Sonographic Characteristics of Papillary Thyroid Carcinoma With Coexistent Hashimoto’s Thyroiditis in the Preoperative Prediction of Central Lymph Node Metastasis

Chen, Sijie; Niu, Chengcheng; Peng, Qinghai; Tang, Kui

doi:10.3389/fendo.2021.556851

Cited by 11 publications

(16 citation statements)

References 25 publications

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“…However, mixed cystic nodules or almost cystic nodules (cystic portion >75%) were excluded from previous studies due to the demand for elastography ( 10 , 17 , 18 ). In our study, 43.5% of PCPTCs showed hypoenhancement, 95.7% of PCPTCs showed heterogeneous enhancement, and 87% of PCPTCs exhibited centrifugal perfusion, which is inconsistent with the CEUS enhancement of solid PTCs reported in previous studies ( 10 , 19 , 20 ). Compared with benign nodular goiters, PCPTCs more frequently had hypoenhancement, heterogeneous enhancement, centrifugal perfusion, PI index <1, TP index ≥1, and AUC index <1 on preoperative CEUS.…”

Section: Discussioncontrasting

confidence: 99%

Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas

et al. 2021

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Partially cystic papillary thyroid carcinomas (PCPTCs) are rarely reported papillary thyroid carcinomas (PTCs) and are usually misdiagnosed as benign nodules. The objective of this study was to provide the various sonographic characteristics of partially cystic thyroid nodules for differentiation between malignant and benign nodules, including those for conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Twenty-three PCPTC patients and 37 nodular goiter patients were enrolled in this study. We evaluated the size, cystic percentage, solid echogenicity, calcification, vascularity, and CEUS parameters for each nodule. The final diagnosis of all patients was confirmed via surgery. Univariate analysis demonstrated that compared with benign nodular goiters, PCPTCs more frequently presented with calcification, hypoechogenicity of the solid part, hypoenhancement, heterogeneous enhancement, centrifugal perfusion, peak intensity index <1, time to peak index ≥1, and area under the curve index <1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that heterogeneous enhancement, centrifugal perfusion, and peak intensity index <1 are independent CEUS characteristics related to malignant PCPTCs and can be used for their differentiation from benign nodular goiters (all p < 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to distinguish malignant PCPTCs from benign thyroid nodules.

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Section: Discussioncontrasting

confidence: 99%

Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas

et al. 2021

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“…Thus, univariate and multivariate analyses were performed to discover more indicators in predicting the CLNM. In accordance with the previous findings (16,24,27), male gender, tumor size (>1 cm), and micro-calcification of the tumor were the risk factors of CLNM during the univariate analysis. Among the PTC patients with HT, the serum TgAb level was significantly higher in the CLNM group (656.95 ± 931.09 vs. 363.49 ± 440.51, p = 0.002) and the serum TPOAb level was lower in the CLNM group (137.70 ± 142.11 vs. 195.26 ± 195.13, p = 0.016).…”

Section: Discussionsupporting

confidence: 91%

“…As a result, how surgeons could preoperatively distinguish the hyperplastic and malignant lymph nodes becomes a pivotal step in guiding the precision surgical protocol in dealing with the CLN. Reviewing recent studies on evaluating the prediction risk factors of CLNM in PTC patients (22)(23)(24), only a few studies were focusing on the PTC patients with the presence of HT condition (11,12,(16)(17)(18). Moreover, a majority of prediction variables were only dependent on the single examination result, like the thyroid function test (18), sonographic characteristics (16), or clinical factors (17).…”

Section: Discussionmentioning

confidence: 99%

“…Reviewing recent studies on evaluating the prediction risk factors of CLNM in PTC patients (22)(23)(24), only a few studies were focusing on the PTC patients with the presence of HT condition (11,12,(16)(17)(18). Moreover, a majority of prediction variables were only dependent on the single examination result, like the thyroid function test (18), sonographic characteristics (16), or clinical factors (17). Although Zhao and colleagues (15) determined multiple preoperative factors in predicting the CLNM in patients with HT, the ultrasound characteristics of CLN seemed to be missed.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, how surgeons could preoperatively distinguish malignant from benign lymph nodes in PTC patients coexisting with HT seems to be an interesting topic in the field of thyroid surgery. Recently, several studies (15)(16)(17)(18) have evaluated the clinicopathological characteristics associated with CLNM in patients with HT. To the best of our knowledge, none of them measured the ultrasonic characteristics of the CLN in this population.…”

