Effect of Carbon Nanoparticles Dyeing on Axillary Lymph Node Dissection in Modified Radical Mastectomy for Breast Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGZhen ,  ZHANGXiao-hong , ZHAOLi-juan , TANGZhuo-wei

The Department of Breast Surgery, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China;

Corresponding author：

ZHANGXiao-hong, Email: jiangzhangtong@sina.Com

Keywords：

Carbon nanoparticles; Breast cancer; Lymph node; Tracer

DOI：

10.7507/1007-9424.20140271

Video：

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Objective To explore the effect of carbon nanoparticles dyeing on axillary lymph node dissection in modified radical mastectomy for breast cancer. Methods Eighty-eight patients with breast cancer who received modified radical mastectomy in Mianyang Central Hospital between Mar. 2012 and May. 2013 were recruited in the study, and they were equally divided into areola group and peripheral tumor group. After induction of anesthesia before operation, carbon nanoparticles were injected around the areolar in the areola group, and carbon nanoparticles were injected around the tumor in the peripheral tumor group. The number of dissected lymph nodes(be dyed or not be dyed), metastatic lymph nodes, and black dyed lymph nodes, as well as value of operation related indexes were recorded and compared. Results In the areola group, lymph nodes were detected in 1 453, in which 1 396 lymph nodes were stained black(96.1%); the average number of dissected lymph nodes were 33.0±7.1 per case; and 19 patients (43.2%, in total of 220 metastatic lymph nodes) of them were suffered from lymph node metastasis with the average number of metastatic lymph nodes of 5±2 per case. in addition, in the areola group, operative time were(122.1±10.2) min, blood loss were(83.8±10.1) mL, postoperative hospital stay were(7±1) d, and postoperative complications occurred in 3 patients. In the peripheral tumor group, lymph nodes were detected in 909, in which 594 lymph nodes were stained black (65.3%); the average number of dissected lymph nodes were 20.7±3.2 per case; 20 patients (45.5%, in total of 88 metastatic lymph nodes) of them were suffered from lymph nodes metastasis, with the average number of metastatic lymph nodes of 2±1 per case. In addition, in the peripheral tumor group, operative time were (121.6±11.4) min, blood loss were (84.2±11.3) mL, postoperative hospital stay were (7±2) d, postoperative complications occurred in 3 patients. The black staining rate of lymph nodes, the number of lymph nodes retrieved, and the number of metastatic lymph nodes in areola group were significantly higher than those of peripheral tumor group(P < 0.01). Operative time, blood loss, postoperative hospital stay, and postoperative complication rate did not significantly differ between the 2 groups (P > 0.05). Conclusion The dyeing effect of carbon nanoparticles suspension, which was injected at areola area after induction of anesthesia, is better than that of injected around the tumor, without increasing the incidence of complication.

Citation： ZHANGZhen, ZHANGXiao-hong, ZHAOLi-juan, TANGZhuo-wei. Effect of Carbon Nanoparticles Dyeing on Axillary Lymph Node Dissection in Modified Radical Mastectomy for Breast Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1130-1133. doi: 10.7507/1007-9424.20140271 Copy

