Application Of Carbon Nanoparticles In Laparoscopic Sentinel Lymph Node Detection In Patients With Early Cervical Cancer

Objective Sentinel lymph nodes(SLNs)mapping for cervical cancers is a current technique that could provide more benefits than traditional lymphadenectomy.Carbon nanoparticles(CNP)is a tracer that has a promising prospect for identifying SLNs in this process.This research aims to explore the feasibility and clinical value of the use of CNP in the detection of SLNs in the treatment of early-stage cervical cancer.Methods Institutional Review Board approval was obtained from the Department of Gynecologic Oncology,Affiliated Tumor Hospital of Guang Xi Medical University.There were 83 patients with early-stage cervical cancer who underwent radical lymphadenectomy and SLNs mapping from Nov 2014 and Apr 2017 selected.The International Federation of Gynecology and Obstetrics(FIGO)2009 staging of these 83 patients was IA2 to IIA.A normal cervix tissue injection with total of 3ml CNP suspension(1ml CNP +2ml sterile water)at the 3 and 9 o'clock positions was conducted after the induction of general anesthesia.Through laparoscopic observation and positioning of the first black lymph nodes that were identified as SLNs and removed,and then all cases wereunderwent radical hysterectomy and pelvic lymph node dissection with or without aortic lymphadenectomy.All SLNs,non-SLNs and resection of the whole uterus tissue were sent to the pathological examination and /or immunohistochemistry after surgery.The overall detection rate,bilateral detection rate,accuracy,sensitivity,false negative rate,negative predictive value and other test results of SLNs were analyzed.Results All 83 patients were swept out of the number of retroperitoneal lymph nodes was 2354 and the SLNs number was 267.The tracing time of CNP was(9.0±1.2)min.SLNs detection rate was impacted by tumor size,clinical stage and preoperative adjuvant chemotherapy and the difference was statistically significant(P <0.05).SLNs was identified with 95.18% and bilateral detection rate with 80.72%.The sensitivity,the specificity and the accuracy rate was 100%,96.92% and 97.47%,respectively.The false-negative rate and the negative predictive value was 0 and100%,respectively.The distribution of SLN was most commonly identified in the external iliac(45.69%),obturator(25.47%),internal iliac(15.36%),common iliac(6.37%),para-aortic(4.12%),sacral(1.12%)and parametrium(1.87%)regions.The metastatic status of SLNs in early-stage cervical cancer was highly consistent with the true metastatic status of pelvic lymph nodes,and the Kappa coefficient was 0.918.Conclusions SLNs tracing techniques were affected by a lot of factors,such as tumor size,clinical stage and preoperative adjuvant chemotherapy.The distribution of SLNs was most commonly identified in the external iliac,obturator,internal iliac,and then common iliac,para-aortic,parametrium and sacral regions.Cervical injection with CNP was a very safe,efficient and feasible method prior to cervical radical surgery.We made the clear of the true status of retroperitoneal lymph nodes through the detection of whether SLNsmetastasis or not,which was of great value in guiding the clinical treatment of cervical cancer.