Application of Carbon Nanoparticles in Tracing Lymph Nodes and Locating Tumors in Colorectal Cancer: A Concise Review

Tracing Sentinel Lymph Nodes and Inhibiting Lymphatic Metastasis with TiN Nanobipyramids Through Photothermal Therapy

Background

The lymphatic system is the major route of cancer metastasis, and sentinel lymph nodes (SLNs) are the first station for the spread of cancer cells. Accurate identification of SLNs by tracers during surgery is crucial for SLN biopsy and lymphadenectomy. However, conventional monomodal tracers such as blue dyes and carbon nanoparticles often induce a misjudgment of SLNs and thus are still unsatisfying for clinical applications. In addition, SLN imaging agents with therapeutic capabilities to achieve perfect theranostics have been less exploited.

Purpose

Titanium nitride (TiN) nanostructures have the advantages of high stability and low cost and show superior plasmonic properties over both the visible and near-infrared (NIR) regions. Herein we report on the synthesis of TiN nanobipyramids (NBPs) with large sizes for multimodal SLN mapping.

Methods

A hydrothermal method and post nitridation treatment were used to prepare the TiN NBPs. Bright- and dark-field imaging of SLNs with TiN NBPs were performed. The effect of TiN NBP size on SLN tracing was studied. The effect of TiN NBP-based photothermal ablation of SLNs combined with removal of primary tumors on pulmonary metastasis was studied.

Results

The TiN NBPs with dual bright- and dark-field imaging functions show high drainage in lymph nodes and thus can act as a potential substitute for SLN tracing. Moreover, owing to the superior plasmonic properties of TiN nanostructures, the produced TiN NBPs show a high photothermal conversion efficiency under 1064 nm laser irradiation. TiN NBP-based photothermal ablation of metastatic LNs in the second NIR window (NIR-II) combined with surgical removal of primary tumors shows remarkable inhibition of pulmonary metastasis.

Conclusion

This study not only demonstrates TiN NBPs as a new tracer for SLN mapping, but also presents a strategy for the photothermal ablation of lymph nodes in NIR-II for the inhibition of lymphatic metastasis.

Exploring the effect of carbon nanoparticle tracing technique on five-year overall survival and disease-free survival in patients undergoing radical surgery for colorectal cancer: a retrospective study

Background

To investigate the effect of preoperative carbon nanoparticle tracing technique via colonoscopy on the five-year overall survival and disease-free survival rates in patients undergoing radical resection for colorectal cancer.

Methods

A retrospective cohort study was conducted to collect data from patients diagnosed with colorectal cancer who underwent radical resection with complete postoperative pathological information at the First Affiliated Hospital of Chongqing Medical University from March 2013 to February 2017. Patients with multiple primary cancers were excluded, resulting in 2,237 eligible patients in the study. Of these, 368 patients were lost to follow-up within five years after surgery, resulting in a final sample of 1,869 patients. These patients were then divided into two groups: 758 patients who underwent preoperative carbon nanoparticle tracing technique via colonoscopy (CAS group) and 1,111 patients who did not undergo carbon nanoparticle tracing (non-CAS group). Survival curves for both overall survival and disease-free survival were plotted for both groups based on follow-up results. Univariate and multivariate analyses were performed to investigate the effect of carbon nanoparticle tracing technique on the 5-year overall survival and disease-free survival rates in patients, as well as to explore the factors influencing these outcomes.

Results

The results showed that the total number of lymph nodes detected in the tracing group 15(11,19) was significantly higher than that in the non-tracing group 11(7,15), with a statistically significant difference (p<0.05). The 5-year overall survival rates were 90.8% in the CAS group and 87.4% in the non-CAS group, and, while the disease-free survival rate were 88.5% and 83.4%, respectively. However, the differences between 5-year overall survival and disease-free survival between the two groups were not statistically significant (p>0.05). Both univariate and multivariate cox regression analyses demonstrated that patient age, tumor stage, postoperative chemoradiotherapy, postoperative radiotherapy, and postoperative tumor recurrence were independent factors influencing the 5-year overall survival and disease-free survival rates in colorectal cancer patients.

Conclusion

Carbon nanoparticle tracing technique can effectively increase the total detected number of lymph nodes in patients with radical resection for colorectal cancer, but it does not significantly impact the 5-year overall survival and disease-free survival rates in these patients.