Section: Introductionmentioning

confidence: 99%

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Preoperatively Predicting the Central Lymph Node Metastasis for Papillary Thyroid Cancer Patients With Hashimoto’s Thyroiditis

et al. 2021

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BackgroundThe preoperative distinguishment of lymph nodes with reactive hyperplasia or tumor metastasis plays a pivotal role in guiding the surgical extension for papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT), especially in terms of the central lymph node (CLN) dissection. We aim to identify the preparative risk factors for CLN metastasis in PTC patients concurrent with HT.Materials and MethodsWe retrospectively reviewed and analyzed the data including the basic information, preoperative sonographic characteristics, and thyroid function of consecutive PTC patients with HT in our medical center between Jan 2019 and Apr 2021. The Chi-square and Fisher’s exact tests were used for comparison of qualitative variables among patients with or without CLN metastasis. Univariate and multivariate logistic regression analyses were used to determine the risk factors for CLN metastasis. The nomogram was constructed and further evaluated by two cohorts produced by 1,000 resampling bootstrap analysis.ResultsA total of 98 in 214 (45.8%) PTC patients were identified with CLN metastasis. In multivariate analysis, four variables including high serum thyroglobulin antibody (TgAb) level (>1,150 IU/ml), lower tumor location, irregular margin of CLN, and micro-calcification in the CLN were determined to be significantly associated with the CLN metastasis in PTC patients with HT. An individualized nomogram was consequently established with a favorable C-index of 0.815 and verified via two internal validation cohorts.ConclusionsOur results indicated that preoperatively sonographic characteristics of the tumor and lymph node condition combined with serum TgAb level can significantly predict the CLN in PTC patients with HT and the novel nomogram may further help surgeons to manage the CLN in this subpopulation.

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Diagnostic value of contrast-enhanced ultrasonography in the preoperative evaluation of lymph node metastasis in papillary thyroid carcinoma: a single-center retrospective study

Yang,

Wang,

Tao

et al. 2023

BMC Surg

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Background Contrast-enhanced ultrasound (CEUS) has been recently used for the assessment of cervical lymph node metastasis (LNM) to guide surgical operation in patients with papillary thyroid carcinoma (PTC). However, the specificity and sensitivity of CEUS reported from previous studies are not consistent. The objective of this study was to evaluate the diagnostic value of CEUS for the metastasis of cervical lymph nodes in PTC patients based on data from one regional central hospital. Methods The diagnostic value of CEUS in preoperative LNM of PTC patients was concluded by comparing the results of CEUS on lymph node status with postoperative pathology examination. In addition, this study conducted hierarchical analysis of PTC patients to explore whether tumor size, different lymph node regions, and Hashimoto’s thyroiditis influence the assessment of CEUS. Results This research study ultimately enrolled 965 PTC patients, including 266 males and 699 females with a mean age of 42.27 ± 11.34 years. A total of 527 patients were considered clinical-node negative, and 438 were clinical-node positive before surgery. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS in the assessment of LNM in PTC patients were 56.00%, 71.00%, 57.06%, 69.76% and 62.59%, respectively. For central and lateral lymph nodes, the accuracy of CEUS in PTC patients was 49.43% and 54.30%, respectively. In addition, it was shown that the accuracy of CEUS in PTC patients with Hashimoto’s thyroiditis (HT) slightly decreased to 58.44%, and the accuracy of CEUS in PTC patients with non-HT in turn increased to 64.17%. The accuracy of CEUS in non-papillary thyroid microcarcinoma (PTMC) and PTMC patients was 65.68% and 61.24%, respectively. The accuracy of CEUS in predicting central LNM was significantly different between PTC patients with or without HT (P < 0.001) in this study but not for lateral lymph nodes (P = 0.114). Conclusion The accuracy of CEUS in the assessment of LNM in PTC is not consistently satisfactory, especially for central lymph nodes, small tumor diameters, or patients with HT. More diagnostic technologies for abnormal lymph nodes should be considered in PTC patients.

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Sonographic Characteristics of Papillary Thyroid Carcinoma With Coexistent Hashimoto’s Thyroiditis in the Preoperative Prediction of Central Lymph Node Metastasis

Cited by 11 publications

References 25 publications

Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas

Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas

Preoperatively Predicting the Central Lymph Node Metastasis for Papillary Thyroid Cancer Patients With Hashimoto’s Thyroiditis

Diagnostic value of contrast-enhanced ultrasonography in the preoperative evaluation of lymph node metastasis in papillary thyroid carcinoma: a single-center retrospective study

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