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.
Highlights
Thyroid cancer is the most common malignancy of the endocrine system worldwide
The inclusion criteria were as follows: 1 age between 20 and 80, male and female; 2 At least one suspected malignant thyroid nodule (ACR TI-RADS 4 or TI-RADS 5) [14] was found by ultrasound examination within one month before surgery, which was clinically diagnosed as Papillary thyroid cancer (PTC) and confirmed by postoperative pathology of thyroidectomy at our hospital; 3 patients undergoing thyroid surgery for the first time; 4 patients who have no contraindications to SonoVue, are in good mental state and can cooperate with the examination; 5 patients who agree to participate in the study
By the end of follow-up, all the patients were healthy and alive without distant metastasis or death caused by tumors
Summary
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. Papillary thyroid cancer (PTC) is the most common pathologic type, accounting for 80 - 90% of thyroid cancer [3]. When central lymph node metastasis (CLNM) is found in patients after surgery, a second operation is often necessary, increasing the difficulty of surgery and the risk of complications such as recurrent laryngeal nerve injury and reduced parathyroid function; CLNM is an important risk factor for PTC recurrence and a reduced survival rate [8]
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