The effect of intra-operative autofluorescence monitoring on unintentional parathyroid gland excision rates and post-operative PTH concentrations  a single-blind randomized controlled trial

Papavramidis, Theodosios; Chorti, Angeliki; Tzikos, George; Anagnostis, Panagiotis; Pantelidis, Pantelis; Pliakos, Ioannis; Panidis, Stavros; Papaioannou, Maria; Bakkar, Sohail; Ünal, Ethem; Michalopoulos, Antonios

doi:10.1530/endoabs.73.pep6.5

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“…Most studies, including several randomized controlled trials, consistently show lower frequencies of postoperative transient hypoparathyroidism (54)(55)(56)(57). However, some recent randomized controlled trials found no significant difference in postoperative calcium and parathormone concentrations in NIRAF and control groups (58,59). No reduction in the frequency of permanent hypoparathyroidism has been observed so far (54)(55)(56).…”

Section: Near-infrared Autofluorescence Of the Parathyroid Glandsmentioning

confidence: 99%

“…A recent meta-analysis of eight studies and 2889 patients concluded that the use of NIRAF led to an almost threefold decrease in the incidence of transient hypocalcemia, from 22.4% to 7.11%, and a nearly two-fold decrease in parathyroid gland resection rates, from 14.4% to 7.7%, with no impact on permanent hypocalcemia (71). Studies reporting positive effects of NIRAF imaging on the frequency of postoperative hypoparathyroidism are scarcer (58). This difference highlights the need for further studies, especially for evaluation of the usefulness of fluorescence imaging in thyroidectomy with lymph node dissection in low-volume centres.…”

Section: Niraf and Clndmentioning

confidence: 99%

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Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence

et al. 2023

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The most common site of lymph node metastases in papillary thyroid carcinoma is the central compartment of the neck (level VI). In many patients, nodal metastases in this area are not clinically apparent, neither on preoperative imaging nor during surgery. Prophylactic surgical clearance of the level VI in the absence of clinically suspicious lymph nodes (cN0) is still under debate. It has been suggested to reduce local recurrence and improve disease-specific survival. Moreover, it helps to accurately diagnose the lymph node involvement and provides important staging information useful for tailoring of the radioactive iodine regimen and estimating the risk of recurrence. Yet, many studies have shown no benefit to the long-term outcome. Arguments against the prophylactic central lymph node dissection (CLND) cite minimal oncologic benefit and concomitant higher operative morbidity, with hypoparathyroidism being the most common complication. Recently, near-infrared fluorescence imaging has emerged as a novel tool to identify and preserve parathyroid glands during thyroid surgery. We provide an overview of the current scientific landscape of fluorescence imaging in thyroid surgery, of the controversies around the prophylactic CLND, and of fluorescence imaging applications in CLND. To date, only three studies evaluated fluorescence imaging in patients undergoing thyroidectomy and prophylactic or therapeutic CLND for thyroid cancer. The results suggest that fluorescence imaging has the potential to minimise the risk of hypoparathyroidism associated with CLND, while allowing to exploit all its potential benefits. With further development, fluorescence imaging techniques might shift the paradigm to recommend more frequently prophylactic CLND.

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Section: Near-infrared Autofluorescence Of the Parathyroid Glandsmentioning

confidence: 99%

Section: Niraf and Clndmentioning

confidence: 99%

Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence

et al. 2023

View full text Add to dashboard Cite

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The effect of intra-operative autofluorescence monitoring on unintentional parathyroid gland excision rates and post-operative PTH concentrations a single-blind randomized controlled trial

Cited by 1 publication

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Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence

Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence

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The effect of intra-operative autofluorescence monitoring on unintentional parathyroid gland excision rates and post-operative PTH concentrations  a single-blind randomized controlled trial

Cited by 1 publication

References 0 publications

Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence

Central node dissection in papillary thyroid carcinoma in the era of near-infrared fluorescence

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The effect of intra-operative autofluorescence monitoring on unintentional parathyroid gland excision rates and post-operative PTH concentrations a single-blind randomized controlled trial