Objective To investigate the guiding value and safety of three tracers in identifying sentinel lymph nodes (SLN) for lymph node dissection during radical surgery for early-stage cervical cancer.

Methods A total of 114 patients with early-stage cervical cancer from January 2021 to November 2022 were selected as the study subjects. They were randomly divided into methylene blue group, nano-carbon group, and indocyanine green (ICG) group according to the random number table method, with 38 cases in each group. All three groups underwent radical surgery. The methylene blue group used methylene blue for SLN identification during surgery, the nano-carbon group used nano-carbon, and the ICG group used ICG fluorescence imaging. The SLN identification status and surgery-related indicators were compared among the three groups. Trauma indicatorsserum cortisol (Cor), epinephrine (E), adrenocorticotropic hormone (ACTH), and C-reactive protein (CRP)were compared among the three groups before surgery and on 1, 3, and 7 d after surgery. Tumor markerscarcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen 125 (CA125), and carbohydrate antigen 199 (CA199)were compared among the three groups before surgery and 3 months after surgery. The complication rates and recurrence rates were also compared among the three groups.

Results The tracing time in the ICG group was shorter than that in the nano-carbon and methylene blue groups, and the tracing time in the nano-carbon group was shorter than that in the methylene blue group (P < 0.05). In terms of the success rate and number of identified SLN, the nano-carbon group was higher than the ICG and methylene blue groups, and the ICG group was higher than the methylene blue group (P < 0.05). Regarding the SLN resection time, the nano-carbon group had the shortest time, and the methylene blue group had the longest time, with a statistically significant difference (P < 0.05). The serum levels of CEA, AFP, CA125, and CA199 in the three groups decreased significantly 3 months after surgery compared with those before surgery (P < 0.05). The within-group effects of one-way repeated-measures analysis of variance showed that the serum levels of Cor, E, ACTH, and CRP in the three groups increased first and then decreased on 1, 3, and 7 d, with statistically significant differences (P < 0.05). There was no statistically significant difference in the complication rates among the three groups (P>0.05). During the 1-year follow-up, 2 patients were lost during follow-up in the nano-carbon group, 1 in the ICG group, and 2 in the methylene blue group. No recurrence was found in any of the three groups.

Conclusion Among the three tracers, ICG has the shortest time for tracing SLN during radical surgery for early-stage cervical cancer. Nano-carbon exhibits relatively high application value compared with the other two tracers, and it guides the scope of lymph node dissection and demonstrates certain safety.