The potential role of carbon nanoparticles-assisted biopsy for sentinel lymph nodes of incidental thyroid carcinoma

Zhang, Chaojie; Li, Xinying; Zhang, Zhigong; Lei, Shanshan; Fan, Ping; Xiao, Qiang

doi:10.21037/gs.2019.07.08

Cited by 10 publications

(8 citation statements)

References 36 publications

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“…4 Although a few articles have mentioned the injection depth, this depth is not the same among different reports; some surgeons inject the suspension into the superficial thyroid gland to a depth of 2 to 3 mm, while others inject the suspension more deeply into the thyroid gland to no definite depth. 15,16 In the present case, two injection points around the tumor were selected, the total injection volume was 0.4 mL, and the waiting time was 10 minutes; these parameters are consistent with those reported in the literature. 4 When the tracheal tube was retrieved after the operation, some carbon-containing secretions were present in the mouth, and the inflatable balloon surface of the tracheal tube was covered with these secretions.…”

Section: Discussionsupporting

confidence: 74%

Infiltration of nanocarbon suspension into the tracheal cavity during surgical treatment of papillary thyroid carcinoma: a case report

Zhu¹,

Zhu

Li³

et al. 2020

J Int Med Res

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Cervical lymph node metastasis in patients with differentiated thyroid cancer affects postoperative recurrence and survival. Hypoparathyroidism is caused by parathyroid gland injury during thyroidectomy. Carbon nanoparticles can trace stained lymph nodes, aiding in thorough dissection of lymph nodes in the operation area. To reduce postoperative occurrence of hypoparathyroidism, the parathyroid glands and their functions (identified by negative imaging induced by carbon nanoparticles) are retained in situ. However, the safety and adverse effects of nanocarbon suspension in thyroid surgery have rarely been evaluated. In this report, we describe a patient with thyroid cancer who had carbon secretions in the trachea caused by nanocarbon suspension when tracheal intubation was performed under general anesthesia, and the inflatable balloon surface of the tracheal tube was covered with these secretions. The patient recovered without fever, cough, phlegm production, chest pain, hoarseness, or hypocalcemia-induced convulsions. No consensus has yet been reached on the most appropriate injection site, depth, dose, or waiting time for nanocarbons in thyroid cancer surgery. We believe that nanocarbon suspension is safe for use in thyroid cancer surgery, but the most appropriate injection depth should be based on the thickness of the thyroid gland tissue to avoid deep injection into the trachea.

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Section: Discussionsupporting

confidence: 74%

Infiltration of nanocarbon suspension into the tracheal cavity during surgical treatment of papillary thyroid carcinoma: a case report

Zhu¹,

Zhu

Li³

et al. 2020

J Int Med Res

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“…Recently, CN was applied in thyroid cancer as reported by several authors. Zhang et al reported that carbon nanoparticle-assisted sentinel lymph node biopsy can detect incidental thyroid carcinoma which prevents the need for a second surgery [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Zhang

Feng

2021

BioMed Research International

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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.

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“…Cervical LNM is common in PTC patients and accounts for 30–80% [ 4 , 5 , 21 ]. LNM was associated with local recurrence of PTC and overall mortality of patients [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…To address this, our study first established an individual nomogram model for predicting skip metastasis. The nomogram is a practical and simple tool for identifying high-risk patients and quantifying individual risk, which has been frequently reported in cancer research [19][20][21][22]. The aim of this study was to develop a nomogram to predict skip metastasis in PTC patients to provide an individual risk assessment and guide treatment decisions for patients.…”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict skip metastasis in papillary thyroid cancer

2020

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Background: Skip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients. Patients and methods: A total of 378 consecutive PTC patients with clinically suspected LNM who underwent modified radical neck dissection (MRND) from March 2018 to July 2019 in our hospital were enrolled. Univariate and multivariate analyses were used to examine risk factors of skip metastasis, and a nomogram prediction model was established and internally validated. Results: The incidence of skip metastases was 11.6% (44/378). Primary tumor size of ≤ 1 cm (OR = 2.703; 95% CI, 1.342-5.464; P = 0.005), age (OR = 1.051; 95% CI, 1.017-1.805; P = 0.005), and primary tumor location in the upper portion (OR = 6.799; 95% CI, 2.710-17.060; P < 0.001) were found to be independent risk factors for skip metastasis in PTC patients. A nomogram based upon these predictors performed well. The area under the curve (AUC) was 0.806 (95% CI, 0.736-0.876), and the P value of the Hosmer-Lemeshow goodness of fit test was 0.66. Decision curve analysis revealed that the nomogram was clinically useful. Conclusion: Based on the risk factors of skip metastasis, a high-performance nomogram was established, which can provide an individual risk assessment and can guide treatment decisions for patients.

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The potential role of carbon nanoparticles-assisted biopsy for sentinel lymph nodes of incidental thyroid carcinoma

Cited by 10 publications

References 36 publications

Infiltration of nanocarbon suspension into the tracheal cavity during surgical treatment of papillary thyroid carcinoma: a case report

Infiltration of nanocarbon suspension into the tracheal cavity during surgical treatment of papillary thyroid carcinoma: a case report

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

A nomogram to predict skip metastasis in papillary thyroid cancer

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