A Meta‐analysis of Carbon Nanoparticles for Identifying Lymph Nodes and Protecting Parathyroid Glands during Surgery

Li, Yin; Jian, Wenhua; Z, Guo; Li, Qiuli; Lin, Sheng; Huang, Haiyan

doi:10.1177/0194599815580765

Cited by 44 publications

(54 citation statements)

References 13 publications

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“…Recently, the technology of carbon nanoparticles (CNs) has been applied to distinguish developing lymph nodes from nondeveloping parathyroid glands, which can facilitate preservation of the normal anatomic structure and physiologic function of parathyroid glands during thyroidectomy and central neck dissections. [10] However, frozen sections are still a necessity when encountering an atypical parathyroid. In this study, we excluded patients in which even a frozen section could not positively identify the gland.…”

Section: Resultsmentioning

confidence: 99%

A prospective cohort study of novel functional types of parathyroid glands in thyroidectomy

Cui

Kong

et al. 2016

Medicine

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The best method of preventing hypoparathyroidism after thyroidectomy is to keep parathyroid glands in situ. However, hypoparathyroidism still regularly occurs with the existing parathyroid classification system, and the incidence of permanent hypoparathyroidism has not been reduced. We created a novel system for classifying parathyroid glands that can guide parathyroid preservation in thyroidectomy.We prospectively observed parathyroid glands using the new system in 218 neck surgeries, compared with 132 under the traditional system from January 2014 to September 2015 at a single clinic center. Briefly, we classified parathyroid glands as follows: Type A, no dependency on the thyroid; B1, partial blood supply from the thyroid but retains adequate blood supply after removal of the thyroid; B2, partial blood supply from the thyroid and becomes devascularized after the removal of the thyroid; B3, blood supply mostly from the thyroid; and C, blood supply completely dependent on the thyroid. The classifications were used to decide between in situ preservation or auto-transplantation.The most common type of parathyroid gland was type B1 (53.77%), followed by type A (20.89%), which are the perfect categories for in situ preservation. Type B2 (17.52%) and type B3 (1.21%) have a chance to be kept in situ. For type C (6.61%), in situ preservation is impossible. When in-situ preservation is ruled out, parathyroid auto-transplantation is an alternative, with partial or total gland tissue, depending on the classification and the surgeon's discretion. Among the patients who were classified under the new system, 43.6% presented with transient hypoparathyroidism (symptoms lasting ≤6 months) after surgery, versus 42.4% in the old system, which was not a significant difference. However, permanent hypothyroidism (symptoms lasting >6 months) was not detected in the applied group, but in 3.0% of patients in the nonapplied group (P = 0.01).Our novel functional nomenclature system for parathyroid glands can provide a guide for preserving parathyroid function. For certain types, such as type B2 and C, instead of being kept in situ, auto-transplantation of partial or total parathyroid tissue is a prudent choice to ensure continued function.

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Section: Resultsmentioning

confidence: 99%

A prospective cohort study of novel functional types of parathyroid glands in thyroidectomy

Cui

Kong

et al. 2016

Medicine

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“…Previous studies have demonstrated that CNs could help visualize the lymph nodes and preserve the parathyroid. In addition, a meta-analysis has also been published to support this viewpoint 20. However, controversy still exists about the usefulness of CNs.…”

Section: Introductionmentioning

confidence: 99%

“…Before 2014, all articles published on the usage of CNs in thyroid cancer surgeries were in Chinese, and there were only limited randomized controlled trials (RCTs) reported. Accordingly, a considerable amount of non-RCTs were included in the previous meta-analysis 20. However, in recent years, more RCTs have been published.…”

Section: Introductionmentioning

confidence: 99%

Application of carbon nanoparticles in lymph node dissection and parathyroid protection during thyroid cancer surgeries: a systematic review and meta-analysis

