Carbon nanoparticles combined with indocyanine green for sentinel lymph node detection in endometrial carcinoma

Abstract

Objective: To evaluate the feasibility and clinical value of the combination of carbon nanoparticles (CNPs) and indocyanine green (ICG) for identifying sentinel lymph nodes (SLNs) in endometrial cancer. Materials and Methods: About 153 patients with endometrial cancer were recruited from July 2015 to May 2019. All patients underwent SLN biopsy according to the SLN algorithm for surgical staging with ICG and/or CNPs. The detection rate, factors associated with the detection rate, sensitivity, and negative predictive value (NPV) of SLNs were analyzed.Results: The detection rates of SLNs with the combined method were the highest among the different methods. As calculated per hemipelvis, the sensitivity and NPV with ICG alone or with ICG plus CNPs were 100%. With CNP, tumor Grade 3 and laparoscopy were related to unsuccessful overall SLN mapping while tumor diameter greater than 2 cm and laparoscopy were statistically associated with failed bilateral mapping. With ICG, a higher body mass index was significantly associated with unsuccessful bilateral detection of SLN.Conclusion: SLN assessment in endometrial cancer is feasible and safe with high sensitivity and high NPV when ICG and CNPs are combined and in low-risk patients.

Comparing carbon nanoparticles and indocyanine green for sentinel lymph node mapping in endometrial cancer: A randomized‐controlled single‐center trial

“…Cervical stromal invasion first presented a key link to worse detection ability in our study, while previous investigations have indicated this underlying tendency with a p value of approximately 0.05 28,29 . Contrary to our results, many studies demonstrated no significant association between deep myometrial invasion and failure of bilateral SLN mapping using different tracers 21,28,30,31 . Lymphatic vessel obstruction could impact the DR, while factors such as cervical involvement and deep myometrial invasion may affect the lymphatic drainage pathway, thus reducing the chances of detecting SLNs 32,33 .…”

“…Moreover, ultrastaging was not performed, leading to a probable underestimation in diagnostic accuracy. Our group also conducted a retrospective study previously analyzing 138 patients receiving CNPs and found that the DRs were 78.3% and 47.1% for bilateral detection and that the combination of ICG and CNPs can significantly improve the ability to detect SLNs 21 . The slight increase in the DR in this trial indicates that there has likely been a learning curve in recent years.…”

“…All these advantages indicate CNPs as a promising SLN mapping method for EC. There have been several published studies using CNPs as tracers in EC reporting satisfactory results, 18,21 while the level of evidence is decreased because of the retrospective study design and limited sample size. This study is the first randomized controlled trial to compare CNPs with ICG in the SLN mapping procedure for EC.…”

The Role of Carbon Nanoparticles in Lymph Node Dissection and Parathyroid Gland Preservation during Surgery for Thyroid Cancer: A Systematic Review and Meta-Analysis

“…Carbon nanoparticles play a significant role, since they can serve as carriers of various types of drugs, be used in the reconstruction of bone tissue, contribute to the early diagnosis of cancer cells, have anti-inflammatory and antibacterial properties, act as markers in imaging diagnostics and facilitate tracing of lymph nodes in various operations [ 11 , 12 ]. So far, carbon nanoparticles have been successfully used for lymph node tracing in endometrial cancer, gastric cancer, colorectal cancer, breast cancer and thyroid cancer [ 13 , 14 , 15 , 16 , 17 ]. The administration of carbon nanoparticles can also be combined with indocyanine green, which further increases the efficiency of the technique [ 17 , 18 ].…”

Novel Development of Nanoparticles—A Promising Direction for Precise Tumor Management

“…However, recent research revealed that the intertumoral injection of carbon nanomaterials cannot decrease the incidence of hypoparathyroidism, and this may be associated with the fact that the parathyroid glands possess compensatory potential [ 64 ]. For low-risk endometrial cancer patients, clinical trials have confirmed that cervical injection of carbon nanoparticles combined with indocyanine green can significantly improve the detection rate of sentinel lymph nodes (SLNs) [ 66 ]. In patients undergoing laparoscopic radical gastric cancer surgery, those who received carbon nanomaterials labeling can increase the lymph node discovery rate by 25.7% and shorten the operation time by 15.3% compared with the control group [ 67 ].…”