1.	Chua B, Ung O, Taylor R, et al. Frequency and predictors of axillary lymph node metastases in invasive breast cancer[J]. ANZ J Surg, 2001, 71(12):723-728.
2.	Cunnick GH, Jiang WG, Gomez KF, et al. Lymphangiogenesis and breast cancer metastasis[J]. Histol Histopathol, 2002, 17(3):863-870.
3.	Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival:an overview of the randomised trials[J]. Lancet, 2005, 366(9503):2087-2106.
4.	瞿欢, 张亚男, 陈卫东. 纳米炭在乳腺癌前哨淋巴结示踪的实验研究[J]. 中国普通外科杂志, 2010, 19(5):489-492.
5.	Yokota T, Saito T, Narushima Y, et al. Lymph-node staining with activated carbon CH40:a new method for axillary lymph-node dissection in breast cancer[J]. Can J Surg, 2000, 43(3):191-196.
6.	Zavagno G, Rubello D, Franchini Z, et al. Axillary sentinel lymph nodes in breast cancer:a single lymphatic pathway drains the entire mammary gland[J]. Eur J Surg Oncol, 2005, 31(5):479-484.
7.	张波, 陈佳平, 胡建昆. 纳米炭混悬注射液检测胃癌前哨淋巴结的临床研究[J]. 华西医学, 2006, 21(3):514-515.
8.	张李, 梁寒. 纳米活性炭的特性及其在胃癌治疗中的应用[J]. 国际肿瘤学杂志, 2007, 34(1):52-55.
9.	Fiorito S, Serafino A, Andreola F, et al. Toxicity and biocompatibility of carbon nanoparticles[J]. J Nanosci Nanotechnol, 2006,6(3):591-599.
10.	Bianco A, Kostarelos K, Prato M. Applications of carbon nanotubes in drug delivery[J]. Curr Opin Chem Biol, 2005, 9(6):674-679.
11.	郑春雷, 许军. 国产纳米活性炭在胃癌根治术中的应用[J]. 齐齐哈尔医学院学报, 2008, 29(3):275-277.
12.	雷建, 黄炯强, 胡明, 等. 活性炭示踪指导进展期胃癌手术淋巴结清扫的意义[J]. 岭南现代临床外科,2008,8(3):187-188.
13.	于永扬, 王存, 郑阳春, 等. 比较研究纳米炭示踪剂在低位直肠癌淋巴结清扫及病理检查中的价值[J]. 中国普外基础与临床杂志, 2008, 15(5):358-361.
14.	Liu CL, Yang TL, Chen BF. Sentinel lymph node mapping with emulsion of activated carbon particles in patients with pre-mastectomy diagnosis of intraductal carcinoma of the breast[J]. J Chin Med Assoc, 2003, 66(7):406-410.
15.	Hagiwara A, Takahashi T, Sawai K, et al. Selective drug delivery to peri-tumoral region and regional lymphatics by local injection of aclarubicin adsorbed on activated carbon particles in patients with breast cancer-a pilot study[J]. Anticancer Drugs, 1997, 8(7):666-670.
16.	Hagiwara A, Takahashi T, Lee R, et al.Chemotherapy of carcinomatous peritonitis and carcinomatous pleuritis by using activated charcoal particle adsorbing mitomycin C (MMC-CH)-studies on the clinical trials[J]. Nihon Gan Chiryo Gakkai Shi, 1985,20(9):2144-2153.
17.	Hagiwara A, Takahashi T, Sawai K, et al. Lymph nodal vital staining with newer carbon particle suspensions compared with India ink:experimental and clinical observations[J]. Lymphology, 1992, 25(2):84-89.
18.	Catarci M, Guadagni S, Zaraca F, et al. Prospective randomized evaluation of preoperative endoscopic vital staining using CH-40 for lymph node dissection in gastric cancer[J]. Ann Surg Oncol, 1998, 5(7):580-584.
19.	关丽梅, 高琼, 赵德安, 等. 纳米炭混悬注射液在颈淋巴结清扫术中应用[J]. 延安大学学报:医学科学版, 2008, 6(4):106-107.
20.	周卫华, 李勇, 周毅, 等. 纳米炭在乳腺癌腋窝淋巴结清扫中的临床应用[J]. 中华老年多器官疾病杂志, 2012, 11(12):930-932.
21.	陈波, 毕唯静, 吕青. 纳米炭混悬注射液在乳腺癌淋巴结清扫及病理检查中的应用[J]. 华西医学, 2009, 24(8):2121-2122.
22.	范林军, 钟玲, 郭德玉, 等. 纳米炭对乳腺癌腋窝淋巴结示踪效果及其安全性的初步研究[J/CD]. 中华乳腺病杂志:电子版, 2010, 4(3):47-50.
23.	van Tongeren MJ, Kromhout H, Gardiner K. Trends in levels of inhalable dust exposure, exceedance and overexposure in the European carbon black manufacturing industry[J]. Ann Occup Hyg, 2000, 44(4):271-280.
24.	Magrez A, Kasas S, Salicio V, et al. Cellular toxicity of carbonbased nanomaterials[J]. Nano Lett, 2006, 6(6):1121-1125.
25.	Ito T, Hagiwara A, Takagi T, et al. Local administration of methotrexate bound to activated carbon particles (MTX-CH) for treating cancers in mice[J]. Anticancer Res, 2003, 23(2B):1401-1404.