Wang¹,

Yang²,

Lv³

et al. 2017

OTT

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PurposeTo investigate whether carbon nanoparticles (CNs) are helpful in identifying lymph nodes and metastatic lymph nodes and in parathyroid protection during thyroid cancer surgery.MethodsEnglish and Chinese literature in PubMed, Cochrane Database of Systematic Reviews, EMBASE, ClinicalTrials.gov, China Biology Medicine Database, China National Knowledge Infrastructure, China Master’s and Doctoral Theses Full-Text Database, Wanfang database, and Cqvip database were searched (till March 22, 2016). Randomized controlled trials (RCTs) that compared the use of CNs with a blank control in patients undergoing thyroid cancer surgery were included. Quality assessment and data extraction were performed, and a meta-analysis was conducted using RevMan 5.1 software. The primary outcomes were the number of retrieved central lymph nodes and metastatic lymph nodes, and the rate of accidental parathyroid removal.ResultsWe obtained 149 relevant studies, and only 47 RCTs with 4,605 patients (CN group: n=2,197; blank control group: n=2,408) met the inclusion criteria. Compared with the control group, the CN group was associated with more retrieved lymph nodes/patient (weighted mean difference [WMD]: 3.39, 95% confidence interval [CI]: 2.73–4.05), more retrieved metastatic lymph nodes (WMD: 0.98, 95% CI: 0.61–1.35), lower rate of accidental parathyroid removal, and lower rates of hypoparathyroidism and hypocalcemia. However, the total metastatic rate of the retrieved lymph nodes did not differ between the groups (odds ratio: 1.13, 95% CI: 0.87–1.47, P=0.35).ConclusionCNs can improve the extent of neck dissection and protect the parathyroid glands during thyroid cancer surgery. And the number of identified metastatic lymph nodes can be simultaneously increased.

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“…The most important point for this comparison was parathyroid function recovery; although the total thyroidectomy group showed many parathyroidectomies, all of these removed parathyroids were confirmed by intraoperative frozen pathology and were autotransplanted in the sternocleidomastoid, with the surgical details presented in our previous research 25. Carbon nanoparticles as a lymph node tracer may help to identify affected lymph nodes and preserve the parathyroid 26,27…”

Section: Discussionmentioning

confidence: 99%

Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis

Lei¹,

Zhu

et al. 2016

OTT

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ObjectiveWe sought to evaluate and compare the outcomes of different surgical protocols for papillary thyroid cancer (PTC) located in the isthmus in a retrospective intention-to-treat analysis.Patients and methodsThe data of 3,068 patients who received thyroidectomy due to thyroid cancer in our center were reviewed. Of these, 103 patients had a dominant carcinoma located in the isthmus. Various baseline and tumor characteristics and surgical outcomes were evaluated and compared with respect to the different surgical protocols (85 cases with total thyroidectomy and 18 cases with less-than-total thyroidectomy). Univariate and multivariate analyses were performed to identify resected patients who developed recurrence with isthmic PTC.ResultsThe postoperative complication rates were comparable between the two groups (17.6% versus 11.1%, P=0.500). Although the total thyroidectomy group showed a much higher rate (P=0.004) and number (P<0.001) of parathyroidectomies, long-term follow-up indicated that parathyroid autotransplantation did not significantly damage the function of the parathyroid (P>0.05). Tumor recurrence was observed in five patients, including two patients in the total thyroidectomy group and three patients in the less-than-total thyroidectomy group; the tumor recurrence rate in the total thyroidectomy group was significantly lower than that in the less-than-total thyroidectomy group (P=0.040). Univariate and multivariate analyses indicated less-than-total thyroidectomy as a risk factor for tumor recurrence in PTC cases with tumors located at the isthmus (hazard ratio: 1.870, 95% confidence interval: 1.320–2.218, P<0.001).ConclusionOur findings indicate that total thyroidectomy is an appropriate initial surgical protocol for isthmic PTC due to the lower recurrence rate, comparable postoperative complication rate, and parathyroid function recovery.

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A Meta‐analysis of Carbon Nanoparticles for Identifying Lymph Nodes and Protecting Parathyroid Glands during Surgery

Abstract: CNs partially improve the extent and accuracy of neck dissection and preserve the normal anatomic structure and physiologic function of the parathyroid glands during thyroid cancer surgery.

Cited by 44 publications

References 13 publications

A prospective cohort study of novel functional types of parathyroid glands in thyroidectomy

A prospective cohort study of novel functional types of parathyroid glands in thyroidectomy

Application of carbon nanoparticles in lymph node dissection and parathyroid protection during thyroid cancer surgeries: a systematic review and meta-analysis

Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis

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