Preoperative ultrasound-guided carbon nanoparticles localization for metastatic lymph nodes in papillary thyroid carcinoma during reoperation

Abstract

Due to the damaged anatomical structure and a large amount of fibrous and scar tissues in the surgical field, reoperation of papillary thyroid carcinoma is difficult. This study introduces a new method of locating metastatic lymph nodes during reoperation and evaluates the effectiveness and safety of the preoperative ultrasound-guided carbon nanoparticles (CNs) localization. This retrospective cohort study enrolled 52 patients who were diagnosed with lymph node metastasis by histopathology and underwent reoperation from October 2015 to February 2016. The modified radical neck dissection or selective neck node dissection was performed. A total of 26 patients underwent preoperative ultrasound-guided CNs injection, and other 26 patients did not. Tolerance, the result of injection, the number of resected metastatic lymph nodes, and postoperative complications were recorded and analyzed. In CNs group, 102 suspicious nonpalpable lesions in 26 patients were injected with CNs, and 99 of the 102 lesions were successfully identified by surgeon in the reoperation. The positive rate of resected lymph nodes in total, in the central compartment, and in the lateral compartment were 31.6%, 31.2%, and 32.8%, respectively, which was significantly higher than that in the control group (P < 0.001, P < 0.001, and P = 0.041). In addition, the positive rates of levels III, IV, and V in the CNs group were 35.6%, 21.9%, and 30.5%, respectively, which was significantly higher than that in the control group (P < 0.001, P = 0.005, and P = 0.01). In additional, in the CNs group, the rate of temporary hypoparathyroidism was significantly lower compared with the control group (0% vs 26.9%, P = 0.021). Preoperative ultrasound-guided CNs injection is a safe and effective method for localization of the metastatic lymph nodes during reoperation.

How Pre-operative Sentinel Lymph Node Contrast-Enhanced Ultrasound Helps Intra-operative Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience

“…A previous study recruited 110 patients with an identification rate of 96.4% by SLN-CEUS, and the median number of SLNs detected by CEUS was 1.2. SLN-CEUS had a 100% sensitivity, 52.0% specificity, 64.9% accuracy, 43.4% positive predictive value and 100% negative predictive value in identifying metastatic LNs (Zhao et al 2017). Another study recruited 101 patients, and the sensitivity and specificity were 81.8% and 86.2%.…”

“…If no enhanced LCs were observed after massaging around the areola, the second injection of contrast agent was performed to re-assess the enhancement of LCs and SLNs according to the previous procedure. The patterns of enhancement in SLNs can be classified as follows: homogeneous enhancement, inhomogeneous enhancement and no enhancement (Sharma and Cox 2017;Zhao et al 2017). In this study, homogeneously enhanced SLNs were considered to be non-metastatic nodes.…”

“…Goldberg et al (2004) used intradermal injection in SLN-CEUS in a swine melanoma model to prove that microbubbles could successfully enter breast lymphatics and identify the axillary nodes. Likewise, Zhao et al (2017) found that SLN-CEUS can determine whether the SLN is metastatic with a sensitivity and specificity of 100% and 52%, respectively. Ganott et al (2014) observed five lymphatic drainage patterns in the clinical use of SLN-CEUS.…”

The function of carbon nanoparticles to improve lymph node dissection and identification of parathyroid glands during thyroid reoperation for carcinoma

“…[ 19 ] Moreover, CNs was safety and nontoxic to date. [ 20 – 22 ] Therefore, we conducted the retrospective study to evaluate the function of CNs as lymph nodes tracer during thyroid reoperation.…”

Nanoparticles can improve the positive rate of metastatic lymph node in thyroid cancer surgery

“…Thyroid cancer is the most common endocrine malignant tumor, and the most common pathological type is papillary thyroid cancer (PTC), accounting for more than 90% of the total thyroid cancer [1][2] .Surgical treatment is the main treatment of this disease 3 ,because of its high rate of lymph node metastasis 4] therefore, the routine cervical lymph node dissection in China increases the injury rate of parathyroid gland and the risk of postoperative hypocalcaemia with the expansion of surgical scope 5 .Studies have shown that carbon nanoparticles can darken lymph nodes and negatively develop parathyroid glands 6 ,it is widely used in thyroid surgery, but whether carbon nanoparticles have a protective effect on parathyroid glands is controversial 10,17 .The purpose of this study was to investigate the value of carbon nanoparticles in thyroid cancer surgery and cervical central lymph node dissection.…”