Abstract
To assess the efficiency of the carbon nanoparticles (CNs) in lymph node identification and parathyroid gland (PG) protection during thyroidectomy for non-anaplastic thyroid carcinoma (N-ATC). A systematic literature search for relevant literatures published up to December 2018 in PubMed, EMBASE, Web of Science and Cochrane Library was performed. Both English and Chinese literatures were retrieved and analyzed. Randomized controlled trials or nonrandomized controlled trials comparing the use of CNs with the use of methylene blue or a blank control in patients undergoing thyroidectomy for N-ATC were enrolled in this study. The primary outcomes included the number of lymph nodes harvested, the rate of lymph nodes involved, and the rates of accidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Weighted mean differences (WMDs), odds ratios (ORs) and risk differences (RDs) were calculated for the dichotomous outcome variables. Between study heterogeneity was tested using the Q tests and the I2 statistics. All analyses were performed using Review Manager (version 5.3.5). 25 studies comprising 3266 patients were included in this analysis. The total number of lymph nodes harvested in the CNs groups was significantly higher than that in the control groups (WMD, 2.36; 95% CI, 1.40 to 3.32; P <0.01). Administrating CNs was associated with a lower incidence of accidental PG removal (OR = 0.28, 95% CI = 0.21 to 0.37, P<0.01) and lower rates of both postoperative transient hypoparathyroidism (OR = 0.46, 95% CI = 0.33 to 0.64, P <0.01) and transient hypocalcemia (OR = 0.46, 95% CI = 0.33 to 0.65, P <0.01). No significant difference was found concerning lymph node metastatic rates between CNs group and control group. Subgroup analysis indicated that the application of CNs in reoperation thyroidectomy reduced both the rate of transient hypoparathyroidism (OR = 0.21, 95% CI = 0.06 to 0.75, P = 0.02) and the possibility of accidental PGs removal (OR = 0.21, 95% CI = 0.07 to 0.62, P = 0.004, P<0.05). The application of CNs in thyroidectomy for N-ATC results in higher number of lymph node harvested and better PG protection during both initial and reoperation thyroidectomy.
Highlights
Thyroid cancer is one of the most common types of cancer in the world, the incidence of which increased dramatically in the recent two decades [1]
The total number of lymph nodes harvested in the Carbon nanoparticles (CNs) groups was significantly higher than that in the control groups (WMD, 2.36; 95% confidence interval (CI), 1.40 to 3.32; P
Administrating CNs was associated with a lower incidence of accidental parathyroid glands (PG) removal (OR = 0.28, 95% CI = 0.21 to 0.37, P
Summary
Thyroid cancer is one of the most common types of cancer in the world, the incidence of which increased dramatically in the recent two decades [1]. CNs have a mean diameter of 150 nm larger than the size of the capillary endothelial cell gap (20–50 nm), and cannot enter the blood vessels. They can penetrate the lymphatic capillary endothelial cell gap (120–500 nm) and may be phagocytized by macrophages These CNs accumulate in the lymph nodes, staining them black and been identified with naked eyes [9, 10]. The parathyroid glands (PG) remains unstained due to their possible lack of lymphatics This so called “negative development” increases the number of lymph nodes harvested during compartmental dissection, and facilitates the surgeons’ distinguishing of the PGs from the lymph nodes and decreases the possibility of unintentional removal of PGs [11,12,13]. The pattern of CNs metabolism is the hypothetic basis that CNs can be used as a tracer to detect the sentinel nodes
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