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.
Highlights
Thyroid carcinoma is one of the most common malignancies of the endocrine system [1]
162 patients were in the lymph node metastasis group, including 37 males and 125 females, with an average age of 42.04 ± 11.51 years
Referring to the relevant literature [11, 12], thyroid carcinoma with a tumor size less than 1 cm was defined as papillary thyroid microcarcinoma, so we divided the tumor size into two groups with a cutoff of 1 cm
Summary
Thyroid carcinoma is one of the most common malignancies of the endocrine system [1]. The incidence of thyroid carcinoma has been increasing in recent years [2]. The presence of cervical lymph node metastasis (CLNM) is well associated with an increased risk of recurrence and affects the postoperative survival rate in select patient populations [4, 5]. The early diagnosis of lymph node metastasis can guide clinicians to perform aggressive therapeutic neck dissection. It can improve the surgical management of patients with clinical lymph node-negative papillary thyroid carcinoma to avoid additional prophylactic cervical lymph node dissection and reduce the risks of surgery [6]. Preoperative prediction of lymph node metastases has a major impact on prognosis and recurrence for patients with papillary thyroid carcinoma (PTC). Purpose: To 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)
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