title: The application of carbon nanoparticles in the lymph node biopsy of cN0 papillary thyroid carcinoma: A randomized controlled clinical trial.
abstract: OBJECTIVE
  We applied carbon nanoparticle suspensions to the papillary thyroid carcinoma cases with no clinical regional lymph node metastasis (cN0) to show the lymph flow from primary tumors, and evaluated its value in the lymph node biopsy of cN0 papillary thyroid carcinoma and protection of parathyroid.
  
  
  METHODS
  One hundred and fourteen patients with cN0 papillary thyroid carcinoma were randomly assigned to experimental and control groups. The experimental group received carbon nanoparticles injection around the primary tumor, while the control group received no injection. Both groups subsequently received standard lateral thyroid gland resection, isthmus resection, subtotal thyroidectomy, or clearance of lymph nodes (LNs) of the central compartment.
  
  
  RESULTS
  A total of 342 LNs of the central compartment were dissected in the experimental group (6.00 ± 0.98 per patient) with 81 LNs confirmed to be positive (0.95 ± 0.77 per patient), whereas 261 LNs of the same area were dissected in the control group (4.58 ± 0.60 per patient) with 27 confirmed to be positive (0.47 ± 0.50 per patient). There is a significant difference between experimental and control groups in the average number of LNs dissected per patient (6.00 ± 0.98 vs. 4.58 ± 0.60, p < 0.001) but not the positive LNs per patient (0.95 ± 0.77 vs. 0.47± 0.50, p = 0.11). Parathyroid was found in two patients from the experimental group and in seven patients in the control group (p = 0.29). Three patients in the experimental group and seven patients in the control group had hypocalcemia (p = 0.21), and four patients in each group had hoarseness (p = 0.58).
  
  
  CONCLUSIONS
  Carbon nanoparticle suspensions can be used to stain central lymph nodes of cN0 papillary thyroid carcinoma without staining of parathyroid and leakage, and improve the resection of LNs.
authors.affiliation: Department of General Surgery, Jin Ling Hospital, Clinical School of Medical College of Nanjing University, Nanjing, Jiangsu, China.
authors.forename: Xiao Fan
authors.initials: XF
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Jin Ling Hospital, Clinical School of Medical College of Nanjing University, Nanjing, Jiangsu, China. Electronic address: mssubmission13@gmail.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002244:Carbon; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D053758:Nanoparticles; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D002244:Carbon
keywords: carbon nanoparticles; clinical lymph node metastasis; lymph node; papillary thyroid carcinoma; parathyroid; stochastic control