Advances in Optical and Fluorescence Imaging for Surgical Management of Thyroid Cancer

Background/Objectives: The majority of thyroid cancer patients are diagnosed with papillary thyroid cancer. A complete R0 resection significantly lowers cancer recurrence risk for high-risk papillary thyroid cancer but can be difficult to achieve because tumor margins are not easily visualized. The purpose of the present narrative review is to describe current work and future directions in fluorescence-guided thyroid cancer surgery. Methods: PubMed and Google Scholar were used to identify 45 articles that focused on fluorescence labeling and imaging of thyroid cancer published through February 2026 using the search terms “thyroid cancer” AND (“fluorescence imaging,” OR “NIR imaging” OR “optical imaging”) OR “fluorescence guided thyroidectomy”. Standalone abstracts and publications not available in English were excluded. Results: 17 fluorescent probes were shown to visualize tumor margins and micrometastases, 3 probes were able to visualize nerves, and 2 probes targeted lymph nodes. Most studies were done using animal models. Two probes (EMI-137, which targets tumors, and bevonescein, which targets nerves) were tested in clinical trials with good safety profiles. Conclusions: Several tumor-targeted fluorophores and optical imaging strategies have shown promise for thyroid cancer localization, margin assessment, lymph node evaluation, and nerve visualization; however, most remain preclinical, and clinical utility will require standardized dosing, imaging thresholds, safety assessment, and outcome-based validation with multicenter clinical trials.