Chen Zhongyan, Zhong Zhiming, Chen Guoqing, Feng Yun
Department of Otolaryngology, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Otolaryngology, Jianou Municipal Hospital, Fujian 353100, China.
Biomed Res Int. 2021 Apr 21;2021:6693585. doi: 10.1155/2021/6693585. eCollection 2021.
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).
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.
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 ( = 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 ( = 0.001 for hypocalcemia, <0.05; = 0.047 for hypoparathyroidism, <0.05).
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.
本回顾性研究旨在评估碳纳米颗粒在颈清扫术中的优势，并总结其在临床淋巴结阴性的乳头状甲状腺癌（CN0PTC）治疗中的应用。
作为一项回顾性队列研究，我们根据碳纳米颗粒（CN）的使用情况将纳入的患者分为两组，即碳纳米颗粒组（CN组）和对照组。在CN组中，应用CN来显示引流淋巴结，并将摘取的淋巴结送去做快速冰冻检查。如果存在转移，则进行改良根治性侧颈淋巴结清扫术（LLND）。对于两组患者，均常规进行预防性中央淋巴结清扫术。最后，收集人口统计学信息、肿瘤特征、术后病理结果和实验室数据进行分析。
本研究共纳入61例CN0PTC患者，CN组33例，对照组28例。CN的黑染率为29/40（72.5%），阳性预测率为34.5%。颈侧主要黑染区域为Ⅲ区，淋巴结比例最高（17.5%）。Ⅵ区转移在CN组和对照组分别为30%和11.8%（P = 0.058）。在可用的随访期间，无人出现复发。统计分析表明，CN混悬液可显著降低甲状旁腺受损风险（低钙血症P = 0.001，<0.05；甲状旁腺功能减退P = 0.047，<0.05）。
临床分期为cT1aN0的乳头状甲状腺微小癌患者的颈侧转移并不罕见。CN可帮助外科医生区分真正需要进行LLND的患者。在预防性CLND中，CN作为示踪剂可使甲状旁腺更易于识别，并避免神经和腺体损伤风险。
