Abstract
Purpose 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). Methods 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. Results 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 (p = 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 (p = 0.001 for hypocalcemia, <0.05; p = 0.047 for hypoparathyroidism, <0.05). Conclusion 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.
Highlights
With the development of ultrasonography, especially with the coming out of high-resolution machines, the incidence of thyroid cancer in China is dramatically increasing in recent years [1]
A total of 61 CN0PTC were enrolled in this study, 33 in the carbon nanoparticle (CN) group (8 were men and 25 were women) and 28 in the control group (4 were men and 24 were women)
The occurrence of complications showed no significant difference between the two groups
Summary
With the development of ultrasonography, especially with the coming out of high-resolution machines, the incidence of thyroid cancer in China is dramatically increasing in recent years [1]. Over 90% of thyroid malignancies are differentiated thyroid cancer (DTC), most of which are papillary thyroid carcinoma (PTC) [2]. Surgery including thyroidectomy plus neck dissection is the best means of treatment. The surgical strategy about lymph nodes is an essential issue that concerns every head and neck surgeon. A series of meta-analyses and clinical articles have discussed the outcomes of pCLND (prophylactic central lymph node dissection). A recently published retrospective study analyzing 399 patients to explore the role of prophylactic central lymph node dissection (pCLND) showed that pCLND can improve disease-free survival in patients with intermediate and high risk of disease recurrence [3]. PCLND is believed to reduce locoregional recurrence rate and provide pathological evidence for the adjuvant radioiodine (RAI) treatment [4]. Gambardella et al considered that pCLND has no positive influence on recurrence rate but brings higher postoperative complications [5]
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