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

Abstract

Background and Objectives: To compare the feasibility and diagnostic value of sentinel lymph node (SLN) mapping with carbon nanoparticles (CNPs) and indocyanine green (ICG) in endometrial cancer (EC).Methods: This was a single-center, open-label, randomized controlled trial. Between August 1, 2020 and April 30, 2022, patients with early-stage EC were assessed for enrollment. All patients underwent SLN mapping with ICG or CNPs ± pelvic and/or para-aortic lymphadenectomy. The detection rate (DR), its impact factors, the sensitivity and the negative predictive value (NPV) of SLN mapping were analyzed.Results: In total, 206 patients, with 103 per group, were included. The overall and bilateral DRs of the two groups were comparable without significant differences.There was no difference regarding the distribution of mapped SLNs. The sensitivity was 66.7% for both groups, and the NPVs were not significantly different.Furthermore, the sensitivity and NPV reached 100% when calculated either per hemipelvis or only in patients with bilateral SLN detection.Conclusions: SLN mapping by CNPs in EC is feasible with high DRs and diagnostic accuracy compared with ICG. CNPs might be an alternative to ICG for SLN mapping when near-infrared imaging equipment is lacking, especially in stage IA patients.carbon nanoparticles, endometrial cancer, indocyanine green, sentinel lymph node mapping | INTRODUCTIONEndometrial cancer (EC) is the most common gynecologic malignancy in the United States, and its rapidly increasing incidence rate ranks second in China. 1,2 The metastatic status of regional lymph nodes is considered an independent prognostic factor for EC. Thus, the evaluation of lymph nodes should be completed precisely, as this is essential for tumor staging and clinical decisions on the selection of adjuvant therapy. For preoperatively presumed early-stage EC patients, comprehensive lymphadenectomy (LAD) is often adopted

The Role of Carbon Nanoparticles as Lymph Node Tracers in Colorectal Cancer: A Systematic Review and Meta-Analysis

“…Moreover, ICG was found to be superior to carbon nanoparticles in lymph node tracing in thyroid cancer surgery, resulting in a higher number of lymph nodes harvested at a lower cost [47]. However, He et al found similar outcomes between ICG and carbon nanoparticles during surgery for endometrial cancer [48], pointing out that carbon nanoparticles can be used when near-infrared imaging equipment is not available. Another study by Qin et al showed that the combination of ICG and methylene blue has better results in the detection of sentinel lymph nodes in surgery for breast surgery [49].…”

Sentinel lymph node biopsy with carbon dye in endometrial cancer: a single center, prospective cohort study

“…ICG has been shown superior to blue dye and Tc99 combination for the detection of SLNB [ 4 , 5 ]. On the other hand, carbon dye, consisting of carbon nanoparticles with a diameter of 150 μm, enters the lymphatic circulation by macrophages and is mainly excreted through the gastrointestinal tract [ 6 ]. Carbon dye, which has a strong staining ability and high contrast capacity due to its dark black color, enables the lymph nodes efficiently identified.…”

“…Thereafter, carbon dye has gained acceptance among general surgeons in SLNB procedures. The present study is one of the few studies using carbon dye alone as a tracer during the SLNB procedure in endometrial cancer [ 6 , 12 , 13 ]. Therefore, the objective of the present study was to evaluate the safety and efficacy of carbon dye for the detection of sentinel lymph nodes in endometrial cancer patients.…”