The impact of detecting and autotransplanting parathyroid gland with near-infrared imaging during total laryngectomy with total thyroidectomy

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY

Auris Nasus Larynx Pub Date : 2025-04-09 DOI:10.1016/j.anl.2025.03.004

Takeshi Takahashi , Kohei Otaki , Shusuke Ohshima , Yuto Takahashi , Ryoko Tanaka , Kohei Saijo , Jo Omata , Yusuke Yokoyama , Ryusuke Shodo , Yushi Ueki , Keisuke Yamazaki , Hiroshi Matsuyama , Arata Horii

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引用次数: 0

Abstract

Objective

Persistent postoperative hypoparathyroidism (hypoPT) after total thyroidectomy (TT) is a serious complication necessitating lifelong treatment. HypoPT would be more serious when combined with total laryngectomy (TL), since in situ preservation nor autotransplantation of parathyroid glands (PGs) is not always attempted. This study examined the accuracy of identifying PGs using near-infrared fluorescence imaging (NIFI) and assessed the oncological safety and impact of PG autotransplantation on hypoPT in TL+TT.

Methods

This prospective study was conducted between June 2020 and November 2023 at three hospitals in Niigata, Japan. Twelve patients who underwent TL+TT were included. Specimens were evaluated for autofluorescence (AF) using NIFI ex vivo followed by histological examination. Levels of albumin-corrected calcium and intact parathyroid hormone (PTH) were monitored postoperatively.

Results

Twenty-nine AF-positive tissues were identified as possible PGs using NIFI. Histological examination revealed that 27 were PGs and 2 were adipose tissues: 0–5 (median=2) PGs were autotransplanted per patient. All 272 tissues isolated as lymph nodes by the surgeon's visual inspection were negative for AF, none of which were PGs by histological examinations. Therefore, NIFI exhibited 100 % sensitivity and 99 % specificity for PG identification. The rate of persistent postoperative hypoPT was 33 % (4/12). After a median follow-up of 42 months (range 16–54 months), no tumor recurrence was observed in the sites of parathyroid autotransplantation.

Conclusion

This study demonstrated the high accuracy of NIFI in identifying PGs during TL+TT. PG autotransplantation with NIFI assistance emerged as a viable technique for mitigating postoperative hypoPT in TL+TT procedures.

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来源期刊

Auris Nasus Larynx 医学-耳鼻喉科学

CiteScore

3.40

自引率

5.90%

发文量

169

审稿时长

30 days

期刊介绍： The international journal Auris Nasus Larynx provides the opportunity for rapid, carefully reviewed publications concerning the fundamental and clinical aspects of otorhinolaryngology and related fields. This includes otology, neurotology, bronchoesophagology, laryngology, rhinology, allergology, head and neck medicine and oncologic surgery, maxillofacial and plastic surgery, audiology, speech science. Original papers, short communications and original case reports can be submitted. Reviews on recent developments are invited regularly and Letters to the Editor commenting on papers or any aspect of Auris Nasus Larynx are welcomed. Founded in 1973 and previously published by the Society for Promotion of International Otorhinolaryngology, the journal is now the official English-language journal of the Oto-Rhino-Laryngological Society of Japan, Inc. The aim of its new international Editorial Board is to make Auris Nasus Larynx an international forum for high quality research and clinical sciences.