Mitoxantrone hydrochloride as a novel tracer for lymphatic mapping and complication reduction in thyroid cancer...

To explore the imaging effect of the novel tracer, mitoxantrone hydrochloride injection for tracing (MHI), on cervical lymph nodes during thyroid cancer radical surgery, and its clinical value in assisting the identification of parathyroid glands and recurrent laryngeal nerves.

A prospective randomized controlled study was conducted from January 2022 to March 2025, recruiting 220 thyroid cancer cases at Tianjin First Central Hospital. The CONSORT checklist was followed. Among the participants, 64 were male and 156 were female, with ages ranging from 26 to 69 years. Based on different lymph node tracing methods, the cases were divided into three groups: the MHI lymph node tracing group (MHI group, n = 100), the nanoparticle carbon lymph node tracing group (nanoparticle carbon group, n = 60), and the no lymph node tracer group (control group, n = 60). All patients underwent total thyroidectomy and regional lymph node dissection. General clinical indicators were recorded, and the number of detected lymph nodes, positive metastasis, surgical field clarity, parathyroid gland identification rate, and error excision rate were compared. Serum calcium, parathyroid hormone (PTH) levels, and complications were analyzed at different time points. Statistical analysis was conducted using one-way ANOVA, chi-square test, and two independent sample non-parametric tests.

The MHI group and nanoparticle carbon group had significantly shorter operative times, less cervical drainage volume, and shorter hospital stays compared to the control group (P<0.05 for all). The MHI group had significantly higher staining scores, successful tracing rates, and surgical field clarity scores compared to the nanoparticle carbon group (P<0.05 for all). The MHI group had significantly more lymph nodes removed, a higher number of positive metastases, and a higher parathyroid identification rate compared to both the nanoparticle carbon and control groups. The error excision rate for the parathyroid gland in the MHI and nanoparticle carbon groups was significantly lower than in the control group (P<0.05 for all). On post-operative days 1 and 5, the MHI group had significantly higher serum calcium and PTH levels compared to both the nanoparticle carbon and control groups. However, on post-operative day 1, there was no difference in serum calcium levels between the nanoparticle carbon and control groups (P>0.05), but the PTH level in the nanoparticle carbon group was higher than that in the control group. On post-operative day 5, the nanoparticle carbon group had higher levels of both serum calcium and PTH compared to the control group (P<0.05 for all). On post-operative days 14 and 30, there was no significant difference in serum calcium and PTH levels between the MHI and nanoparticle carbon groups (P>0.05). The MHI and nanoparticle carbon groups had a lower risk of facial numbness, hand and foot convulsions, and dysphagia compared to the control group (P<0.05 for all).

MHI can provide several advantages during radical thyroid cancer surgery, including clear lymph node tracing within the surgical field, enhanced nodal identification and pathological retrieval, and improved surgical visibility and nodal harvest. These advantages can contribute to reduce the risk of injury to the recurrent laryngeal nerve and parathyroid glands.