Clinical Study of Ultrasonographic Risk Factors for Central Lymph Node Metastasis of Papillary Thyroid Carcinoma

Abstract

BackgroundThyroid cancer is the most common malignancy of the endocrine system worldwide. Papillary thyroid cancer (PTC) is the most common pathologic type. The preoperative diagnosis of PTC and central lymph node metastasis (CLNM) or metastatic tendency is of great clinical significance to the diagnosis, treatment and prognosis of these patients. This study was conducted to investigate the correlation between ultrasound features and central CLNM of PTC.MethodsThis study retrospectively analyzed patients who underwent PTC surgery and central lymph node dissection in the Department of Surgery, Beijing Tiantan Hospital, from January 2019 to February 2020. According to the inclusion and exclusion criteria, data from 136 patients were ultimately included, and the clinical and ultrasonic data of the patients were analyzed by multivariate regression to evaluate the correlation among grayscale ultrasound (US), superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) features of thyroid nodules and CLNM of PTCs.ResultsThe multivariate analysis showed that tumor size, multifocality, microcalcification characteristics, SMI vascularization, and CEUS evaluation of contact with the adjacent capsule were correlated with PTC metastasis (P=0.008, P=0.001, P=0.028, P=0.041, and P< 0.001, respectively). Comparisons of the area under the ROC curves revealed that the area under the ROC curve of the degree of nodular invasion into the thyroid capsule was the largest (AUC: 0.754). The sensitivity and specificity for evaluating CLNM of PTC were 67.7% and 83.1%, respectively.ConclusionsUltrasound characteristics of the following features are associated with a high risk of lymph node metastasis in PTCs: maximum diameter of nodules ≥1 cm, multifocality, ≥5 microcalcifications, abundant blood flow of SMI in nodules and nodule contact with the thyroid capsule ≥25% under CEUS. Ultrasound has clinical value in the preoperative evaluation of CLNM of PTCs.

A Clinical Predictive Model of Central Lymph Node Metastases in Papillary Thyroid Carcinoma

“…Multifocality was defined as more than one lesion observed in cervical ultrasound and pathologically confirmed as PTC. Tumor size was the maximum diameter of the suspected nodule under ultrasound that was pathologically confirmed as PTC ( 8 ). All patients had a review of the cervical ultrasound with the same sonographer preoperatively.…”

“…When CLNM is found in patients after surgery, a second operation is often necessary. Extra surgery not only is difficult but also increases the risk of complications ( 8 ). Prophylactic lymph node dissection of the central cervical facilitates accurate clinical staging ( 9 ).…”

Horizontes atuais da ultrassonografia na investigação de nódulos e câncer de tireoide

“…A partir disso, pôde-se observar que o fluxo sanguíneo abundante que supre um NT é indicativo de alto risco de metástase linfonodal, compondo uma ferramenta muito útil na avaliação terapêutica. (Guang, et al 2021).…”

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

“…The enhancement of residual areas in lymph nodes is considered to be incomplete ablation. The edge of some burned areas is not obvious during routine ultrasonography detection, but the edge can be clearly displayed with the help of CEUS (37)(38)(39). Therefore, CEUS plays an important role in monitoring ablation efficacy and postoperative follow-up (40)(41).…”