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.	瞿歡, 張亞男, 陳衛東. 納米炭在乳腺癌前哨淋巴結示蹤的實驗研究[J]. 中國普通外科雜志, 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.	張波, 陳佳平, 胡建昆. 納米炭混懸注射液檢測胃癌前哨淋巴結的臨床研究[J]. 華西醫學, 2006, 21(3):514-515.
8.	張李, 梁寒. 納米活性炭的特性及其在胃癌治療中的應用[J]. 國際腫瘤學雜志, 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.	鄭春雷, 許軍. 國產納米活性炭在胃癌根治術中的應用[J]. 齊齊哈爾醫學院學報, 2008, 29(3):275-277.
12.	雷建, 黃炯強, 胡明, 等. 活性炭示蹤指導進展期胃癌手術淋巴結清掃的意義[J]. 嶺南現代臨床外科,2008,8(3):187-188.
13.	于永揚, 王存, 鄭陽春, 等. 比較研究納米炭示蹤劑在低位直腸癌淋巴結清掃及病理檢查中的價值[J]. 中國普外基礎與臨床雜志, 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.	關麗梅, 高瓊, 趙德安, 等. 納米炭混懸注射液在頸淋巴結清掃術中應用[J]. 延安大學學報:醫學科學版, 2008, 6(4):106-107.
20.	周衛華, 李勇, 周毅, 等. 納米炭在乳腺癌腋窩淋巴結清掃中的臨床應用[J]. 中華老年多器官疾病雜志, 2012, 11(12):930-932.
21.	陳波, 畢唯靜, 呂青. 納米炭混懸注射液在乳腺癌淋巴結清掃及病理檢查中的應用[J]. 華西醫學, 2009, 24(8):2121-2122.
22.	范林軍, 鐘玲, 郭德玉, 等. 納米炭對乳腺癌腋窩淋巴結示蹤效果及其安全性的初步研究[J/CD]. 中華乳腺病雜志:電子版, 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. 瞿歡, 張亞男, 陳衛東. 納米炭在乳腺癌前哨淋巴結示蹤的實驗研究[J]. 中國普通外科雜志, 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. 張波, 陳佳平, 胡建昆. 納米炭混懸注射液檢測胃癌前哨淋巴結的臨床研究[J]. 華西醫學, 2006, 21(3):514-515.
8. 張李, 梁寒. 納米活性炭的特性及其在胃癌治療中的應用[J]. 國際腫瘤學雜志, 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. 鄭春雷, 許軍. 國產納米活性炭在胃癌根治術中的應用[J]. 齊齊哈爾醫學院學報, 2008, 29(3):275-277.
12. 雷建, 黃炯強, 胡明, 等. 活性炭示蹤指導進展期胃癌手術淋巴結清掃的意義[J]. 嶺南現代臨床外科,2008,8(3):187-188.
13. 于永揚, 王存, 鄭陽春, 等. 比較研究納米炭示蹤劑在低位直腸癌淋巴結清掃及病理檢查中的價值[J]. 中國普外基礎與臨床雜志, 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. 關麗梅, 高瓊, 趙德安, 等. 納米炭混懸注射液在頸淋巴結清掃術中應用[J]. 延安大學學報:醫學科學版, 2008, 6(4):106-107.
20. 周衛華, 李勇, 周毅, 等. 納米炭在乳腺癌腋窩淋巴結清掃中的臨床應用[J]. 中華老年多器官疾病雜志, 2012, 11(12):930-932.
21. 陳波, 畢唯靜, 呂青. 納米炭混懸注射液在乳腺癌淋巴結清掃及病理檢查中的應用[J]. 華西醫學, 2009, 24(8):2121-2122.
22. 范林軍, 鐘玲, 郭德玉, 等. 納米炭對乳腺癌腋窩淋巴結示蹤效果及其安全性的初步研究[J/CD]. 中華乳腺病雜志:電子版, 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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