The following is a summary of “Real-time imaging of ipsilateral parathyroid glands by retrograde injection of methylene blue into the superior thyroid artery: a new intraoperative parathyroid protection method,” published in the April 2024 issue of Surgery by Guo et al.
Postoperative hypoparathyroidism stemming from parathyroid injury remains a significant concern in thyroid surgery, necessitating reliable intraoperative parathyroid imaging methods. In this study, researchers recruited patients with differentiated thyroid carcinoma (DTC) undergoing unilateral thyroidectomy alongside ipsilateral central lymph node dissection. The approach involved dissecting the main trunk of the superior thyroid artery (STA) and inserting a venous indwelling tube for retrograde catheterization into the artery, enabling real-time imaging of the parathyroid glands using methylene blue.
The study group evaluated this method’s sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Out of 132 patients enrolled, 105 completed the retrograde catheterization procedure, with sensitivity and specificity ranging from 69.23% to 83.33% and 72.91% to 64.89%, respectively. The method exhibited high PPV and NPV, with no instances of allergic reactions or toxicity associated with methylene blue. The findings demonstrate that retrograde injection of methylene blue via the superior thyroid artery (STA) offers an effective and safe means of visualizing parathyroid glands during thyroid surgery.
This approach facilitates precise localization of the target organ by selectively accessing the blood vessel and administering the contrast agent, thereby minimizing background contamination and reducing the required contrast agent volume.
Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02360-z