Nanocarbon localization and 68Ga-DOTA-NOC scan in the diagnosis and management of neuroendocrine tumors (NETs): A case report

INTRODUCTION

Reports of rectal neuroendocrine tumor (R-NET) are relatively rare. There is a lack of experience in how to accurately locate and resect metastatic lateral lymph nodes.

CASE PRESENTATION

We present a challenging case. The patient was diagnosed with rectal neuroendocrine tumor. After endoscopic submucosal dissection (ESD), this patient came to hospital for reexamination. The imaging results indicated the presence of left lateral lymph node metastasis, so total mesorectal excision (TME) plus lateral lymph node dissection(LLND) was performed. One year later, PET-CT was reexamined again, using a contrast agent targeted at somatostatin receptor. The result showed residual metastatic lymph nodes. We used nanocarbon combined with coil to accurately locate the metastatic lymph nodes and finally successfully resected the lymph node. The patient recovered and was discharged 5 days after the operation.

DISCUSSION

Surgery is the most effective method for treating rectal neuroendocrine tumors. However, it is still challenging to accurately detect and locate metastatic lymph nodes after surgery. 68Ga-DOTA-NOC is a special contrast agent that targets somatostatin receptors, and somatostatin receptors are highly expressed in NETs. Using it can clearly trace whether the lateral lymph nodes are metastasized. Nanocarbon localization has been used for the localization of various tumors. We combined it with coils and effectively located the metastatic lymph nodes. This localization method has great potential.

CONCLUSION

Surgical resection is the most effective way to treat rectal neuroendocrine tumors. Nanocarbon combined with coils can effectively locate metastatic lymph nodes, which is helpful for accurate resection later. And 68Ga-DOTA-NOC can assist in detection of metastatic lymph nodes.

Improved lymph node detection in minimally invasive radical surgery for colorectal cancer using nanocarbon tracer

To investigate the influencing factors of lymph node detection after minimally invasive radical surgery in patients with colorectal cancer (CRC) and the application value of carbon nanoparticle tracing. A total of 120 patients with CRC who underwent minimally invasive radical surgery were included. They were divided into groups according to whether they were grouped by carbon nano-tracers, and the baseline data were matched by propensity score method. Univariate and multivariate methods were used to evaluate lymph nodes and positive lymph nodes after minimally invasive radical surgery. The number of detected independent factors. After propensity score matching, there were 37 patients in the tracer group and the non-tracer group; there was no significant difference in baseline data between the two groups; the number of positive lymph nodes detected in the tracer group was significantly higher than that in the non-tracer group. The results of univariate analysis showed that gender, lesion location, maximum tumor diameter, and whether to perform nanocarbon tracing were all related to the number of lymph nodes detected after minimally invasive radical surgery. Nanocarbon tracing was an independent influencing factor for the number of lymph nodes detected after minimally invasive radical surgery. Pathological type, T stage, histopathological grade, nerve invasion, and whether or not with cancer nodules were all related to the number of positive lymph nodes detected after minimally invasive radical surgery; multivariate analysis showed that T stage, pathological Histological grade, vascular invasion, and cancer nodules were all independent influencing factors for the number of positive lymph nodes detected after minimally invasive radical surgery. The number of lymph nodes detected in patients with CRC after minimally invasive radical surgery is closely related to the location of the lesion and whether carbon nanoparticle tracing is performed; those with T2-4 stage, histological grade 3-4, combined with vascular invasion and cancer nodules are more likely to Positive lymph nodes were detected.

The parathyroid glands identification of carbon nanoparticles via preoperative injection in reoperation of recurrent benign multinodular goiter

Introduction

Benign multinodular goiter (BMNG) can grow very large and cause compression symptoms, making the operation procedure difficult. However, the recurrence rate of BMNG ranges from 3% to 43%. Reoperative thyroid surgery for BMNG is uncommon and can result in a high rate of complications, including hypoparathyroidism and recurrent laryngeal nerve palsy. Carbon nanoparticles (CNs) have been widely used as a protective agent for the parathyroid gland and as a tracer agent in central lymph node dissection. However, the protection effect of CNs in redoing BMNG has not been well illustrated. This study investigates whether CNs could protect parathyroid glands (PGs) during reoperation for patients with BMNG.

Methods

BMNG patients who previously underwent thyroidectomy and received reoperation between January 2019 and January 2022 were retrospectively recruited. The Dunhill approach was employed for all patients. The patients were divided into two groups: the CNs group, who received injection CNs injection 1 hour before the operation (n = 24), and the control group, who underwent thyroid surgery without CNs injection (control group, n = 25). The numbers of PGs preserved in situ, autotransplantation, the accidental removal of the PGs, and the parathyroid hormone level were recorded and analyzed.

