Application Of Carbon Nanoparticles In Lymph Node Metastasis Of Contralateral Central Lymph Node In Unilateral Papillary Thyroid Carcinoma

Objective:To explore the application value of carbon nanoparticles in the study of the rule of lymph node metastasis in lymph node metastasis of contralateral central lymph node in unilateral papillary thyroid carcinoma,and the risk factors of lymph node metastasis in lymph node metastasis of contralateral central lymph node in unilateral papillary thyroid carcinoma,and to guide the dissection of lymph nodes in the central subregions of papillary thyroid carcinoma patients.Methods:From November,2018 to October,2020,100 cases of unilateral papillary thyroid carcinoma patients were treated in the thyroid surgery department of China-Japan Union Hospital of Jilin University.We introduced the application method,purpose,and adversereactions of carbon nanoparticles to the patient.All patients were treated with carbon nanoparticles.We collected all the data of patients and analyzed the advantages of carbon nanoparticles in lymph node dissection,and analyzed the regularity and risk factors of lymph node metastasis in the contralateral central regions.Results:(1)Among the 100 enrolled patients,70(70%)were confirmed to have lymph node metastasis in the central neck,68(68%)patients in the ipsilateral central neck and 34(34%)in the contralateral central neck.the rate of bilateral central lymph node metastasis was 32%,only 2(2%)exhibiting contralateral metastasis but not the ipsilateral central compartment metastasis(skip metastasis).Among the 396 lymph nodes in the contralateral central group,a total of 292 lymph nodes were stained black by CNs.Among the 73 lymph nodes with metastasis,65 lymph nodes were stained black by CNs.The sensitivity and specificity of CNs for contralateral metastasis was89% and 30%,respectively It was found that there were 50 pieces of diameter < 2mm.(2)Univariate analysis showed that male,thyroid capsule invasion,ipsilateral central group lymph node metastasis,Cervical lymph node metastasis,The tumor location of unilateral papillary thyroid carcinoma was significantly associated with lymph node metastasis in the contralateral central group.When the lesions were located in the lower part of thyroid(68.8%),upper(34.4%)and middle(22.4%),the lymph node metastasis rate of contralateral central group decreased gradually,and the difference has statistics significance(P < 0.01).The comparison between the upper and middle,it can be seen that no statistically significant difference.(P > 0.05).(3)Multivariate analysis showed that male(P < 0.01),thyroid capsule invasion(P <0.05),ipsilateral central group lymph node metastasiswas(P < 0.01),the lower part of cancer(P < 0.05),the ipsilateral central lymph node metastasis rate is more than 27%(P<0.05)were risk factors for lymph node metastasis in contralateral central group of unilateral papillary thyroid carcinoma.(4)The ROC curve results showed that when the number of ipsilateral lymph node metastasis was 1.5,the contralateral central group had the greatest impact on lymph node metastasis,AUC = 0.766 > 0.7,sensitivity and specificity were 88.2% and 60.6%,respectively,P = 0.001 < 0.01.So,when the number of ipsilateral central lymph node metastasis was more than 2,the risk of contralateral central lymph node metastasis is higher.The index has good diagnostic efficacy.Conclusion:1.The high sensitivity of carbon nanoparticles in predicting the metastasis of the contralateral sentinellymph node.In preoperative evaluation,it is recommended to use carbon nanoparticles to assist bilateral central lymph node dissection when bilateral central lymph nodes are found or more ipsilateral central lymph nodes are found.During the preoperative evaluation found swollen lymph nodes in the bilateral central group,it is recommended to use carbon nanoparticles during the operation.We should clean the bilateral central group lymph nodes according to the standard range.If it is difficult to clean,at least cleaned the black lymph nodes.2.In this study,some patients with contralateral central lymph nodes metastases without ipsilateral CLNM.Therefore,some patients with high-risk factors are recommended to clean the bilateral central group lymph nodes3.When there is lymph node metastasis in the ipsilateral central group and the number of metastases is greater than 2,or when the ipsilateral central lymph node metastasis rate is more than 27%,the risk of contralateral central lymph node metastasis is higher,so it is recommended to conduct bilateral central group lymph node dissection.