imaging devices have become more competitive in price, with the introduction of portable devices (reported at $500) 37 …”

Angiografía intraoperatoria con verde de indocianina (ICG) de las glándulas paratiroides para predecir la hipocalcemia postiroidectomía: análisis comparativo de 2 sistemas de puntuación (ICG-2 vs. ICG-4)

“…2 0 2 1 ; x x ( x x ) : x x x -x x x respectivamente. En nuestra serie actual de 50 pacientes, los valores de la puntuacio ´n total de ICG-4 3 fueron algo ma ´s altos, pero menos favorables que la exactitud diagno ´stica asociada con la puntuacio ´n de ICG de una sola gla ´ndula 2 (92 [80,8-97,8] vs. 72% [57, 8]).…”

“…Sin embargo, aunque los niveles de PTH pueden predecir la funcio ´n paratiroidea no pueden usarse para evaluar la viabilidad de cada gla ´ndula individualmente durante el procedimiento quiru ´ rgico. Por el contrario, la angiografı ´a intravenosa con verde de indocianina (ICG) permite la evaluacio ´n intraoperatoria en tiempo real de la perfusio ´n sanguı ´nea de las gla ´ndulas paratiroides de acuerdo con el grado de fluorescencia del ICG en cada gla ´ndula, y la experiencia clı ´nica emergente reportada hasta ahora ha mostrado resultados prometedores [6][7][8][9][10][11][12][13] .…”

Near-infrared fluorescent imaging techniques for the detection and preservation of parathyroid glands during endocrine surgery

“…Many studies have evaluated the use of ICG angiography to identify normal PGs and assess their perfusion in thyroidectomies ( Table 3 ). These studies suggest that ICG angiography is a safe, feasible, effective, and easy technique to identify and preserve PGs [ 65 ]. Owing to the contribution of ICG angiography to intraoperative decision-making, the technique may be widely used in the future, especially as new applications are developed.…”