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After being injected into the surrounding tissue of the tumor, CNSI is swallowed by macrophages and quickly enters lymphatic vessels but does not enter blood vessels. 10 - 12ĬNSI 13, 14 is different from other tracers and has a diameter of 150 nm.
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Carbon nanoparticle suspension injection (CNSI) has been found to provide surgeons with effective visualization of the lymphatic anatomy and sentinel LNs. In recent years, various dyes and tracers have been used clinically to observe LN drainage from primary tumors. 7 Moreover, sufficient dissection of LNs from the resected specimen is critical for the evaluation of nodal status. 4 - 6 Unvisualized LNs are difficult to identify in adipose tissue, and standard lymphadenectomy bears the risk of incomplete resection of potentially metastatic LNs. Adequate lymph node (LN) dissection plays an important role in gastrectomy, and adequate lymphadenectomy is an important factor for accurate postoperative pathological staging and improved prognosis. Gastrectomy is the only possible cure for advanced GC. The incidence and mortality of gastric cancer (GC) have decreased however, it remains one of the most common cancers in the world, ranking as the fifth most commonly diagnosed cancer after lung cancer, breast cancer, colorectal cancer, and prostate cancer and ranking second for mortality. Carbon nanoparticle suspension-guided lymphography may be an alternative to conventional systematic lymphadenectomy for distal gastrectomy. For black-stained LN stations, the sensitivity was 97.8% (95% CI, 91.6%-99.6%), specificity was 38.1% (95% CI, 34.2%-42.3%), positive predictive value was 20.1% (95% CI, 16.6%-24.2%), and negative predictive value was 99.1% (95% CI, 96.4%-99.8%) for the black-stained LNs, sensitivity was 97.6% (95% CI, 95.3%-98.8%), specificity was 35.4% (95% CI, 33.9%-36.8%), positive predictive value was 11.6% (95% CI, 10.5%-12.8%), and negative predictive value was 99.4% (95% CI, 98.8%-99.7%).Ĭonclusions and Relevance These findings suggest that CNSI was associated with facilitating the dissection of all positive LNs, which could improve surgical quality. In the CNSI group, the mean (SD) number of LNs detected at black-stained LN stations was significantly higher than that at nonstained LN stations (9.2 LNs per station vs 3.5 LNs per station P < .001). The mean (SD) number of LNs detected in the CNSI group was 59.6 (21.4), which was significantly higher than that in the conventional group (30.0 LNs P < .001). Results A total of 312 consecutive patients (mean age, 56.7 years 216 men) who underwent distal gastrectomy were enrolled, including 78 patients in the CNSI group, and another 78 patients determined from 1:1 propensity score matching, making an overall cohort size of 156 patients. Black-stained LNs and nonblack-stained LNs were examined separately in the CNSI group.
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Gastrectomy with systematic D1+ (ie, stations 1, 3, 4sb, 4d, 5, 6, and 7) or D2 (ie, all D1 stations, plus 8a, 9, 11p, and 12a) lymphadenectomy was performed. Main Outcomes and Measures The main outcome was the number of LNs detected. Statistical analysis was performed from May to July 2021.Įxposure CNSI was peritumorally injected under an endoscope 1 day before surgery in the CNSI group, and the conventional group did not receive any treatment before surgery.
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The mean number of LNs detected was compared between groups, and the diagnostic role of CNSI was analyzed in the CNSI group. Patients were divided into the CNSI group and conventional group after 1:1 propensity matching analysis. Data from a cohort of 1225 patients at the Fourth Hospital of Hebei Medical University (Shijiazhuang, China) from November 2019 to February 2021 were analyzed. Objective To compare the number of lymph nodes identified in patients with gastric cancer receiving a CNSI vs no injection.ĭesign, Setting, and Participants This is a retrospective cohort study including patients with clinical T1 to T4 disease who underwent laparoscopic or robotic distal gastrectomy. The tracing and diagnostic value of carbon nanoparticle suspension lymphography-guided distal gastrectomy for gastric cancer has not been thoroughly reported. Importance Carbon nanoparticle suspension injection (CNSI) can be used to visualize lymph node (LN) drainage in gastric cancer. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.