Near-infrared Fluorescence With Indocyanine Green for Identification of Sentinels and Parathyroids During Thyroidectomy

NCT ID: NCT04424485

Last Updated: 2020-06-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-06-01

Study Completion Date

2021-06-01

Brief Summary

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Indocyanine green (ICG) is a water-soluble organic dye that is cleared totally through the hepatobiliary system. It has a half-life of 3-4 mins, which allows repeated applications. Near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) imaging has been recently introduced, and has been suggested as a useful tool for the identification and preservation of the parathyroid glands (PGs) during total thyroidectomy (TT). ICG can also be used for sentinel lymph node (SLN) biopsy to predict the micrometastases in central lymph nodes (CLN) in thyroid carcinoma, and central lymph node dissection can reduce local recurrence.

Detailed Description

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Incidence of thyroid cancer has doubled between 1980 and 2020, and it is now the fifth most common malignant tumor among women. The majority are papillary thyroid cancer (PTC), and TT is the procedure of choice. Since the micrometastasis rate of the central lymph nodes (CLNs) is about 30% to 90% in PTC, CLN dissection can improve the prognosis and reduce tumor recurrence as well as provide accurate information for the evaluation of tumor staging. However, TT procedure has some important complications such as vocal cord paralysis (VCP) and hypocalcemia (due to accicental parathyroidectomy or damage to the parathyroid gland-PG- vasculature). Use of intraoperative nerve monitoring (IONM) has reduced the rate of VCP. However, the incidence of postoperative hypocalcemia is still high (15-70%), and it is now the most common complication of TT. Intraoperative identification of SLNs and PGs can help surgeon to overcome these problems.

Conditions

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Thyroid Cancer Thyroid Carcinoma, Papillary Thyroid Metastases Thyroid Neoplasms Sentinel Lymph Node Lymph Node Metastases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Thyroid carcinoma patients (biopsy-proven)-Total thyroidectomy

Control group-Total thyroidectomy (TT) with central lymph node dissection (CLND) procedure for patients with papillary thyroid carcinoma (PTC)

Standard TT+CLND procedure only

Group Type ACTIVE_COMPARATOR

Total thyroidectomy (TT)

Intervention Type PROCEDURE

Standard TT procedure for thyroid carcinoma, for both groups

Central lymph node dissection (CLND)

Intervention Type PROCEDURE

Standard CLND for thyroid carcinoma, for both groups

Thyroid carcinoma patients (biopsy-proven)-Sentinel lymph node

Experimental group- Sentinel lymph node dissection (SLND) after intratumoral indocyanine green (ICG) injection and visualization of all 4 parathyroid glands with infra-red (NIR) fluorescence after intravenous (iv) ICG injection, during total thyroidectomy and central lymph node dissection (CLND).

TT+CLND with NIR fluorescence ICG

Group Type EXPERIMENTAL

Total thyroidectomy (TT)

Intervention Type PROCEDURE

Standard TT procedure for thyroid carcinoma, for both groups

Central lymph node dissection (CLND)

Intervention Type PROCEDURE

Standard CLND for thyroid carcinoma, for both groups

Sentinel lymph node (SLN) bopsy

Intervention Type DIAGNOSTIC_TEST

Intrathyroidal injection of ICG for SL biopsy, for only experimental group

Identification of parathyroid glands (PGs)

Intervention Type DIAGNOSTIC_TEST

Near-infrared (NIR) fluorescence visualization of PGs, for only experimental group

Interventions

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Total thyroidectomy (TT)

Standard TT procedure for thyroid carcinoma, for both groups

Intervention Type PROCEDURE

Central lymph node dissection (CLND)

Standard CLND for thyroid carcinoma, for both groups

Intervention Type PROCEDURE

Sentinel lymph node (SLN) bopsy

Intrathyroidal injection of ICG for SL biopsy, for only experimental group

Intervention Type DIAGNOSTIC_TEST

Identification of parathyroid glands (PGs)

Near-infrared (NIR) fluorescence visualization of PGs, for only experimental group

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Thyroid carcinoma patients (biopsy/cytology-proven) suitable for total thyroidectomy procedure
* Patients at or over 17 years

Exclusion Criteria

* Previous thyroid surgery
* Patients below 17 years
Minimum Eligible Age

17 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Umraniye Education and Research Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Ethem Unal, M.D., PhD, Associate Prof of Surgery & Surgic

A. Prof. of General Surgery and Surgical Oncology

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Umraniye Education and Research Hospital, Department of General Surgery

Istanbul, , Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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Ethem Unal, MD, PhD, USMLE&IFSO-CSS, A. Prof.

Role: CONTACT

+90 216 632 1818 ext. 1950

Sema Yuksekdag, MD

Role: CONTACT

+90 216 632 1818 ext. 1950

Facility Contacts

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Ethem Unal, MD, PhD, A. Prof. of Surgery & Surgical Oncology

Role: primary

+90 216 632 1818 ext. 1950

Sema Yuksekdag, MD

Role: backup

+90 216 632 1818 ext. 1950

References

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Zhang X, Shen YP, Li JG, Chen G. Clinical feasibility of imaging with indocyanine green combined with carbon nanoparticles for sentinel lymph node identification in papillary thyroid microcarcinoma. Medicine (Baltimore). 2019 Sep;98(36):e16935. doi: 10.1097/MD.0000000000016935.

Reference Type RESULT
PMID: 31490376 (View on PubMed)

Spartalis E, Ntokos G, Georgiou K, Zografos G, Tsourouflis G, Dimitroulis D, Nikiteas NI. Intraoperative Indocyanine Green (ICG) Angiography for the Identification of the Parathyroid Glands: Current Evidence and Future Perspectives. In Vivo. 2020 Jan-Feb;34(1):23-32. doi: 10.21873/invivo.11741.

Reference Type RESULT
PMID: 31882459 (View on PubMed)

Related Links

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Other Identifiers

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B.10.1.TKH.4.34.H.GP.0.01/213

Identifier Type: -

Identifier Source: org_study_id

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