Intraoperative Parathyroid Gland Identification Using Autofluorescence Imaging in Thyroid Cancer Surgery with Central Neck Dissection: Impact on Post-Operative Hypocalcemia

Author:

Guerlain Joanne1ORCID,Breuskin Ingrid1,Abbaci Muriel2ORCID,Lamartina Livia3,Hadoux Julien3ORCID,Baudin Eric3,Al Ghuzlan Abir4,Moog Sophie3,Marhic Alix1,Villard Adrien1,Obongo Rais5,Hartl Dana M.1ORCID

Affiliation:

1. Department of Head and Neck Cancer and ENT Surgery, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France

2. Plate-Forme Imagerie et Cytométrie, UMS 23/3655, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94805 Villejuif, France

3. Département d’Imagerie, Service d’Oncologie Endocrinienne, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France

4. Department of Pathology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France

5. Department of Head and Neck Cancer and ENT Surgery, Henri Becquerel Cancer Center, Rue d’Amiens CS 11516, 76038 Rouen, France

Abstract

Hypoparathyroidism is the most frequent complication in thyroid surgery. The aim of this study was to evaluate the impact of intraoperative parathyroid gland identification, using autofluorescence imaging, on the rate of post-operative (PO) hypoparathyroidism in thyroid cancer surgery. Patients undergoing total thyroidectomy with central neck dissection from 2018 to 2022 were included. A prospective cohort of 77 patients operated on using near-infrared autofluorescence (NIRAF+) with the Fluobeam® (Fluoptics, Grenoble, France) system was compared to a retrospective cohort of 94 patients (NIR−). The main outcomes were the rate of PO hypocalcemia, with three cutoffs: corrected calcium (Cac) < 2.10 mmol/L, <2.00 mmol/L and <1.875 mmol/L, and the rate of permanent hypoparathyroidism, at 12 months. The rate of PO Cac < 2.10 mmol/L was statistically lower in the NIRAF+ group, compared to the control group (36% and 60%, p = 0.003, respectively). No statistically significant difference was observed for the other two thresholds. There was a lower rate of permanent hypoparathyroidism in the NIRAF+ group (5% vs. 14% in the control group), although not statistically significant (p = 0.07). NIRAF is a surgically non-invasive adjunct, and can improve patients’ outcomes for thyroid cancer surgery by reducing post-operative temporary hypoparathyroidism. Larger prospective studies are warranted to validate our findings.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

Reference34 articles.

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5. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: A multivariate analysis of 5846 consecutive patients;Thomusch;Surgery,2003

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