Carbon Nanoparticles Suspension Used In The Central Group Lymph Node Dissection Of Papillary Thyroid Carcinoma

BackgroundIn recent years, due to the thyroid ultrasound is widely used in the public examination, early papillary thyroid carcinoma shows a rising trend. Thyroidectomy with the central lymphadenectomy has gradually become one of the standards method in early stage papillary thyroid carcinoma. However, the risk of thyroid parathyroid dysfunction exists in central lymph node dissection of papillary thyroid carcinoma, how to reduce the risk of parathyroid injury in the central lymph node dissection in thyroid surgery becomes a hot research. The nano-carbon suspension has been successfully applied to the gastrointestinal cancer lymph node dissection. In recent years, nano-carbon suspension has also been widely used in thyroid cancer lymph tracer. It is necessary to assess the value of carbon nano-suspensions used in the papillary thyroid carcinoma.MethodSelected the cases of papillary thyroid carcinoma with central group lymph node dissection from May2011to May2013in the renmin Hospital of Wuhan University. Inclusion criteria:tumor diameter less than2cm, not infringe capsule, preoperative imaging showed no abnormal lymph nodes. Among them, There were45cases to use nano-carbon suspension for lymph node tracing in the operation (lymph tracer group), the control group,49cases had not used carbon suspension (control group).Compared lymph tracer group with the control group in patients’age, BMI, operative time, blood loss, postoperative drainage. Measured the levels of the serum calcium and PTH, and compared them in the time of surgery, postoperative day, one week after surgery. Calculated the number of lymph node dissection, and calculated the black dyed lymph node metastasis rate. Compared the sentinel lymph node metastasis rate and the real rate of lymph node metastasis. Evaluated the incidence of complications such as postoperative hoarseness, cough, and hypocalcemia. Measurement data was used mean±standard deviation (x±s) to express,and the groups set of data were compared using a t-test.Count data groups were compared with corrected X2test,using SPSS17.0statistical analysis software, P<0.05was considered statistically significant. ResultThere were no statistical difference between the two groups in the age, operative time, blood loss and postoperative drainage(P>0.05).And there were no statistical difference between the two groups in the incidence of postoperative hoarseness, cough and hematoma (P>0.05). The incidence of postoperative numbness symptom in lymph tracer group was lower than the control group (P<0.05).One day after surgery, the PTH levels (P<0.05) and serum calcium levels (P<0.01) had a significant difference between the two groups. The levels of PTH after one week of surgery between the two groups were statistically significant difference (P<0.01).The number of lymph nodes resected in nano-carbon tracer group was (9.4±2.3) pieces per case, while the control group was (7.9±2.1) pieces per case. The number of lymphadenectomy was considered statistically significant (t=0.604, P<0.01).the rate of lymph node metastasis in nano-carbon tracer group was12.5%,while the control group was11.9%. The difference was not statistically significant (X2=0.022, P>0.05),The metastasis rate of black dyed lymph nodes in nano-carbon tracer group was14.2%,while the not black dyed lymph nodes was11.9%.The difference was statistically significant (X2=3.994, P<0.05).In nano-carbon suspension lymph tracer group,7patients only SLN metastasis,4patients only Non-SLN metastasis(false negative),18patients without lymph node metastasis (pNO),16patients both SLN and Non-SLN metastasis. SLN discovery rate was100%, accuracy rate was91.11%, the sensitivity rate was85.16%, the specificity rate was100%and with14.81%false negative rate, false positive rate was0%.ConclusionThe use of nano-carbon suspension intraoperative has not increased operative time, postoperative drainage and postoperative complications. The use of nano-carbon suspension intraoperative increases the number of the central lymph node dissection. Meanwhile, the use of nano-carbon suspension intraoperative can help to identify parathyroid and protect parathyroid function. It is a safe and feasible mean of modern medical technology. Nano-carbon suspension used for sentinel lymph node biopsy to thyroid cancer, the accuracy and sensitivity remain to be improved. Sample size needs to be expanded, and further clinical trials will be needed.