Application of Carbon Nanoparticles in Neck Dissection of Clinically Node-Negative Papillary Thyroid Carcinoma

Abstract

Purpose. The purpose of this retrospective study was to evaluate the advantages of carbon nanoparticles in neck dissection and to conclude its application in the treatment of clinically node-negative papillary thyroid carcinoma (CN0PTC). Methods. As a retrospective cohort study, we divided the enrolled patients into two groups, the carbon nanoparticle (CN) group and the control group according to the usage of CN. In the CN group, CN was applied to reveal drainage lymph nodes and the picked LNs were sent for fast frozen testing. If metastasis exits, modified radical lateral lymph node dissection (LLND) was performed. For both groups, prophylactic central lymph node dissection was routinely done. Finally, the demographic information, tumor characteristics, postoperative pathological results, and laboratory data were collected for analysis. Results. A total of 61 CN0PTC were enrolled in this study, 33 in the CN group and 28 in the control group. The black-stained rate for CN was 29/40 (72.5%) with a positive prediction rate of 34.5%. The mainly black-stained region in the lateral neck was level III and possesses the highest lymph node ratio (17.5%). The metastasis that occurred in level VI was 30% and 11.8% in the CN and control groups, respectively ( p = 0.058 ). During the available follow-up, no one showed recurrence. Statistical analysis showed that the CN suspension can significantly reduce the risk of damage to the parathyroid gland ( p = 0.001 for hypocalcemia, <0.05; p = 0.047 for hypoparathyroidism, <0.05). Conclusion. The lateral neck metastasis in patients with papillary thyroid microcarcinoma in clinical stage cT1aN0 is not rare. CN can help surgeons to distinguish the real person who actually needs LLND. In prophylactic CLND, CN acts as a tracer which makes the parathyroid gland more identifiable and avoids risks of injuries to nerves and glands.

Carbon Nanoparticles for Thyroidectomy and Central Lymph Node Dissection for Thyroid Cancer

“…A total of 71 references were obtained through retrieval, and 12 articles 7,[12][13][14][15][16][17][18][19][20][21][22] met the inclusion criteria. The literature search flowchart is shown in Figure 1.…”

“…Results of meta-analysis for postoperative transient hypocalcemia. Nine studies 7,12,13,15,[17][18][19][20][21] compared postoperative transient hypocalcemia. The fixed-effects model was used for meta-analysis (I 2 = 0%).…”

“…Results of meta-analysis for postoperative permanent hypocalcemia. Eight studies 12,13,15,[17][18][19][20][21] compared postoperative permanent hypocalcemia. Only one of the 8 studies involved a positive event of permanent hypocalcemia, so the effect model could not be selected.…”

Evaluation of the clinical value of carbon nanoparticles in endoscopic thyroidectomy and prophylactic central neck dissection through total mammary areolas approach for thyroid cancer

“…Although the true assistive role of CNs in lymph node harvest in thyroid surgery is somewhat controversial, the application of CNs is not limited to the initial surgical LND. For example, Chen et al applied CNs to reveal drainage lymph nodes and to pick the lateral lymph nodes for pathological assessment in cN0 PTC patients, and modified radical lateral lymph node dissection was applied when metastasis presented [ 19 ]. CN injection was also reported to help perform CLND and identify PGs in reoperation, significantly lowering the incidence of transient hypoparathyroidism [ 23 ].…”

Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma

“…Endoscopic bilateral thyroidectomy and CLND using the complete areola approach were performed. After exposing the thyroid lobes unilaterally, 0.2 mL of a suspension of nano-sized carbon particles was injected percutaneously into the gland ( 13 ): the thyroid gland stains black, while the parathyroid gland does not ( Figure 1 ). The trachea and recurrent laryngeal nerve were then carefully dissected and the lobes of the thyroid were removed ( Figure 2 ).…”