Factors influencing identification accuracy rate of parathyroid glands using near-infrared autofluorescence during endoscopic thyroidectomy

Background Near-infrared autofluorescence (NIRAF) enhances parathyroid gland (PG) identification during thyroidectomy. However, its identification rate is frequently affected by false-positive and false-negative results. Methods This prospective cohort study enrolled 50 patients scheduled for endoscopic thyroidectomy, employing a 1:1 case-matched design. The patients were assigned to an experimental group (NIRAF group; n = 25) and a control group (Non-NIRAF group; n = 25). Results In the NIRAF group, levels of parathyroid hormone (PTH) on the first postoperative day ( P = 0.002) and at the first postoperative month ( P = 0.04), as well as serum calcium levels at the first month, were significantly higher than those in the Non-NIRAF group ( P = 0.03). The sensitivity and specificity of NIRAF for identifying PGs were 80% and 84%, respectively. A higher body mass index (BMI) was associated with an increased incidence of false negatives ( P = 0.07). Four false-positive events were recorded, originating from a thyroid nodule, thymus, adipose tissue, and a lymph node. Conclusion NIRAF is a highly sensitive navigation tool that effectively improves PG preservation and postoperative outcomes. Nevertheless, its diagnostic accuracy is challenged by false positives from heterogeneous tissues and false negatives driven by anatomical barriers like excessive fat.