Bai BJ, Xu DY, Chen L, Ding LY, Song ZF. Clinical value of carbon nanoparticles in identifying metastatic lymph nodes in colorectal cancer: A single-center observational study. World J Gastrointest Oncol 2026; 18(8): 122077 [DOI: 10.4251/wjgo.122077]
Corresponding Author of This Article
Zhang-Fa Song, MD, Doctor, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qinchun East Road, Hangzhou 310016, Zhejiang Province, China. songzhangfa@zju.edu.cn
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Oncology
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Bai BJ, Xu DY, Chen L, Ding LY, Song ZF. Clinical value of carbon nanoparticles in identifying metastatic lymph nodes in colorectal cancer: A single-center observational study. World J Gastrointest Oncol 2026; 18(8): 122077 [DOI: 10.4251/wjgo.122077]
World J Gastrointest Oncol. Aug 15, 2026; 18(8): 122077 Published online Aug 15, 2026. doi: 10.4251/wjgo.122077
Clinical value of carbon nanoparticles in identifying metastatic lymph nodes in colorectal cancer: A single-center observational study
Bing-Jun Bai, Deng-Yong Xu, Li Chen, Li-Ya Ding, Zhang-Fa Song
Bing-Jun Bai, Deng-Yong Xu, Li Chen, Zhang-Fa Song, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Bing-Jun Bai, Zhang-Fa Song, Zhejiang Key Laboratory of Biological Treatment, Hangzhou 310016, Zhejiang Province, China
Bing-Jun Bai, Zhang-Fa Song, Key Laboratory of Integrated Traditional Chinese and Western Medicine Research on Anorectal Diseases of Zhejiang Province, Hangzhou 310016, Zhejiang Province, China
Li-Ya Ding, Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Co-first authors: Bing-Jun Bai and Deng-Yong Xu.
Author contributions: Bai BJ and Xu DY were responsible for the study conception and design, as they are co-first authors; Chen L analyzed the data and wrote the manuscript; Ding LY and Song ZF critically revised the article for important intellectual content; all the authors reviewed and approved the final version to be published.
AI contribution statement: No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions.
Institutional review board statement: The study was approved by the Ethics Committee of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University (No. 2024-0110).
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at songzhangfa@zju.edu.cn. Consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
Corresponding author: Zhang-Fa Song, MD, Doctor, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qinchun East Road, Hangzhou 310016, Zhejiang Province, China. songzhangfa@zju.edu.cn
Received: April 13, 2026 Revised: June 7, 2026 Accepted: June 17, 2026 Published online: August 15, 2026 Processing time: 118 Days and 6.1 Hours
Abstract
BACKGROUND
Carbon nanoparticles (CNPs) are increasingly utilized for tracing lymph nodes (LNs) in colorectal cancer (CRC) surgeries. However, the relationship between CNP-stained LNs and metastatic LNs remains unclear.
AIM
To evaluate the clinical utility of CNPs in identifying metastatic LNs in CRC.
METHODS
A single-center observational study was conducted, enrolling patients between January 2022 and March 2024. CNP suspension was injected preoperatively. All patients underwent radical resection with main (D3) LN dissection. Regional LNs and selected non-regional LNs were harvested following clinical guidelines. Stained and non-stained LNs were identified by microscopic examination.
RESULTS
A total of 146 CRC patients were enrolled, yielding 3212 regional LNs. Of these, 2789 (86.8%) were stained with CNPs and 423 (13.2%) were non-stained, predominantly located in the pericolic/perirectal region (79.7%). The metastatic rate in stained LNs was 2.8%, significantly lower than in non-stained LNs (13.9%, P < 0.001). Across all T stages, non-stained LNs had a significantly higher proportion of metastases compared to stained LNs (P < 0.001). Additionally, left-sided colon cancers showed a higher proportion of metastatic LNs among non-stained LNs than among stained LNs (P < 0.001).
CONCLUSION
CNP staining effectively traces LNs; however, metastatic involvement is more likely in non-stained LNs, particularly in left-sided colon cancer.
Core Tip: The clinical value of carbon nanoparticles (CNPs) staining for identifying metastatic lymph nodes (LNs) in colorectal cancer remains unclear. Our study demonstrates that while CNPs staining can effectively trace LNs, tumor metastasis is more frequently observed in non-stained LNs.
