Analysis of the Relevance of the Ultrasonographic Features of Papillary Thyroid Carcinoma and Cervical Lymph Node Metastasis on Conventional and Contrast-Enhanced Ultrasonography

Abstract

BackgroundPreoperative prediction of lymph node metastases has a major impact on prognosis and recurrence for patients with papillary thyroid carcinoma (PTC). Thyroid ultrasonography is the preferred inspection to guide the appropriate diagnostic procedure.PurposeTo investigate the relationship between PTC and cervical lymph node metastasis (CLNM, including central and lateral LNM) using both conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS).Material and MethodsOur study retrospectively analyzed 379 patients diagnosed with PTC confirmed by surgical pathology at our hospital who underwent US and CEUS examinations from October 2016 to March 2021. Individuals were divided into two groups: the lymph node metastasis group and the nonmetastasis group. The relationship between US and CEUS characteristics of PTC and CLNM was analyzed. Univariate and multivariable logistic regression methods were used to identify the high-risk factors and established a nomogram to predict CLNM in PTC. Furthermore, we explore the frequency of CLNM at each nodal level in PTC patients.ResultsUnivariate analysis indicated that there were significant differences in gender, age, tumor size, microcalcification, contact with the adjacent capsule, multifocality, capsule integrity and enhancement patterns in CEUS between the lymph node metastasis group and the nonmetastasis group (all P<0.05). Multivariate regression analysis showed that tumor size ≥1 cm, age ≤45 years, multifocality, and contact range of the adjacent capsule >50% were independent risk factors for CLNM in PTC, which determined the nomogram. The diagnostic model had an area under the curve (AUC) of 0.756 (95% confidence interval, 0.707-0.805). And calibration plot analysis shown that clinical utility of the nomogram. In 162 PTC patients, the metastatic rates of cervical lymph nodes at levels I-VI were 1.9%, 15.4%, 35.2%, 34.6%, 15.4%, 82.1%, and the difference was statistically significant (P<0.001).ConclusionOur study indicated that the characteristics of PTC on ultrasonography and CEUS can be used to predict CLNM as a useful tool. Preoperative analysis of ultrasonographical features has important value for predicting CLNM in PTCs. The risk of CLNM is greater when tumor size ≥1 cm, age ≤45 years, multifocality, contact range of the adjacent capsule >50% are present.

A model based on clinical data and multi-modal ultrasound for predicting cervical lymph node metastasis in patients with thyroid papillary carcinoma

“…In this study, multifocality was an independent risk factor for predicting CLNM in PTC patients (p = 0.001), which is consistent with a previous study. The OR value of multifocality (OR = 5.274) in this study was significantly higher than previous studies (OR = 1.297-3.235) (14,18,24). The ill-defined, lobulated, or irregular margin of thyroid nodules is generally associated with the irregular growth of the fibrous stroma surrounding the PTC nodules or carcinoma invasion of the surrounding thyroid parenchyma.…”

“…Recently, CEUS has been widely used in differentiating between benign and malignant thyroid nodules and is a promising noninvasive method in the diagnosis of thyroid nodules (11). Several studies have reported that CEUS is useful for the evaluation of biological behavior and CLNM (12)(13)(14), but the enhancement patterns in different studies were inconsistent; thus, it is important to conduct further studies.…”

The clinical significance of thyroid hormone-responsive in thyroid carcinoma and its potential regulatory pathway

“…LNM had a close correlation with an unfavorable prognosis of thyroid cancer. [ 7 ] Some clinical characteristics such as age, gender, and tumor size were identified as biomarkers for predicting LNM, but their functions are limited. [ 34 ] Besides, the alterations of genes including BRAF and TERT have been proved to be associated with LNM, but with contradictory results.…”

“…Accurate prediction of LNM is essential in selecting appropriate treatment methods, improving curative effects, and prolonging the survival time of patients. [ 7 ] Although ultrasound is a convenient and effective method for thyroid disease screening, the efficacy of LNM detection by ultrasound is not ideal and occult LNM might be missed. [ 8 – 10 ] Therefore, it is of great importance to identify new biomarkers for assisting the LNM prediction and improving THCA treatment.…”

Ultrasonography-Guided Thermal Ablation for Cervical Lymph Node Metastasis of Recurrent Papillary Thyroid Carcinoma: Is it Superior to Surgical Resection?

“…Most patients can be cured by almost all thyroidectomy and neck lymph node dissection, and 131 I is used for postoperative ablation of occult microlesions. However, there are still 15-30% of patients with local recurrence and cervical lymph node metastasis (LNM) (1)(2)(3). More than 96% of potential driver mutations in PTC have been identified, which can lead to special histological features or biological behavior (4).…”