Thyroid Parenchyma Microcalcifications on Ultrasound for Predicting Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Prospective Multicenter Study in China

Liu, Juan; Jia, Xiaohong; Gu, Ying; Xia, Chen; Guan, Lina; Yan, Jiping; Zhao, Hong; Zhou, Na; Dong, Yijie; Zhan, Wei; Luo, Xiaomao; Zhou, Jianqiao

doi:10.3389/fonc.2021.609075

Cited by 11 publications

(10 citation statements)

References 45 publications

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“…Our study showed that microcalcifications in thyroid nodules were significantly different between the metastasis and nonmetastasis groups ( P <0.05), which is consistent with the findings of previous studies ( 19 ). Microcalcification occurs when calcium salt deposits form due to excessive tumor tissue proliferation, and it is commonly used as a potential malignant feature on ultrasonography ( 20 ).…”

Section: Discussionsupporting

confidence: 93%

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

Tian

Liu

et al. 2021

Front. Oncol.

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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.

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Section: Discussionsupporting

confidence: 93%

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

Tian

Liu

et al. 2021

Front. Oncol.

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“…Incidence rates were not significantly different regarding sex and location. Similar to the reported papillary thyroid gland in the literature, the age of onset is approximately 36 years (11)(12)(13)(14). The maximum diameter of the mass in this group of patients was approximately 2 cm, which is larger than that reported in the literature on papillary thyroid carcinoma (12)(13)(14).…”

Section: Discussionsupporting

confidence: 85%

“…Similar to the reported papillary thyroid gland in the literature, the age of onset is approximately 36 years (11)(12)(13)(14). The maximum diameter of the mass in this group of patients was approximately 2 cm, which is larger than that reported in the literature on papillary thyroid carcinoma (12)(13)(14). This group of papillary carcinomas are speculated to have a rich blood supply and are easier to grow up.…”

Section: Discussionsupporting

confidence: 85%

The spoke wheel color Doppler blood flow signal is a specific sign of papillary thyroid carcinoma

Xue

Li²,

Deng³

et al. 2022

Front. Endocrinol.

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BackgroundPapillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Grayscale ultrasound (US) is the main method used to diagnose benign and malignant thyroid nodules, While color doppler blood flow imaging(CDFI) is not widely recognized when diagnosing thyroid cancer.MethodsThis study used a retrospective analysis. The study included 36 spoked wheel blood flow nodules detected by CDFI in 37,372 patients in five hospitals from January 2020 to June 2021. All thyroid nodules were examined histologically after ultrasound-guided fine needle biopsy or following surgical resection. The value of color doppler in diagnosing papillary thyroid carcinoma was evaluated based on pathological results.ResultsAmong 36 thyroid nodules, only 6 were highly suspected of being malignant on grayscale ultrasound (classified as 5, according to ACR TI-RADS). However, these 36 thyroid nodules showed spoke wheel blood flow signal distribution on CDFI. If the spoke wheel blood flow signal is used to diagnose papillary thyroid cancer, then the diagnostic accuracy of this group of papillary thyroid cancers can reach 100%, which is significantly higher than the accuracy of grayscale ultrasound diagnosis, and the difference is statistically significant (p<0.05).ConclusionsThe results of this study found that spoke wheel blood flow sign on CDFI can be used to diagnose PTC. PTC with spoke wheel blood flow have benign characteristics on gray-scale ultrasound, which is easy to be misdiagnosed.

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“…The optimal cut-off value of size for the prediction of cN1 was 1.4cm, whereas that for the prediction of microscopic pN1 was 1.0cm. Previous studies ( 31 , 32 , 37 ) found that young age was connected with LNMs. This conclusion was demonstrated in our study, although Jianming Li et al.…”

Section: Discussionmentioning

confidence: 79%

“…In these studies, the LNMs included both cN1 and microscopic pN1. It has been reported that calcification was an independent predictor of LNMs for patients with PTC ( 31 – 33 ). In our study, calcification was associated with cN1, but not with microscopic pN1.…”

Section: Discussionmentioning

confidence: 96%

Ultrasound and Contrast-Enhanced Ultrasound Characteristics Associated With cN1 and Microscopic pN1 in Papillary Thyroid Carcinoma

et al. 2022

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ObjectivesLymph node metastases (LNMs) could be stratified into clinical N1 (cN1) and microscopic pN1 (pathological N1), which bear different biological behavior and prognosis. Our study aimed to investigate the associations between LNMs and primary tumor’s US (ultrasound) and CEUS (contrast-enhanced ultrasound) characteristics based on the stratification of LNMs into cN1 and microscopic pN1 in papillary thyroid carcinoma (PTC).MethodsFrom August 2019 to May 2020, 444 consecutive PTC patients who underwent preoperative neck US and CEUS evaluation were included. According to regional lymph node status, the patients were classified into cN1 group versus cN0 (clinical N0) group and microscopic pN1 group versus pN0 (pathological N0) group. For multiple PTCs, the largest one was selected for the evaluation of US, CEUS and clinical features. Univariate and multivariate analyses were performed to determine independent predictors of cN1 and microscopic pN1.Results85 cN1 versus 359 cN0 patients and 117 microscopic pN1 versus 242 pN0 patients were analyzed. Multivariate logistic regression analysis showed that <55-years-old (OR: 2.56 (1.08–6.04), male [OR: 2.18 (1.22–3.91)], large size [OR: 2.59 (1.71–3.92)], calcification [OR: 3.88 (1.58–9.51)], and hyper-enhancement [OR: 2.78 (1.22–6.30)] were independent risk factors of cN1, while <55-years-old [OR: 1.91 (1.04–3.51)], large size [OR: 1.56 (1.003–2.42)], multifocality [OR: 1.67 (1.04–2.66)] were independent risk factors of microscopic pN1.ConclusionsFor patients with PTC, young age, male, large size, calcification, and hyper-enhancement were independent predictors of cN1, while young age, large size and multifocality were independent predictors of microscopic pN1.

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Thyroid Parenchyma Microcalcifications on Ultrasound for Predicting Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Prospective Multicenter Study in China

Cited by 11 publications

References 45 publications

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

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

The spoke wheel color Doppler blood flow signal is a specific sign of papillary thyroid carcinoma

Ultrasound and Contrast-Enhanced Ultrasound Characteristics Associated With cN1 and Microscopic pN1 in Papillary Thyroid Carcinoma

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