Abstract
The purpose of this study was to evaluate the usefulness of the sonographic characteristics of papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT) for predicting central lymph node metastasis (CLNM). One hundred thirty-three patients who underwent thyroidectomy and central cervical lymph node dissection for PTC with coexistent HT were retrospectively analyzed. All PTCs with HT were preoperatively evaluated by ultrasound (US) regarding their nodular number, size, component, shape, margin, echogenicity, calcification, capsule contact with protrusion, vascularity and contrast enhanced ultrasound (CEUS) parameters. Univariate analysis demonstrated that patients with PTCs with HT and CLNM more frequently had age ≤ 45 years, size > 10 mm, a wider than tall shape, microcalcification, hypo-enhancement and peak intensity index < 1 than those without CLNM (all p<0.05). Binary logistic regression analysis demonstrated that size > 10 mm and CEUS hypo-enhancement were independent characteristics for the presence of CLNM. Our study indicated that preoperative US characteristics could offer help in predicting CLNM in PTCs with coexistent HT.
Highlights
Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignant tumor with a significantly increased incidence in recent years [1,2,3]
The results indicated that size > 10 mm (B= 1.460, OR = 4.306, 95% CI = 2.239-8.278, p=0.000) and contrast enhanced ultrasound (CEUS) hypo-enhancement (B = 1.064, OR =2.899, 95% CI = 1.457-5.767, p=0.002) were independent characteristics for the presence of central lymph node metastasis (CLNM) (Table 3)
On univariate analysis, we found that a wider than taller shape and microcalcification were significantly associated with CLNM of papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT), and the former perhaps contributed to the size of thyroid nodules
Summary
Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignant tumor with a significantly increased incidence in recent years [1,2,3]. Zaydfudim et al identified 30,504 PTC patients (49% > 45 years old) and 2,584 follicular carcinoma patients (55% > 45 years old). The study by these researchers found that cervical lymph node metastases conferred an increased risk of death in all patients with follicular carcinoma and in those patients with PTC who were > 45 years old [8]. Central Lymph Node Metastasis dissection (CCND) improved disease-free survival in patients with intermediate- and high-risk differentiated thyroid carcinoma [9]. According to the American Thyroid Association’s (ATA’s) guidelines, PTC patients with clinically involved central lymph nodes (CLNs) are strongly recommended to undergo therapeutic CCND, while PTC patients with clinically uninvolved CLNs can be considered for prophylactic CCND [10]. Prophylactic CCND can result in overtreatment and lead to nerve injury to the voice, permanent hypoparathyroidism and airway function compromise [7]
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