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Research of Tracing Value on Carbon Nanoparticles in Thyroid Papillary Carcinoma of Sentinel Lymph Node Biopsy

Author: JiaZhongMing
Tutor: HuangQiuLin
School: Nanhua University
Course: Surgery
Keywords: Carbon nanoparticles sentinel lymph node thyroid papillary carcinoma
CLC: R736.1
Type: Master's thesis
Year: 2011
Downloads: 107
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Abstract

Objective:As a new lymphatic tracer, Carbon Nanoparticles Suspensions Injection(CNS) is widly used in clinical, but less used in lymph tracing of thyroid cancer. Theaim of our study was to detect sentinel lymph node (SLN) of clinical lymph nodenegative (cN0) thyroid papillary carcinoma, trace the lymph drainage, analyse thefeasibility of carbon nanoparticles positioning, and to investigate the area of carbonnanoparticles with cN0thyroid papillary thyroid carcinoma lymph node dissection.Methods:A total of60patients of Binzhou Medical College Hospital from June2009toJune2011diagnosed cN0papillary thyroid carcinoma were choosed, and divided intoCarbon nanoparticles group (experimental group) and methylene blue group (controlgroup) randomly,30cases in each group. Under general anesthesia, the thyroid ofeach patient was exposed intraoperative, and then to explore the position of lumpmass and inject tracer in the lump mass and multiple surrounding points of lump mass.Then to identify first staining of lymph node as SLN. The lump mass was excised anddiagnosed through intraoperative rapid frozen pathology detecting, and half of thesentinel lymph nodes were detected through intraoperative rapid frozen pathologydetecting, and the rest were detected through postoperative routine pathologydetecting, then the ipsilateral thyroid tissue compare to lump mass，isthmic tissue，andcontralateral Portio major thyroid tissue were excised, and offside functional necklymph nodes were dissected routinely, and all the tissue was examed by postoperativeroutine pathology detecting. The sentinel lymph node SLN detection rate, dyeing time,fading time, lymphatic imaging number, dye leakage number, parathyroid andrecurrent laryngeal nerve staining number of two groups was compared. And the SLN number and neck lymph node number of two groups was compared, the divisionposition of the SLN in two groups was recorded. To compare the pathology conditionbetween sentinel lymph node rapid intraoperative frozen section pathology andpostoperative paraffin pathology, and the pathology condition of other district lymphnode. The number of the SLN positioning in every area in two groups, and thetransfer positive rate of tow groups was compared. The positioning accuracy,sensitivity, false negative rate of the sentinel lymph node, and the surgerycomplications of the two groups was compared. The feasibility of carbonnanoparticles positioning cN0thyroid papillary carcinoma of the sentinel lymph nodewas evaluated and the area of carbon nanoparticles with cN0thyroid papillary thyroidcarcinoma lymph node dissection was investigated.Results:1.29patients of Carbon nanoparticles group and26patiens of methyleneblue group were detected with SLN and the detection rate was96.67%and86.67%respectively. There was no statistical difference between the two groups (P>0.05).The time for dyeing SLN is6.41±1.40min in Carbon nanoparticles group, and thatwas6.73±1.56min in methylene blue group, there was no statistical differencebetween the two groups (P>0.05). The two groups were observed for160min, we didnot see obvious fading in Carbon nanoparticles group, but the average fade time ofmethylene blue group was109.37min. Carbon nanoparticles group took longer timeof fading than methylene blue group; and there were22cases with lymphatic dyeingin Carbon nanoparticles group, the number in Methylene blue group was13(P<0.05);the number of stainer exosmosis case was2in Carbon nanoparticles group and it was10in Methylene blue group (P<0.05). There was1case of parathyroid dyeing andwere2cases of recurrent laryngeal nerve dyeing in Carbon nanoparticles group, thenumber in methylene blue group was18and19respectively, there was statisticaldifference between the groups (P<0.05). The detection number of SLN in Carbonnanoparticles group was70pieces, the average was2.41pieces. That of Methyleneblue group was67pieces, the average was2.58pieces, there was no statistical difference between the two groups (P>0.05). The total number of lymph nodedetected in Carbon nanoparticles group was1389pieces, the average was46.30±7.83pieces; the total number of methylene blue group was1179pieces, the averagewas39.30±9.41pieces, and there were more lymph nodes in Carbon nanoparticlesgroup than that in methylene blue group, and there was statistical difference betweentwo groups (P<0.05).2. There were70SLN detected in Carbon nanoparticles group,39positive(55.8%),59of which were detected in area IV and VI (84.29%). The positive rate ofSLN in area IV was68.2%, while66.2%in area VI. There were67SLN detected inmethylene blue group,40positive (59.7%),58of which were detected in area IV andVI (86.57%). The positive rate of SLN in area IV was67.9%, while66.7%in area VI.It was indicated that SLN were most frequently distributed in area IV and VI, withhighest positive rate. Compared with other areas, there was significant difference inboth two groups (P<0.05). There was no difference of SLN distribution and positiverate in the two groups (P>0.05). The accuracy, sensitivity, false negative rate inCarbon Nanoparticles group was93.33%,94.12%and5.88%respectively; theaccuracy, sensitivity, false negative rate in Methylene blue group was80%,88.24%and11.76%respectively. There was no statistical difference of accuracy, sensitivityand false negative rate between the two groups (P>0.05). There was statisticaldifference of the incidence of parathyroid and recurrent laryngeal nerve injury in twogroups (P<0.05).Conclusion:1. Carbon Nanoparticles Suspensions Injection (CNS) has advantages ofdistinct tracing for lymph nodes, uneasy exosmose, long duration of dyeing, not easyto cause parathyroid and recurrent laryngeal nerve dyed in cN0thyroid papillarycarcinoma sentinel lymph node biopsy (SLNB). It could increase the cervical lymphdissection rate, decline the parathyroid and recurrent laryngeal nerve injury.2. SLN could reflect the general situation of cervical lymph nodes of cN0 thyroid papillary carcinoma. It is wise to do selective cervical lymph node dissectionaccording to the positive SLN position. The areas of IV and VI were the commonsites of the SLN in thyroid papillary carcinoma.

Research of Tracing Value on Carbon Nanoparticles in Thyroid Papillary Carcinoma of Sentinel Lymph Node Biopsy

Abstract

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