Does parathyroid autofluorescence reduces unintentional parathyroidectomy during total thyroidectomy with central lymph node compartment dissection?

Postoperative hypoparathyroidism is the most frequent complication after thyroid surgery. Parathyroid autofluorescence ability serves as a useful tool for localizing parathyroid glands intraoperatively. The aim of this study is to evaluate the efficacy of intra-operative autofluorescence imaging concerning the unintentional excision rate of parathyroids during total thyroidectomy with central lymph node compartment dissection. This s a prospective randomized study enrolling patients with thyroid cancer that underwent total thyroidectomy with therapeutic bilateral central lymph node compartment dissection in a high-volume center during a two-year period. Patients were separated in two groups [without (A) or with FLUOBEAM® LX (B)] and the number of identified parathyroid glands intraoperatively was recorded and correlated with postoperative levels of parathyroid hormone and serum calcium. One-hundred eighty patients were included in this study. A higher number of parathyroid glands were identified and distinguished from lymph nodes in the central compartment with autofluorescence compared to naked eye visualization (3.84 ± 0.51 vs. 3.69 ± 0.78, p = 0.03). The number of parathyroid glands found in specimen were lower in Group B (17 vs. 8, p = 0.06). Group B had lower incidence of transient postoperative hypoparathyroidism (16.1% vs. 9.4%, p = 0.058, odds ratio 0.54, 95% CI 0.28-1.02). Moreover, the autofluorescence score had influence on postoperative transient hypoparathyroidism rates (p < 0.001). Parathyroid autofluorescence is a safe and efficient tool in experienced hands during central compartment neck dissection, improving postoperative hypoparathyroidism rates and quality of lymph node dissection.