1. Chua B, Ung O, Taylor R, et al. Frequency and predictors of axillary lymph node metastases in invasive breast cancer[J]. ANZ J Surg, 2001, 71(12):723-728.
2. Cunnick GH, Jiang WG, Gomez KF, et al. Lymphangiogenesis and breast cancer metastasis[J]. Histol Histopathol, 2002, 17(3):863-870.
3. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival:an overview of the randomised trials[J]. Lancet, 2005, 366(9503):2087-2106.
4. 瞿欢, 张亚男, 陈卫东. 纳米炭在乳腺癌前哨淋巴结示踪的实验研究[J]. 中国普通外科杂志, 2010, 19(5):489-492.
5. Yokota T, Saito T, Narushima Y, et al. Lymph-node staining with activated carbon CH40:a new method for axillary lymph-node dissection in breast cancer[J]. Can J Surg, 2000, 43(3):191-196.
6. Zavagno G, Rubello D, Franchini Z, et al. Axillary sentinel lymph nodes in breast cancer:a single lymphatic pathway drains the entire mammary gland[J]. Eur J Surg Oncol, 2005, 31(5):479-484.
7. 张波, 陈佳平, 胡建昆. 纳米炭混悬注射液检测胃癌前哨淋巴结的临床研究[J]. 华西医学, 2006, 21(3):514-515.
8. 张李, 梁寒. 纳米活性炭的特性及其在胃癌治疗中的应用[J]. 国际肿瘤学杂志, 2007, 34(1):52-55.
9. Fiorito S, Serafino A, Andreola F, et al. Toxicity and biocompatibility of carbon nanoparticles[J]. J Nanosci Nanotechnol, 2006,6(3):591-599.
10. Bianco A, Kostarelos K, Prato M. Applications of carbon nanotubes in drug delivery[J]. Curr Opin Chem Biol, 2005, 9(6):674-679.
11. 郑春雷, 许军. 国产纳米活性炭在胃癌根治术中的应用[J]. 齐齐哈尔医学院学报, 2008, 29(3):275-277.
12. 雷建, 黄炯强, 胡明, 等. 活性炭示踪指导进展期胃癌手术淋巴结清扫的意义[J]. 岭南现代临床外科,2008,8(3):187-188.
13. 于永扬, 王存, 郑阳春, 等. 比较研究纳米炭示踪剂在低位直肠癌淋巴结清扫及病理检查中的价值[J]. 中国普外基础与临床杂志, 2008, 15(5):358-361.
14. Liu CL, Yang TL, Chen BF. Sentinel lymph node mapping with emulsion of activated carbon particles in patients with pre-mastectomy diagnosis of intraductal carcinoma of the breast[J]. J Chin Med Assoc, 2003, 66(7):406-410.
15. Hagiwara A, Takahashi T, Sawai K, et al. Selective drug delivery to peri-tumoral region and regional lymphatics by local injection of aclarubicin adsorbed on activated carbon particles in patients with breast cancer-a pilot study[J]. Anticancer Drugs, 1997, 8(7):666-670.
16. Hagiwara A, Takahashi T, Lee R, et al.Chemotherapy of carcinomatous peritonitis and carcinomatous pleuritis by using activated charcoal particle adsorbing mitomycin C (MMC-CH)-studies on the clinical trials[J]. Nihon Gan Chiryo Gakkai Shi, 1985,20(9):2144-2153.
17. Hagiwara A, Takahashi T, Sawai K, et al. Lymph nodal vital staining with newer carbon particle suspensions compared with India ink:experimental and clinical observations[J]. Lymphology, 1992, 25(2):84-89.
18. Catarci M, Guadagni S, Zaraca F, et al. Prospective randomized evaluation of preoperative endoscopic vital staining using CH-40 for lymph node dissection in gastric cancer[J]. Ann Surg Oncol, 1998, 5(7):580-584.
19. 关丽梅, 高琼, 赵德安, 等. 纳米炭混悬注射液在颈淋巴结清扫术中应用[J]. 延安大学学报:医学科学版, 2008, 6(4):106-107.
20. 周卫华, 李勇, 周毅, 等. 纳米炭在乳腺癌腋窝淋巴结清扫中的临床应用[J]. 中华老年多器官疾病杂志, 2012, 11(12):930-932.
21. 陈波, 毕唯静, 吕青. 纳米炭混悬注射液在乳腺癌淋巴结清扫及病理检查中的应用[J]. 华西医学, 2009, 24(8):2121-2122.
22. 范林军, 钟玲, 郭德玉, 等. 纳米炭对乳腺癌腋窝淋巴结示踪效果及其安全性的初步研究[J/CD]. 中华乳腺病杂志:电子版, 2010, 4(3):47-50.
23. van Tongeren MJ, Kromhout H, Gardiner K. Trends in levels of inhalable dust exposure, exceedance and overexposure in the European carbon black manufacturing industry[J]. Ann Occup Hyg, 2000, 44(4):271-280.
24. Magrez A, Kasas S, Salicio V, et al. Cellular toxicity of carbonbased nanomaterials[J]. Nano Lett, 2006, 6(6):1121-1125.
25. Ito T, Hagiwara A, Takagi T, et al. Local administration of methotrexate bound to activated carbon particles (MTX-CH) for treating cancers in mice[J]. Anticancer Res, 2003, 23(2B):1401-1404.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Carbon Nanoparticles Dyeing on Axillary Lymph Node Dissection in Modified Radical Mastectomy for Breast Cancer

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