Results

The results revealed that more PGs were preserved in situ in the CNs group compared to the control group (3.25±0.15 vs 2.60±0.16, P=.007). Moreover, fewer PGs were subjected to autotransplantation and were accidentally discovered in the specimen in the CNs group compared to the control group. Patients who had CNs injection exhibited a lower rate of transient (5/24 vs. 13/25, P=.024) and permanent hypoparathyroidism (2/24 vs. 9/25, P=.020) compared to the control group.

Efficacy and prognostic analysis of carbon nanotracers combined with the da Vinci robot in the treatment of esophageal cancer

BACKGROUND

Traditional methods cannot clearly visualize esophageal cancer (EC) tumor contours and metastases, which limits the clinical application of da Vinci robot-assisted surgery.

AIM

To investigate the efficacy of the da Vinci robot in combination with nanocarbon lymph node tracers in radical surgery of EC.

METHODS

In total, 104 patients with early-stage EC who were admitted to Liuzhou worker's Hospital from January 2020 to June 2023 were enrolled. The patients were assigned to an observation group (n = 52), which underwent da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) with the intraoperative use of nanocarbon tracers, and a control group (n = 52), which underwent traditional surgery treatment. The operation time, intraoperative blood loss, postoperative drainage tube indwelling time, hospital stay, number of lymph nodes dissected, incidence of complications, and long-term curative effects were comparatively analyzed. The postoperative stress response C-reactive protein (CRP), cortisol, epinephrine (E) and inflammatory response interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α) were evaluated.

RESULTS

Compared with the control group, the observation group had significantly lower postoperative CRP, cortisol, and E levels (P < 0.05) with a milder inflammatory response, as indicated by lower IL-6, IL-10, and TNF-α levels (P < 0.05). Patients who underwent RAMIE had less intraoperative blood loss and shorter operation times and hospital stays than those who underwent traditional surgery. The average number of dissected lymph nodes, time of lymph node dissection, and mean smallest lymph node diameter were all significantly lower in the observation group (P < 0.05). The rate of postoperative complications was 5.77% in the observation group, significantly lower than the 15.38% observed in the control group. Furthermore, the lymphatic metastasis rate, reoperation rate, and 12- and 24-month cumulative mortality in the observation group were 1.92%, 0%, 0%, and 0%, respectively, all of which were significantly lower than those in the control group (P < 0.05).

CONCLUSION

The treatment of EC using the da Vinci robot combined with nanocarbon lymph node tracers can achieve good surgical outcomes and demonstrates promising clinical applications.

Clinical value of nano-carbon lymphatic tracer for regional lymph node dissections of rectal cancer after neoadjuvant chemoradiotherapy

OBJECTIVES

Regional lymph node (LN) volume decreases after neoadjuvant therapy, requiring a tracer for more accurate detection. Nano-carbon tracer is a third-generation tracer with several advantages, but its use for LN detection after neoadjuvant chemoradiotherapy for middle and low rectal cancer remains unclear. Therefore, this study investigated the effects and safety of anoscope-guided subrectal injections of nano-carbon suspension in this patient population.

METHODS

This study retrospectively reviewed the medical records of 45 patients with middle and low rectal cancer admitted to our institution from March 2019 to March 2022. All patients received preoperative neoadjuvant chemotherapy and radiotherapy and were divided into nano-carbon injection (n = 23; anoscope-guided injections of nano-carbon suspension in the rectal submucosa 2 cm above the dentate line 24 h preoperatively) and control (n = 22; directly underwent surgery) groups. The LN detection and complication rates were compared between the groups.

RESULTS

The total and mean numbers of LNs and small LNs and the number of patients with > 12 LNs were significantly higher in the nano-carbon injection group than in the control group. The total number of positive LNs and LN metastasis did not differ between the groups, nor did the anastomotic leakage, bleeding, stenosis, and abscess occurrence rates.

CONCLUSIONS

Anoscope-guided nano-carbon lymphatic tracing increased the LN detection rate, caused less trauma, and resulted in fewer postoperative complications than the direct surgical procedure. Thus, it is an effective, safe, and practical method that may improve dissections and the postoperative pathological staging accuracy.

