IMPACT OF NEAR-INFRARED PARATHYROID FLUORESCENCE (NIRAF) FOR TARGETED PARATHYROIDECTOMY CHANGING THE PARADIGM FOR THE MANAGEMENT OF PRIMARY HYPERPARATHYROIDISM.

AUTHORS:
L. Carrillo (Poitiers, France) , B. Sohail (Zarqa, Jordan) , S. Di Lorenzo (Roma, Italy) , G. Donatini (Poitiers, France)
Background:
Patients presenting primary hyperparathyroidism(pHPT) may benefit from targeted surgical approach. However, after parathyroid' adenoma resection, confirmation through frozen section(FS) and/or intraoperative parathyroid hormone(ioPTH) analysis is employed. This may lengthen the overall procedure resulting in increased cost per single surgery. Our study aims to assess the impact of NIRAF' use in patients with pHPT, undergoing targeted surgery, to confirm both successful outcome of surgery and decrease operative time.
Methods:
Eighty-five patients undergoing targeted parathyroidectomy for pHPT with both concordant ultrasound (US) and 99mTc-sestamibi Scintiscan localization between 2021 and 2023 were included in the study. Patients were divided into two groups: NIRAF(AF) or control group(CG). In AF, the autofluorescence pattern of the excised adenoma (heterogeneous compared to normal parathyroid tissue) combined with preoperative ultrasound size concordance was considered to conclude the procedure. In CG, after adenoma removal, ioPTH analysis and frozen section were performed, and the procedure was completed accordingly.
Results:
Twenty-six patients underwent surgery in CG and 59 in AF, respectively. Median duration of surgery was 58 minutes in CG and 33 minutes in AF (p <0.001). No complications were reported in both groups. The pathological report confirmed the pathological nature of the excised lesions. In 57/59 cases, NIRAF detected the typical heterogeneous pattern, while in 2/59 glands, it was negative (hyperplasia).
Conclusions:
The use of NIRAF in selected patients with pHPT undergoing targeted surgery with concordant preoperative localization imaging may represent a safe and reliable management to decrease overall cost of surgery, replacing ioPTH and frozen section.