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Guo H, Zhang Y, Ren S, Yang X, Tian L, Huang Y, Zhang C, Zhang X. Real-time imaging of ipsilateral parathyroid glands by retrograde injection of methylene blue into the superior thyroid artery: a new intraoperative parathyroid protection method. BMC Surg 2024; 24:108. [PMID: 38615003 PMCID: PMC11015547 DOI: 10.1186/s12893-024-02360-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Postoperative hypoparathyroidism caused by parathyroid injury is a problem faced by thyroid surgeons. The current technologies for parathyroid imaging all have some defects. METHODS Patients with differentiated thyroid carcinoma (DTC) who underwent unilateral thyroidectomy plus ipsilateral central lymph node dissection were recruited. We dissected the main trunk of the superior thyroid artery entering the thyroid gland and placed the venous indwelling tube into the artery. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS A total of 132 patients enrolled in this single-arm clinical trial, 105 of them completed retrograde catheterization via the superior artery. The sensitivity was 69.23 and 83.33% respectively. The specificity was 72.91 and 64.89%. The accuracy was 72.91 and 64.89%. The PPV was 85.71 and 81.08%. The NPV was 22.58 and 45.45%. There were no patients with allergic reactions to the methylene blue, or methylene blue toxicity. CONCLUSIONS Retrograde injection of methylene blue via the superior thyroid artery is an effective and safe method to visualize parathyroid glands. This method can accurately locate the target organ by ultraselecting the blood vessel and injecting the contrast agent while avoiding background contamination and reducing the amount of contrast agent. TRIAL REGISTRATION Clinical trial registration numbers and date of registration: ChiCTR2300077263、02/11/2023.
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Affiliation(s)
- Hanjie Guo
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China
| | - Yuxing Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Saiyu Ren
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China
| | - Xiaodong Yang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Lei Tian
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Yun Huang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Chaojun Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China.
| | - Xiliang Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China.
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China.
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China.
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Liu J, Xu C, Wang R, Han P, Zhao Q, Li H, Bai Y, Liu L, Zhang S, Yao X. Do carbon nanoparticles really improve thyroid cancer surgery? A retrospective analysis of real-world data. World J Surg Oncol 2020; 18:84. [PMID: 32359365 PMCID: PMC7196221 DOI: 10.1186/s12957-020-01852-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background Parathyroid protection and central neck dissection (CND) are basic points of thyroid cancer surgery and draw persistent concern. We aimed to evaluate the value of carbon nanoparticles (CNs) for parathyroid gland protection and CND in thyroid surgery for thyroid cancer patients. Methods A total of 386 consecutive thyroid cancer patients were enrolled in the retrospective study. Three hundred thirty-four patients using CNs intraoperatively were included in the CN group, and 52 patients without using CNs or any other helping agent were included in the control group. Intact parathyroid hormone (iPTH) was examined. Medical records and histopathologic reports were reviewed. Histopathologic examination was performed. Results There were no statistical significances in demographic and basic surgical information, preoperative iPTH, and serum calcium between the two groups (P > 0.05). In the CN group, the thyroid tissue and central neck lymph nodes were stained black by CNs, while the parathyroid glands were not. Histopathological examination showed that the carbon nanoparticles might accumulated in the subcapsular sinus of lymph nodes compared with the none-stained samples. The staining with CNs did not impact the histopathological examination. There were no significant differences in postoperative hypocalcemia and hypoPT at day 1, 1 month, and half year after surgery between the two groups, respectively. There was a big decline of iPTH level after surgery, whereas the perioperative decreasing amplitude of PTH was not statistically different between the CNs and control group (57.2 ± 28.6 vs 55.7 ± 27.8, P = 0.710). There were 43 patients occurring incidental parathyroidectomy in the CN group (43/334, 12.9%) and 7 patients in the control group (7/52, 13.5%), without significant difference (P = 0.907). There was no significant difference in the number of lymph nodes identified by pathology per patient between the CNs and control group regardless of unilateral and bilateral CND. Conclusions Carbon nanoparticles help highlight parathyroid glands and lymph nodes in thyroidectomy, but generate no significant benefit for parathyroid glands protection and lymph node dissection. The value of carbon nanoparticles in thyroid cancer surgery should not be exaggerated and needs further evaluation.
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Affiliation(s)
- Junsong Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Chongwen Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Rui Wang
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Peng Han
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Qian Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Honghui Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yanxia Bai
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Lifeng Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Shaoqiang Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Xiaobao Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Clinical Research Center for Thyroid Diseases of Shaanxi Province, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
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