NIRAF imaging associated with improved parathyroid identification during thyroidectomy in retrospective study

This retrospective cohort study evaluated near-infrared autofluorescence (NIRAF) imaging using the Fluobeam LX® device versus conventional visual inspection for identifying parathyroid glands during total thyroidectomy. The single-center analysis included 349 patients, comparing a historical control group (2014–2016) receiving visual inspection alone to a later cohort (2021–2023) receiving NIRAF-assisted identification. The primary outcome was the mean number of parathyroid glands identified intraoperatively.

The NIRAF group had a higher mean number of glands identified (2.91 ± 0.98) compared to the visual inspection group (2.59 ± 1.02), a statistically significant difference (p = 0.004). Postoperative parathyroid hormone (PTH) levels were also higher in the NIRAF group (3.64 ± 1.72 pmol/L vs. 3.03 ± 1.40 pmol/L, p < 0.001). However, postoperative calcium levels were slightly lower in the NIRAF group (2.21 ± 0.11 mmol/L vs. 2.29 ± 0.12 mmol/L, p < 0.001). The incidence of severe hypocalcemia (≤2.0 mmol/L) was low and comparable between groups (3.1% vs. 1.6%, p = 0.497). Safety and tolerability data were not reported.

Key limitations include the retrospective, single-center design and the use of a historical control group, which introduces potential confounding from temporal changes in surgical practice. Rates of parathyroid gland autotransplantation and inadvertent removal were not reported in the abstract. The study design precludes establishing causality. The practice relevance is that NIRAF imaging may be associated with improved intraoperative gland identification and postoperative PTH levels, but the slightly lower calcium levels and study limitations warrant caution.