Reece Mackenzie J, Stevenson Travis W, Liederbach Margaret, Yu Sarah, Kadakia Sameep, Alwani Mohamedkazim M
Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, USA.
Department of Otolaryngology-Head and Neck Surgery, University Hospitals and Case Western Reserve University, Cleveland, USA.
Cureus. 2025 Mar 14;17(3):e80565. doi: 10.7759/cureus.80565. eCollection 2025 Mar.
Proper identification of parathyroid tissue is a critical component in surgery involving the thyroid and parathyroid gland (PG). In recent years, near infrared autofluorescence (NIRAF) has been investigated as a non-invasive strategy to detect PG in parathyroidectomy and in PG preservation in thyroidectomy. There are currently two FDA approved NIRAF modalities, image-based and probe-based. The aim of this meta-analysis is to evaluate the efficacy of these two NIRAF modalities. PubMed, Scopus, and MEDLINE were utilized, with 238 studies analyzed via independent, blinded review. Studies from January 2000 to February 2023, Boolean phrase "parathyroid autofluorescence", written in English, and included results found within the body of the article were the inclusion criteria used. Conference abstracts, reviews, case reports, commentary, discussion and letter, non-English, animal studies, in vitro studies, contrast enhanced fluorescence, and NIRAF with use of indocyanine green, were the exclusion criteria used. Five studies were enrolled based on inclusion and exclusion criteria. The estimated overall accuracy of image-based methods is 0.96 (95% CI of (0.87, 0.99)), while the estimated overall accuracy of probe-based methods is 0.93 (95% CI of (0.92, 0.94)). With p=0.36, there is insufficient evidence to indicate a significant difference in overall accuracy, sensitivity and specificity between image-based methods and probe-based methods. Both imaging and probe-based detection modalities offer effective, noninvasive means for identifying parathyroid glands intraoperatively. Further studies comparing the efficacy of these two modalities are needed to further differentiate their clinical performance.
正确识别甲状旁腺组织是涉及甲状腺和甲状旁腺（PG）手术的关键组成部分。近年来，近红外自发荧光（NIRAF）已被研究作为一种在甲状旁腺切除术中检测甲状旁腺以及在甲状腺切除术中保留甲状旁腺的非侵入性策略。目前有两种获得美国食品药品监督管理局（FDA）批准的NIRAF模式，即基于图像的和基于探头的。本荟萃分析的目的是评估这两种NIRAF模式的疗效。使用了PubMed、Scopus和MEDLINE数据库，通过独立、盲法评审分析了238项研究。纳入标准为2000年1月至2023年2月发表的、用英文撰写的、标题中包含“甲状旁腺自发荧光”且文章正文中有相关结果的研究。排除标准包括会议摘要、综述、病例报告、评论、讨论和信函、非英文研究、动物研究、体外研究、对比增强荧光以及使用吲哚菁绿进行NIRAF的研究。根据纳入和排除标准，共纳入了五项研究。基于图像的方法的估计总体准确率为0.96（95%置信区间为（0.87，0.99）），而基于探头的方法的估计总体准确率为0.93（95%置信区间为（0.92，0.94））。p值为0.36，没有足够的证据表明基于图像的方法和基于探头的方法在总体准确率、敏感性和特异性方面存在显著差异。成像和基于探头的检测模式都为术中识别甲状旁腺提供了有效的非侵入性手段。需要进一步比较这两种模式疗效的研究，以进一步区分它们的临床性能。