The effect of carbon nanoparticles vs. immune colloidal gold technique test strips on parathyroid protection in total thyroidectomy: A randomized clinical trial study

BACKGROUND

The long-term effect of intraoperative usage of carbon nanoparticles (CN) and parathyroid hormone (PTH) test strip using immune colloidal gold technique (ICGT) is unclear. This study aims to compare the effect of intraoperative usage of CN and ICGT test strips on PG function.

METHODS

This randomized clinical study involved adult patients who underwent total thyroidectomy. They were randomly allocated into three groups (control, CN, and ICGT group). Clinical data were analyzed.

RESULTS

Each group involved 98 patients. Serum calcium and PTH concentrations at 24 h postoperatively (PTH24h) were higher in CN group. The parathyroid function recovered quicker in CN group. Use of CN increased in situ PG preservation and PTH24h. Mediation analysis indicated that 23.05% of the total effect of CN on PTH24h was attributed to PGRIS.

CONCLUSION

CN holds promise to improve in situ PG preservation and protect PG vasculature, thereby reducing the incidence of early hypoparathyroidism. The value of ICGT test strips for PG protection is dubious.

Tumor-draining lymph nodes: opportunities, challenges, and future directions in colorectal cancer immunotherapy

Tumor-draining lymph nodes (TDLNs) are potential immunotherapy targets that could expand the population of patients with colorectal cancer (CRC) who may benefit from immunotherapy. Currently, pathological detection of tumor cell infiltration limits the acquisition of immune information related to the resected lymph nodes. Understanding the immune function and metastatic risk of specific stages of lymph nodes can facilitate better discussions on the removal or preservation of lymph nodes, as well as the timing of immunotherapy. This review summarized the contribution of TDLNs to CRC responses to immune checkpoint blockade therapy, local immunotherapy, adoptive cell therapy, and cancer vaccines, and discussed the significance of these findings for the development of diagnostics based on TDLNs and the potential implications for guiding immunotherapy after a definitive diagnosis. Molecular pathology and immune spectrum diagnosis of TDLNs will promote significant advances in the selection of immunotherapy options and predicting treatment efficacy.

A retrospective study analyzing if lymph node ratio carbon nanoparticles predict stage III rectal cancer recurrence

Background

Lymph node ratio has garnered increasing attention as a prognostic marker for rectal cancer; however, few studies have investigated the relationship between lymph node ratio and rectal cancer recurrence. Additionally, Carbon Nanoparticle tracking is a safe and effective strategy for locating tumors and tracking lymph nodes. However, no studies have reported the relationship between Carbon Nanoparticles and rectal cancer recurrence.

Methods

Patients with stage III rectal cancer who underwent radical resection between January 2016 and 2020 were analyzed. The primary outcome was tumor recurrence. 269 patients with stage III rectal cancer were included in this study. The effects of lymph node ratio, Carbon Nanoparticles, and other clinicopathological factors on rectal cancer recurrence were assessed using univariate, multivariate analyses and the t-test.

Results

Univariate analysis determined tumor recurrence using cytokeratin 19 fragment, CA-199, CEA, N-stage, positive lymph nodes, total lymph nodes, and lymph node ratio(positive/total); with the lymph node ratio being the most relevant. Receiver operating characteristic (ROC) analysis determined lymph node ratio =0.38 as the optimal cutoff value. The analysis of lymph node ratio ≥0.38 and <0.38 showed statistical differences in three indicators: tumor recurrence, CEA, and use of Carbon Nanoparticles.

Conclusion

Lymph node ratio is a strong predictor of stage III rectal cancer recurrence and may be considered for inclusion in future tumor-node-metastasis staging and stage III rectal cancer stratification. In addition, we found that Carbon Nanoparticles use significantly increased total lymph nodes and decreased lymph node ratio.

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

Colorectal malignancies are the third-most common malignancies worldwide, with a rising incidence. Surgery remains the treatment of choice and adequate lymph node dissection is required for accurate staging. The objective of this study is to assess the use of carbon nanoparticles in lymph node tracing and resection in cases of colorectal cancer. For that purpose, we conducted a systematic review and meta-analysis of studies included in Medline, Scopus, Embase, Cochrane Library, and Google Scholar databases. In the end, ten studies with a total number of 1418 patients were included in the final statistical analysis. The meta-analysis carried out showed that the use of carbon nanoparticles results in an increased number of lymph nodes harvested (WMD 6.15, 95% CI 4.14 to 8.16, p < 0.001) and a higher rate of cases with more than 12 lymph nodes harvested (OR 9.57, 95% CI 2.87 to 31.96, p = 0.0002). As a consequence, we suggest that carbon nanoparticles are used on a wider scale and that future research focuses on assessing the association between their use and overall patient survival. This study is limited by the fact that all included studies originate from China and by the fact that certain oncologic parameters and long-term outcomes have not been taken into account in the analysis.

