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. Data Sources 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). Review 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). Conclusion 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.