title: A Meta-analysis of Carbon Nanoparticles for Identifying Lymph Nodes and Protecting Parathyroid Glands during Surgery.
abstract: OBJECTIVE
  To investigate the ability of carbon nanoparticles (CNs) to identify lymph nodes and protect parathyroid glands during thyroid cancer surgery.
  
  
  METHODS
  English and Chinese literature in PubMed, ClinicalTrials.gov, EMBASE, the Cochrane Database of Systematic Reviews, the China Biology Medicine Database, the China Master's and Doctoral Theses Full-Text Database, the China National Knowledge Infrastructure, the WANFANG database, and the Cqvip database (from January 2009 to July 2014).
  
  
  METHODS
  Studies were included if they were randomized controlled trials or nonrandomized controlled trials for thyroidectomy and central neck dissections that compared the use of CNs with methylene blue or a blank control in patients undergoing initial thyroid cancer surgery. The primary outcomes were the number of retrieved central lymph nodes and the accidental parathyroid removal rate.
  
  
  RESULTS
  This meta-analysis identified 11 randomized controlled trials and 4 nonrandomized controlled trials comprising 1055 patients. Compared with the outcomes of the blank controls, the use of CNs resulted in an average of 2.71 more lymph nodes removed per patient (weighted mean difference = 2.71, 95% confidence interval [CI] = 1.68-3.74, P < .001), a 23% lower rate of accidental parathyroid removal (odds ratio = 0.23, 95% CI = 0.10-0.54, P = .0008), and similarly reduced rates of transient hypoparathyroidism and hypocalcemia. Compared with methylene blue, the use of CNs resulted in an average of 1.50 more lymph nodes removed per patient (weighted mean difference = 1.50, 95% CI = 0.11-2.89, P = .03) and a 5% reduction in the rate of accidental parathyroid removal (odds ratio = 0.05, 95% CI = 0.01-0.29, P = .0007).
  
  
  CONCLUSIONS
  CNs partially improve the extent and accuracy of neck dissection and preserve the normal anatomic structure and physiologic function of the parathyroid glands during thyroid cancer surgery.
authors.affiliation: Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Li
authors.affiliation: State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Jian
authors.affiliation: Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China guozhum126@126.com.
authors.forename: Zhu-Ming
authors.initials: ZM
authors.lastname: Guo
authors.affiliation: Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Qiu-Li
authors.initials: QL
authors.lastname: Li
authors.affiliation: Department of Vascular and Thyroid Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Shao-Jian
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Department of Head and Neck Oncology, Cancer Center of Guangzhou Medical University, Guangzhou, China.
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Huang
mesh_terms: D002244:Carbon; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007431:Intraoperative Complications / Q000517:prevention & control; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D053758:Nanoparticles; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D010280:Parathyroid Glands / Q000293:injuries*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002244:Carbon
keywords: carbon nanoparticles; lymph node; methylene blue; parathyroid; thyroid cancer