From organ preservation to selective surgery: How immunotherapy changes colorectal surgery?

The emergence of immunotherapy has revolutionized the traditional treatment paradigm of colorectal cancer (CRC). Among them, immune checkpoint blockade has become the first-line treatment for metastatic colorectal cancer (mCRC) and has made significant progress in the treatment of locally advanced colorectal cancer (LACRC). We reviewed a series of clinical trials that have made breakthrough progress. We will emphasize the breakthrough progress in achieving organ preservation in patients with high microsatellite instability or DNA mismatch repair deficiency (MSI-H/dMMR), and based on this, we propose the concept of selective surgery, which includes selectively removing or preserving lymph nodes, with the aim of proving our idea through more research in the future.

Nanodrugs systems for therapy and diagnosis of esophageal cancer

With the increasing incidence of esophageal cancer, its diagnosis and treatment have become one of the key issues in medical research today. However, the current diagnostic and treatment methods face many unresolved issues, such as low accuracy of early diagnosis, painful treatment process for patients, and high recurrence rate after recovery. Therefore, new methods for the diagnosis and treatment of esophageal cancer need to be further explored, and the rapid development of nanomaterials has brought new ideas for solving this problem. Nanomaterials used as drugs or drug delivery systems possess several advantages, such as high drug capacity, adjustably specific targeting capability, and stable structure, which endow nanomaterials great application potential in cancer therapy. However, even though the nanomaterials have been widely used in cancer therapy, there are still few reviews on their application in esophageal cancer, and systematical overview and analysis are deficient. Herein, we overviewed the application of nanodrug systems in therapy and diagnosis of esophageal cancer and summarized some representative case of their application in diagnosis, chemotherapy, targeted drug, radiotherapy, immunity, surgery and new therapeutic method of esophageal cancer. In addition, the nanomaterials used for therapy of esophageal cancer complications, esophageal stenosis or obstruction and oesophagitis, are also listed here. Finally, the challenge and the future of nanomaterials used in cancer therapy were discussed.

Assessment of the efficacy and safety of carbon nanoparticles-guided lymph node dissection in gastric cancer surgery: a systematic review and meta-analysis

BACKGROUND

To investigate the efficacy and safety of lymph nodes (LNs) dissection guided by carbon nanoparticles (CNs) in gastric cancer (GC) surgery.

MATERIALS AND METHODS

We searched electronic databases such as PubMed, Web of Science, Embase, Cochrane Library, and Scopus for relevant articles up to September 2022 and collected all studies comparing the CNs group with blank controls group on the efficacy and safety of LN dissection in gastrectomy. A pooled analysis of the collected data was performed, including the number of retrieved LNs, the staining rate of LNs, the number of metastatic LNs dissection, various intraoperative outcomes, and postoperative complications.

RESULTS

A total of 9 studies including 1770 participants (502 in the CNs group and 1268 in the control group) were included. As compared to the blank control group, the CNs group detected 10.46 more LNs in each patient (WMD = 10.46, 95% CI: 6.63 ~ 14.28, p < 0.00001, I² = 91%), and also significantly more metastatic LNs (WMD = 2.63, 95% CI: 1.43 ~ 3.83, p < 0.0001, I² = 41%). However, there was no significant difference in the rate of metastatic LNs between the CNs and control groups (OR = 1.37, 95% CI: 0.94 ~ 2.00, P = 0.1, I² = 89%). In addition, there was no increase in operative time, intraoperative blood loss, and postoperative complications associated with CNs-guided gastrectomy.

CONCLUSION

CNs-guided gastrectomy is safe and effective, and can increase the efficiency of LN dissection without increasing the risk of surgery.

Preoperative application of carbon nanoparticles in transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer

Background

Carbon nanoparticles (CNs) have been widely used in the protection of the parathyroid gland and act as a tracer agent in central lymph node dissection. However, the right time for CN injection has not been well illustrated in the transoral endoscopic thyroidectomy vestibular approach (TOETVA). The purpose of this study was to evaluate the safety and feasibility of the preoperative injection of CNs in TOETVA for papillary thyroid cancer.

