Assessment of ICG fluorescence in identification and preservation of parathyroid glands in thyroid surgeries and correlation with postoperative parathormone and serum calcium levels.

IF 3.7 3区医学 Q2 Medicine Endocrine Pub Date : 2025-01-08 DOI:10.1007/s12020-024-04158-8

Anupam Lahiri, Vishal Yadav, Vikas Arora, Prerit Sharma, A K Dewan

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Abstract

Introduction: Intraoperative parathyroid gland (PG) localization remains challenging during thyroid surgeries, contributing to postoperative hypocalcemia and hypoparathyroidism. This study assessed the efficacy of indocyanine green (ICG) fluorescence in identifying and preserving PGs during thyroid surgeries and its correlation with postoperative outcomes.

Materials and methods: This ambispective observational study included 57 patients undergoing thyroid surgeries using ICG and compared outcomes with 56 historical controls. ICG was administered intravenously in two 5 mg boluses. Parathyroid identification rates, fluorescence intensity, and postoperative calcium and parathormone levels were assessed. Fluorescence intensity was qualitatively scored on a 1-3 scale.

Results: ICG significantly improved PG identification (92.5% vs 69.3% with white light alone). Postoperative hypocalcemia occurred in 22.81% of ICG patients compared to 39.29% in controls (p = 0.045). Hypoparathyroidism rates were 10.53% and 32.14% respectively (p = 0.005). Higher fluorescence intensity (FI) correlated with lower risk of postoperative hypocalcemia (p = 0.026) and combined hypocalcemia and hypoparathyroidism (p = 0.046). Considering both FI 2 and 3 as positive yielded 100% sensitivity and 85.7% accuracy. When only FI 3 was considered positive, sensitivity was 78.4%, specificity was 50%, and accuracy was 69.4%.

Conclusion: ICG fluorescence is a safe and effective tool for enhancing PG identification and preservation in thyroid surgeries, significantly reducing postoperative hypocalcemia and hypoparathyroidism. It also helps in confirming the vascularity of the PGs post thyroidectomy. Fluorescence intensity of preserved PGs, rather than quantity, better predicts postoperative outcomes. These findings support the integration of ICG fluorescence imaging and the application of our methodology in thyroid surgeries to improve postoperative results.

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评估ICG荧光在甲状腺手术中甲状旁腺的识别和保存及其与术后甲状旁腺激素和血清钙水平的相关性。

在甲状腺手术中，术中甲状旁腺（PG）定位仍然具有挑战性，导致术后低钙和甲状旁腺功能减退。本研究评估了吲哚菁绿（ICG）荧光在甲状腺手术中识别和保存PGs的功效及其与术后预后的相关性。材料和方法：这项双视角观察性研究纳入了57例使用ICG进行甲状腺手术的患者，并与56例历史对照组进行了结果比较。ICG静脉注射2次，每次5毫克。评估甲状旁腺识别率、荧光强度、术后钙和甲状旁腺激素水平。荧光强度定性评分为1-3分。结果：ICG可显著提高PG的鉴别率（92.5% vs单纯白光下69.3%）。术后低钙血症发生率为22.81%，对照组为39.29% （p = 0.045）。甲状旁腺功能减退症发生率分别为10.53%和32.14% （p = 0.005）。较高的荧光强度（FI）与术后低钙血症（p = 0.026）及合并低钙血症和甲状旁腺功能减退的风险较低相关（p = 0.046）。考虑到FI 2和3均为阳性，产生了100%的灵敏度和85.7%的准确度。当仅认为FI 3为阳性时，敏感性为78.4%，特异性为50%，准确性为69.4%。结论：ICG荧光增强甲状腺手术中PG的识别和保存是一种安全有效的工具，可显著减少术后低钙血症和甲状旁腺功能减退。它也有助于确认甲状腺切除术后PGs的血管状况。保存pg的荧光强度比数量更能预测术后预后。这些发现支持ICG荧光成像和我们的方法在甲状腺手术中的应用，以改善术后结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.