AB135. SOH26AB_0436. Shining a light on near-infrared autofluorescence during parathyroidectomy: a systematic review and meta-analysis of surgical outcomes compared to visual inspection

Background: Near-infrared autofluorescence (NIRAF) is an emerging adjunctive tool that facilitates intraoperative identification of parathyroid glands. Although it has shown promise in the setting of thyroidectomy, its role in parathyroidectomy for primary hyperparathyroidism (PHPT) remains unclear. This study aimed to address that question.

Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched to identify studies comparing NIRAF with conventional visual identification of parathyroid glands during parathyroidectomy. The primary outcome was cure rates, and secondary outcomes included operative time and the number of parathyroid glands identified. Methodological quality was assessed using Cochrane RoB2 and the Newcastle-Ottawa tools. Meta-analysis was performed using a random effects model.

Results: Three studies comprising of 522 patients were included: two randomised control trials and one observational cohort study. Meta-analysis showed a non-significant improvement in cure rates with NIRAF [relative risk (RR) =1.06; 95% confidence interval (CI): 1.02–1.10; P=0.21]. Mean operative time was reduced by 2.1 minutes with NIRAF (95% CI: −4.76 to 9.00; P=0.55), and the mean number of placement groups (PGs) identified increased by 0.12 per patient (95% CI: −0.21 to 0.46; P=0.46). Neither of the secondary outcomes reached statistical significance. Heterogeneity was moderate to high across the outcomes.

Conclusions: Although NIRAF has proved promising in the setting of thyroidectomy, in the setting of parathyroidectomy for PHPT, it did not offer statistically significant improvements in surgical outcomes. While the technology appears promising, its impact on cure rates remains uncertain. Larger, high-quality randomised controlled trials (RCTs) are warranted to define the role of NIRAF in parathyroid surgery more clearly.

Keywords: Near-infrared autofluorescence (NIRAF); parathyroid glands; parathyroidectomy; parathyroid surgery; primary hyperparathyroidism (PHPT)