Methods

From October 2021 to October 2022, a total of 53 consecutive patients with PTC were retrospectively analyzed. All patients underwent unilateral thyroidectomy via the TOETVA. The patients were divided into the preoperative group (n = 28) and the intraoperative group (n = 25) according to CN injection time. In the preoperative group, 0.2 ml of CNs were injected into the thyroid lobules with malignant nodules 1 h before surgery. The numbers of total central lymph node (CLN) and metastatic central lymph node (CLNM), parathyroid autotransplantation, accidental removal of the parathyroid, and the parathyroid hormone level were recorded and analyzed.

Results

The leakage of CNs happened more frequently in the intraoperative group than in the preoperative group (P = 0.002). The mean number of retrieved CLN and CLNM was similar in the preoperative group and the intraoperative group. In parathyroid protection, more parathyroid was discovered in the preoperative group than in the intraoperative group (1.57 ± 0.54 vs. 1.47 ± 0.50, P = 0.002), but less parathyroid autotransplantation (P = 0.004) and accidental removal of the parathyroid (P = 0.036) were discovered in the preoperative group. However, the PTH level between the two groups was similar after the first day and the first month.

Conclusion

The preoperative injection of CNs is a safe and effective method to protect the parathyroid glands (PGs) in patients with PTC undergoing TOETVA. However, the value of preoperative injection of CNs in TOETVA for central lymph node dissection needs to be further studied.

Ultrasound-assisted carbon nanoparticle labeling of neoadjuvant chemotherapy for breast-conserving surgery in breast cancer

Background

Neoadjuvant chemotherapy has gradually become an important means of breast cancer treatment; however, tumor regression following chemotherapy remains a concern. This study was conducted to investigate the effect of ultrasound-assisted carbon nanoparticle labeling in neoadjuvant chemotherapy for breast-conserving surgery in breast cancer.

Methods

This was a prospective clinical trial study (clinical registration number: ChiCTR-OOC-15006844). Sixty-eight breast cancer patients confirmed by biopsy between July 2015 and January 2017 were randomly selected from the clinical data. Of these, 32 patients were screened for neoadjuvant chemotherapy, forming a consecutive, random series. An ultrasound-guided carbon nanotube was used to mark the original tumor, and sentinel lymph node biopsies were performed. After 4-6 cycles of standard neoadjuvant chemotherapy, 26 patients were selected for breast-conserving surgery. The feasibility and validity of carbon nanoparticle labeling were analyzed through the negative rate of incision margin, the volume of resected tumors, the detection rate of black-stained sentinel lymph nodes, the recurrence rate of ipsilateral breast, and postoperative survival.

Results

In all, 32 patients underwent sentinel lymph node biopsy, 29 cases were detected (90.6%), the false-negative rate was 3.8% (1/26), and 0-4 sentinel lymph nodes (mean 1.8±1.1) were detected. A total of 26 patients underwent breast-conserving surgery, 5 underwent secondary excision, and 1 underwent subcutaneous adenectomy due to a positive margin. The minimum margin between the resected site and the infiltrated part was 1.0-2.1 cm (1.3±0.3 cm). The diameter of resected tumors ranged from 2.2 to 4.5 cm (3.1±0.6 cm). No recurrence or distant metastasis of ipsilateral breast tumors was observed during follow-up (the median follow-up time was 9 months).

Conclusions

Ultrasound-assisted carbon nanoparticle labeling is effective for sentinel lymph node tracing before neoadjuvant chemotherapy and has a high detection rate for metastatic lymph nodes. During breast-conserving surgery, it can determine the extent of tumor resection to achieve precision surgical treatment.

The effect of carbon nanoparticles staining on lymph node tracking in colorectal cancer: A propensity score matching analysis

Purpose

The aim of this study was to evaluate the effect of carbon nanoparticles staining (CNS) on colorectal cancer (CRC) surgery, lymph node tracing and postoperative complications using propensity score matching (PSM).

Method

Patients who were diagnosed with CRC and underwent surgery were retrospectively collected from a single clinical center from Jan 2011 to Dec 2021. Baseline characteristics, surgical information and postoperative information were compared between the CNS group and the non-CNS group. PSM was used to eliminate bias.

