Min Lei, Lang Brian H H, Chen Weichun, Ai Qing, Jiang Jiang, Huang Zhi Heng
Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR, China.
World J Surg. 2020 Feb;44(2):356-362. doi: 10.1007/s00268-019-05113-9.
Activated carbon nanoparticle (CNP) is a novel tracer that may facilitate nodal dissection in clinically nodal positive (cN1) papillary thyroid carcinoma (PTC). The present study compared the nodal yield and surgical outcomes between surgery with CNP and without CNP.
Patients who underwent total thyroidectomy with therapeutic nodal dissection for cN1 PTC were given the option of intraoperative CNP injection. Among those who received CNP, 0.2 mL CNP suspension was injected in both thyroid lobes before dissection. Study endpoints included number of total and metastatic lymph nodes, inadvertently removed parathyroid glands (PGs), postoperative parathyroid hormone, calcium, and post-6-month thyroglobulin (Tg). Biochemical complete response (BCR) was defined as Tg ≤ 1 ng/mL and/or stimulated Tg ≤ 2 ng/mL.
One-hundred and twenty patients (58.3%) received CNP, while 86 (41.7%) had surgery without CNP. Demographics, tumor characteristics, and operative time were comparable between the two groups. However, total mean number of normal and metastatic lymph nodes retrieved were significantly greater in CNP group (10.0 vs. 8.1, p = 0.032 and 4.5 vs. 2.7, p = 0.002, respectively). Rate of inadvertently removed PG was significantly less in CNP group (13.3% vs. 23.3%, p = 0.042). Postoperative Tg level and BCR were significantly lower in CNP group (9.9 ng/mL vs. 14.7 ng/mL, p = 0.297 and 82.4% vs. 72.9%, p = 0.002, respectively). However, large-sized ( ≥ 3 cm) PTCs had a significantly lower nodal staining rate than smaller-sized PTCs (10.3% vs. 69.4%, p < 0.001).
CNP injection can facilitate therapeutic central nodal dissection by increasing the nodal yield rates and reducing inadvertent PG removal. To enhance its utility, a greater volume of CNP might be necessary in larger-sized (> 3 cm) PTCs.
活性炭纳米颗粒（CNP）是一种新型示踪剂，可能有助于临床淋巴结阳性（cN1）的甲状腺乳头状癌（PTC）的淋巴结清扫。本研究比较了使用CNP和不使用CNP进行手术的淋巴结清除率和手术结果。
接受cN1 PTC全甲状腺切除术及治疗性淋巴结清扫的患者可选择术中注射CNP。在接受CNP的患者中，在清扫前于双侧甲状腺叶注射0.2 mL CNP混悬液。研究终点包括总淋巴结和转移淋巴结数量、意外切除的甲状旁腺（PG）数量、术后甲状旁腺激素、钙以及术后6个月的甲状腺球蛋白（Tg）。生化完全缓解（BCR）定义为Tg≤1 ng/mL和/或刺激后Tg≤2 ng/mL。
120例患者（58.3%）接受了CNP，而86例（41.7%）患者手术未使用CNP。两组患者的人口统计学、肿瘤特征和手术时间具有可比性。然而，CNP组回收的正常和转移淋巴结的总平均数量显著更多（分别为10.0对8.1，p = 0.032；4.5对2.7，p = 0.002）。CNP组意外切除PG的发生率显著更低（13.3%对23.3%，p = 0.042）。CNP组术后Tg水平和BCR显著更低（分别为9.9 ng/mL对14.7 ng/mL，p = 0.297；82.4%对72.9%，p = 0.002）。然而，大尺寸（≥3 cm）PTC的淋巴结染色率显著低于小尺寸PTC（10.3%对69.4%，p < 0.001）。
注射CNP可通过提高淋巴结清除率和减少意外PG切除来促进治疗性中央区淋巴结清扫。为提高其效用，对于大尺寸（>3 cm）PTC可能需要更大剂量的CNP。
