Near-Infrared Autofluorescence Imaging in Thyroid Surgery: A Systematic Review and Meta-Analysis

Abstract

Objective

This meta-analysis aimed to assess the position of near-infrared autofluorescence (NIRAF) imaging in the recognition and protection of the parathyroid gland (PG) during thyroidectomy.

Methods

The PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were searched up to June 2021. The primary outcome was to evaluate the rates of postoperative hypocalcemia, inadvertent PG resection, and autotransplantation of PG when adopting NIRAF imaging compared with standard naked-eye (N–E) surgery.

Results

Eight studies with 2,889 patients were enrolled in the analysis. Our analysis showed that the incidence of transient hypocalcemia was 7.11% (60/844) in the NIRAF group and 22.40% (458/2045) in the N–E group (p < 0.0001) and the rate of transient hypoparathyroidism was 28.31% (126/445) and 33.36% (496/1487) in the NIRAF and N–E groups (p = 0.0008). The rate of inadvertent resection of PGs was 7.65% (55/719) in the NIRAF group and 14.39% (132/917) in the N–E group (p < 0.0001). No significant difference was observed in other indexes including the pooled proportion of permanent hypocalcemia and rate of PG autotransplantation.

Conclusions

The application of NIRAF imaging in thyroidectomy can help lower the incidence of inadvertent PG resection and reduce the risk of postoperative hypocalcemia and hypoparathyroidism compared with N–E recognition.

Keywords:

• near-infrared
• autofluorescence
• hypocalcemia
• hypoparathyroidism
• meta-analysis
• thyroid surgery

Acknowledgements

We thank the authors and participants of the relevant studies for their vital contributions.

Authors’ contribution

Wei Lu: study design, data collections, data analysis and drafting the article, final approval of the version to be submitted. Qiang Chen and Pei Zhang: acquisition of data, data analysis and interpretation. Jingqiang Zhu and Anping Su: study concepts, study design, revising the manuscript, final approval of the version to be submitted.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

This review study did not treat human participants. Therefore, our Institutional Review Board waived the need for informed consent for this systematic review and meta-analysis.

Informed consent

For this type of study, formal consent is not required.

Additional information

Funding

This work was supported by Project for Health Commission of Sichuan Province (20FJ057).