Results

A total of 6,886 patients were enrolled for retrospective analysis. There were 2,078 (30.2%) patients in the CNS group and 4,808 (69.8%) patients in the non-CNS group. After using 1: 1 ratio PSM to eliminate bias, there were 2,045 patients left in each group. Meanwhile, all of their baseline characteristics were well matched and there was no statistical significance between the two groups (P > 0.05). In terms of surgical information and short-term outcomes, the CNS group had less intraoperative blood loss (P < 0.01), shorter operation time (P < 0.01), shorter postoperative hospital stay (P < 0.01), less metastatic lymph nodes (P = 0.013), more total retrieved lymph nodes (P < 0.01), more lymphatic fistula (P = 0.011) and less postoperative overall complications (P < 0.01) than the non-CNS group before PSM. After PSM, the CNS group had less intraoperative blood loss (P = 0.004), shorter postoperative hospital stay (P < 0.01) and more total retrieved lymph nodes (P < 0.01) than the non-CNS group. No statistical difference was found in other outcomes (P > 0.05).

Conclusion

Preoperative CNS could help the surgeons detect more lymph nodes, thus better determining the patient's N stage. Furthermore, it could reduce intraoperative blood loss and reduce the hospital stay.

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

Thyroid cancer is the most common endocrine malignancy with an increasing incidence over the past few years. Surgery is considered the primary therapeutic option, which often involves lymph node dissection. The aim of this study was to assess the role of carbon nanoparticles, a novel agent, in thyroid cancer surgery. For that purpose, we conducted a systematic review of the literature on MEDLINE, EMBASE, Scopus, Cochrane and Google Scholar databases from 1 January 2002 to 31 January 2022. Ultimately, 20 articles with a total number of 2920 patients were included in the analysis. The outcome of the analysis showed that the use of carbon nanoparticles is associated with a higher number of harvested lymph nodes (WMD, 1.47, 95% CI, 1.13 to 1.82, p < 0.001) and a lower rate of accidental parathyroid gland removal (OR 0.34, CI 95% 0.24 to 0.50, p < 0.001). Based on these results, we suggest that carbon nanoparticles are applied in thyroid cancer surgery on a wider scale, so that these findings can be confirmed by future research on the subject.

Colorectal Cancer Lymph Node Detection and Anastomotic Safety of Using Carbon Nano-Tracer Following Minimally Invasive Radical Surgery

Objective: The goal of this study is to examine the impact of rectal submucosal injection of nano-carbon suspension injection following neoadjuvant therapy for middle and low rectal cancer on lymph node identification and anastomotic safety. Methods: 45 patients with intermediate-to-low grade rectal cancer admitted to the Ningbo Medical Center Lihuili Hospital between March 2019 and March 2022 had their medical records reviewed retrospectively. Patients in case group were injected with nanocarbon suspension under an anoscope into the rectal submucosa patients in control group were not injected with nanocarbon suspension. The lymph node identification and anastomotic consequences were then compared. Results: There were statistically significant differences between the two groups in the average number of lymph nodes discovered in the observation group and the percentage of patients with more than 12 lymph nodes detected. The percentage of patients with lymph node metastases did not significantly. The rates of complications such leakage, hemorrhage, stenosis, and abscesses around the anastomosis were similar in both groups. Conclusion: Nano carbon lymph node tracking is a safe, simple, and easy-to-operate method for increasing the number of lymph nodes detected in surgical specimens of middle and low rectal cancer after neoadjuvant therapy.

Lymph Node Cluster Dissection After Carbon Nanoparticles Injection Enhances the Retrieval Number in Colorectal Cancer

For colorectal cancer patients, NCCN recommended that at least 12 lymph nodes should be detected since the number and metastases status of lymph nodes played an important role in the treatment and prognostic. Carbon nanoparticles have been proved to be an efficient lymph node tracer. Faced with the clinical problem of insufficient lymph nodes in colorectal cancer, we proposed a lymph node cluster (D3, D2 and D1) dissection method combined with carbon nanoparticle injection. In our study, patients were divided into 2 groups (CNP and control). All lymph nodes of each patient were collected and made into hematoxylin-eosin sections to observe their size, staining appearance and metastasis status under the microscope. As a result, the total lymph nodes in CNP group were greatly higher than control group (51.45 vs. 29.62, P = 0.000), especially micro LNs and positive micro LNs. Compared with D2 and D1 stations, fewer lymph nodes were found in D3, and it was the same for cancer metastasis status. In CNP group, most lymph nodes got black for quick visualization. In conclusion, lymph node cluster dissection combined with carbon nanoparticles could enhance the number of lymph node retrieval.

