Near-infrared autofluorescence (NIRAF) for intraoperative identification of parathyroid glands
Target Population
Patients undergoing parathyroidectomy for single parathyroid adenoma
Care Setting
Intraoperative surgical setting during parathyroidectomy
Key Highlights
PTeye™ probe-based system identified 100% of parathyroid adenomas, FLUOBEAM® LX camera-based system identified 85%.
PTeye™ identified adenomas faster, with 65% detected in under 1 minute versus FLUOBEAM® LX detecting only 20% under 3 minutes.
NIRAF technology can aid surgeons, especially non-specialists and in reoperative cases with altered anatomy.
Guideline-Based Recommendations
Diagnosis
Use preoperative imaging (ultrasound, Tc-99 sestamibi scintigraphy, MRI, 4D-CT) for adenoma localization.
Intraoperative NIRAF devices (PTeye™ or FLUOBEAM® LX) can be applied for real-time identification of parathyroid adenomas.
Management
Perform minimally invasive single gland parathyroidectomy guided by NIRAF and intraoperative quick PTH assays.
If NIRAF device fails to identify adenoma, perform careful dissection and reapply device.
Monitoring & Follow-up
Use intraoperative quick parathyroid hormone assays to confirm adenoma excision.
Risks
NIRAF effectiveness may be limited by heterogeneous autofluorescence patterns and lower autofluorescence of adenomas compared to normal glands.
Patient & Prescribing Data
Adults undergoing surgery for single parathyroid adenoma; excludes secondary/tertiary hyperparathyroidism, hyperplasia, carcinoma, and patients under 18.
PTeye™ offers faster and more reliable intraoperative identification of parathyroid adenomas compared to FLUOBEAM® LX, potentially reducing operative time.
Clinical Best Practices
Employ NIRAF technology as an adjunct to visual and tactile identification during parathyroidectomy.
Consider probe-based NIRAF systems like PTeye™ for quicker and more sensitive adenoma detection.
Use NIRAF especially in reoperative cases or when anatomy is distorted.
Continue to confirm adenoma removal with intraoperative quick PTH assays despite NIRAF use.
