A multicenter, randomized clinical trial of 754 patients across 4 U.S. medical centers found that using fiber-based near-infrared autofluorescence during endocrine neck surgery increased parathyroid gland detection—particularly during thyroidectomy and bilateral parathyroidectomy.

However, near infrared autofluorescence (NIRAF) did not significantly reduce rates of postoperative hypoparathyroidism.

The trial was conducted from March 2020 to July 2024 and analyzed 712 patients for the primary outcome. Researchers assessed whether NIRAF improved parathyroid gland (PG) identification during surgery and evaluated secondary outcomes such as hypoparathyroidism, operative time, frozen section use, and accidental gland removal.

Among patients undergoing bilateral parathyroidectomy, the mean number of PGs identified was 3.5 in the NIRAF group and 3.2 in the control group. In thyroidectomy cases, the NIRAF group had a mean of 3.3 PGs identified compared with 2.8 in the control group.

For focused parathyroidectomy, NIRAF did not significantly improve detection. The mean PGs identified were 1.6 in the NIRAF group and 1.5 in controls.

Surgical trainees showed the greatest improvement. During thyroidectomy, trainees using NIRAF identified 3.3 PGs per patient versus 1.5 without it. In bilateral parathyroidectomy, their PG detection increased from 0.9 to 3.1 with NIRAF.

Despite improved identification, there was no significant difference in hypoparathyroidism rates. Transient hypoparathyroidism occurred in 48 of 173 thyroidectomy patients (27.8%) in the NIRAF group and 44 of 169 (26%) in the control group. At final follow-up, persistent hypoparathyroidism was reported in 3 of 176 (1.7%) in the NIRAF group and 6 of 176 (3.4%) in controls.

Operative times were comparable. For thyroidectomy, median duration was 127.5 minutes in the NIRAF group and 120.5 minutes in controls. For parathyroidectomy, median times were 81 minutes and 78 minutes, respectively.

NIRAF use during thyroidectomy was associated with reduced frozen section analysis. Surgeons ordered frozen sections in 7 of 176 NIRAF cases (4.0%) versus 20 of 178 control cases (11.2%). There was no statistically significant difference in frozen section use during parathyroidectomy.

Inadvertent PG removal during thyroidectomy occurred in 21 of 176 patients (11.9%) in the NIRAF group and 18 of 178 (10.1%) in controls.

Full disclosures can be found in the published study.

Source: JAMA Surgery