Evaluation of the effectiveness of near-infrared autofluorescence (NIRAF) imaging combined with immunocolloidal gold technique (ICGT) in identifying and protecting parathyroid glands during thyroid cancer surgery.

Abstract

Background: The hypocalcemia and hypoparathyroidism due to parathyroid damage during thyroid cancer surgery seriously affect the quality of life of patients. Although contemporary scholars have implemented different technologies, demonstrating improved intraoperative outcomes, there is still a lack of reliable real-time recognition technology. The aim of this study is to assess the efficacy of near-infrared autofluorescence (NIRAF) imaging combined with immunocolloidal gold technique (ICGT) in identifying and protecting parathyroid glands (PTGs) during thyroid cancer surgery.

Methods: This retrospective cohort study evaluated 62 thyroid cancer patients undergoing total thyroidectomy with bilateral central lymph node dissection (CLND) by the same surgical team (January-December 2023). Cohort allocation was based on intraoperative identification methods: the observation group (n=34) received NIRAF and ICGT, while the control group (n=28) underwent standard visual assessment. Primary endpoints included (I) intraoperative parathyroid detection quantitation; (II) rates of in situ gland preservation vs. autotransplantation; and (III) incidence of unintended parathyroid resection. Secondary outcomes assessed postoperative biochemical profiles [parathyroid hormone (PTH) and calcium levels at 24/72 h] and surgical complications. All statistical comparisons were performed with SPSS version 27.0.

Results: Intraoperative analysis demonstrated superior glandular preservation in the NIRAF-ICGT cohort, with 128/132 (97.0%) PTGs maintained in situ versus 83/97 (85.6%) in conventional controls (P<0.001). Transplantations differed significantly between groups (4 vs. 14 cases, P=0.009). Although accidental resection rates showed non-significant disparity (1 vs. 5 glands, P>0.05), immediate postoperative metrics revealed substantial physiological advantages. Biochemical monitoring at 24 h postoperatively showed higher calcium levels in the observation group (2.11±0.13 vs. 1.94±0.10 mmol/L, P<0.001), paralleled by elevated PTH values {16.88 [interquartile range (IQR) 4.97] vs. 10.50 [3.70] pg/mL, P<0.001}. These differentials persisted through postoperative day 3: calcium concentrations (2.17±0.77 vs. 2.08±0.11 mmol/L, P<0.001) and PTH levels [25.38 (IQR 3.38) vs. 14.32 (IQR 2.08) pg/mL, P<0.001]. Clinically, the observation group exhibited reduced hypocalcemia incidence (12 vs. 18 cases) and lower transient hypoparathyroidism rates (10 vs. 16 case), both P<0.05.

Conclusions: Compared to traditional visual recognition, the NIRAF-ICGT integrated technology can help surgeons better identify and protect parathyroid function during thyroid cancer surgery.