title: A multicenter study of using carbon nanoparticles to show sentinel lymph nodes in early gastric cancer.
abstract: BACKGROUND
  Lymph node metastasis occurs in approximately 10% of early gastric cancer. Preoperative or intra-operative identification of lymph node metastasis in early gastric cancer is crucial for surgical planning. The purpose of this study was to evaluate the feasibility of using carbon nanoparticles to show sentinel lymph nodes (SLNs) in early gastric cancer.
  
  
  METHODS
  A multicenter study was performed between July 2012 and November 2014. Ninety-one patients with early gastric cancer identified by preoperative endoscopic ultrasonography were recruited. One milliliter carbon nanoparticles suspension, which is approved by Chinese Food and Drug Administration, was endoscopically injected into the submucosal layer at four points around the site of the primary tumor 6-12 h before surgery. Laparoscopic radical resection with D2 lymphadenectomy was performed. SLNs were defined as nodes that were black-dyed by carbon nanoparticles in greater omentum and lesser omentum near gastric cancer. Lymph node status and SLNs accuracy were confirmed by pathological analysis.
  
  
  RESULTS
  All patients had black-dyed SLNs lying in greater omentum and/or lesser omentum. SLNs were easily found under laparoscopy. The mean number of SLNs was 4 (range 1-9). Carbon nanoparticles were around cancer in specimen. After pathological analysis, 10 patients (10.99%) had lymph node metastasis in 91 patients with early gastric cancer. SLNs were positive in 9 cases and negative in 82 cases. In pathology, carbon nanoparticles were seen in lymphatic vessels, lymphoid sinus, and macrophages in SLNs. When SLNs were positive, cancer cells were seen in lymph nodes. The sensitivity, specificity, and accuracy of black-dyed SLNs in early gastric cancers were 90, 100, and 98.9 %, respectively. No patient had any side effects of carbon nanoparticles in this study.
  
  
  CONCLUSIONS
  It is feasible to use carbon nanoparticles to show SLNs in early gastric cancer. Carbon nanoparticles suspension is safe for submucosal injection.
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China. ynjun@yahoo.com.|Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, People's Republic of China. ynjun@yahoo.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.|Department of Surgery, Fujian Provincial Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
authors.forename: Zhangyuanzhu
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
authors.forename: Zhenwei
authors.initials: Z
authors.lastname: Deng
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.|Department of Surgery, Fujian Provincial Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China.
authors.forename: Fangqing
authors.initials: F
authors.lastname: Xue
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.|Department of Surgery, Fujian Provincial Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, People's Republic of China.
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Pathology, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, People's Republic of China.
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Pathology, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, Fujian, People's Republic of China.
authors.forename: Jianping
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Surgery, Zhangzhou Hospital, Teaching Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian, People's Republic of China.
authors.forename: Lisheng
authors.initials: L
authors.lastname: Cai
authors.affiliation: Department of Surgery, Zhangzhou Hospital, Teaching Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian, People's Republic of China.
authors.forename: Mingzhi
authors.initials: M
authors.lastname: Cai
authors.affiliation: Department of Surgery, Nanping Hospital, Teaching Hospital of Fujian Medical University, Nanping, 353000, Fujian, People's Republic of China.
authors.forename: Gao
authors.initials: G
authors.lastname: Xiang
authors.affiliation: Department of Surgery, Nan'an Hospital, Teaching Hospital of Fujian Medical University, Nan-an, 362300, Fujian, People's Republic of China.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Hong
authors.affiliation: Department of Surgery, Nan'an Hospital, Teaching Hospital of Fujian Medical University, Nan-an, 362300, Fujian, People's Republic of China.
authors.forename: Wenbo
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China. gzliguoxin@163.com.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D002244:Carbon; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D053758:Nanoparticles; D000071036:Sentinel Lymph Node / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology*
chemical_list: D002244:Carbon
keywords: Carbon nanoparticles; Early gastric cancer; Lymph node metastasis; Multicenter study; Sentinel lymph nodes