Chemo-Phototherapy with Carfilzomib-Encapsulated TiN Nanoshells Suppressing Tumor Growth and Lymphatic Metastasis

The design of nanomedicine for cancer therapy, especially the treatment of tumor metastasis has received great attention. Proteasome inhibition is accepted as a new strategy for cancer therapy. Despite being a big breakthrough in multiple myeloma therapy, carfilzomib (CFZ), a second-in-class proteasome inhibitor is still unsatisfactory for solid tumor and metastasis therapy. In this study, hollow titanium nitride (TiN) nanoshells are synthesized as a drug carrier of CFZ. The TiN nanoshells have a high loading capacity of CFZ, and their intrinsic inhibitory effect on autophagy synergistically enhances the activity of CFZ. Due to an excellent photothermal conversion efficiency in the second near-infrared (NIR-II) region, TiN nanoshell-based photothermal therapy further induces a synergistic anticancer effect. In vivo study demonstrates that TiN nanoshells readily drain into the lymph nodes, which are responsible for tumor lymphatic metastasis. The CFZ-loaded TiN nanoshell-based chemo-photothermal therapy combined with surgery offers a remarkable therapeutic outcome in greatly inhibiting further metastatic spread of cancer cells. These findings suggest that TiN nanoshells act as an efficient carrier of CFZ for realizing enhanced outcomes for proteasome inhibitor-based cancer therapy, and this work also presents a "combined chemo-phototherapy assisted surgery" strategy, promising for future cancer treatment.

Biocompatible Tantalum Nanoparticles as Radiosensitizers for Enhancing Therapy Efficacy in Primary Tumor and Metastatic Sentinel Lymph Nodes

Metastasis of breast carcinoma is commonly realized through lymphatic circulation, which seriously threatens the lives of breast cancer patients. Therefore, efficient therapy for both primary tumor and metastatic sentinel lymph nodes (SLNs) is highly desired to inhibit cancer growth and metastasis. During breast cancer treatment, radiotherapy (RT) is a common clinical method. However, the efficacy of RT is decreased by the radioresistance to a hypoxic microenvironment and inevitable side effects for healthy issues at high radiation doses. Considering the above-mentioned, we provide high biocompatible poly(vinylpyrrolidone) coated Ta nanoparticles (Ta@PVP NPs) for photothermal therapy (PTT) assisted RT for primary tumor and metastatic SLNs. On the one hand, for primary tumor treatment, Ta@PVP NPs with a high X-ray mass attenuation coefficient (4.30 cm²/kg at 100 keV) can deposit high radiation doses within tumors. On the other hand, for metastatic SLNs treatment, the effective delivery of Ta@PVP NPs from the primary tumor into SLNs is monitored by computed tomography and photoacoustic imaging, which greatly benefit the prognosis and treatment for metastatic SLNs. Moreover, Ta@PVP NPs-mediated PTT could enhance the RT effect, and immunogenic cell death caused by RT/PTT could induce an immune response to improve the therapeutic effect of metastatic SLNs. This study not only explores the potential of Ta@PVP NPs as effective radiosensitizers and photothermal agents for combined RT and PTT but also offers an efficient strategy to cure both primary tumor and metastatic SLNs in breast carcinoma.

Nanoprobes-Assisted Multichannel NIR-II Fluorescence Imaging-Guided Resection and Photothermal Ablation of Lymph Nodes

Lymph node metastasis is a major metastatic route of cancer and significantly influences the prognosis of cancer patients. Radical lymphadenectomy is crucial for a successful surgery. However, iatrogenic normal organ injury during lymphadenectomy is a troublesome complication. Here, this paper reports a kind of organic nanoprobes (IDSe-IC2F nanoparticles (NPs)) with excellent second near-infrared (NIR-II) fluorescence and photothermal properties. IDSe-IC2F NPs can effectively label lymph nodes and helped achieve high-contrast lymphatic imaging. More importantly, by jointly using IDSe-IC2F nanoparticles and other kinds of nanoparticles with different excitation/emission properties, a multichannel NIR-II fluorescence imaging modality and imaging-guided lymphadenectomy is proposed. With the help of this navigation system, the iatrogenic injury can be largely avoided. In addition, NIR-II fluorescence imaging-guided photothermal treatment ("hot" strategy) can ablate those metastatic lymph nodes which are difficult to deal with during resection ("cold" strategy). Nanoprobes-assisted and multichannel NIR-II fluorescence imaging-guided "cold" and "hot" treatment strategy provides a general new basis for the future precision surgery.