Central Lymph Research Articles

Risk factors for central neck lymph node metastasis in patients with macro and micropapillary thyroid carcinoma

Risk factors for central neck lymph node metastasis in patients with macro and micropapillary thyroid carcinoma

Ultrasound-based radiomics analysis for preoperative prediction of central and lateral cervical lymph node metastasis in papillary thyroid carcinoma: a multi-institutional study

BackgroundAn accurate preoperative assessment of cervical lymph node metastasis (LNM) is important for choosing an optimal therapeutic strategy for papillary thyroid carcinoma (PTC) patients. This study aimed to develop and validate two ultrasound (US) nomograms for the individual prediction of central and lateral compartment LNM in patients with PTC.MethodsA total of 720 PTC patients from 3 institutions were enrolled in this study. They were categorized into a primary cohort, an internal validation, and two external validation cohorts. Radiomics features were extracted from conventional US images. LASSO regression was used to select optimized features to construct the radiomics signature. Two nomograms integrating independent clinical variables and radiomics signature were established with multivariate logistic regression. The performance of the nomograms was assessed with regard to discrimination, calibration, and clinical usefulness.ResultsThe radiomics scores were significantly higher in patients with central/lateral LNM. A radiomics nomogram indicated good discrimination for central compartment LNM, with an area under the curve (AUC) of 0.875 in the training set, the corresponding value in the validation sets were 0.856, 0.870 and 0.870, respectively. Another nomogram for predicting lateral LNM also demonstrated good performance with an AUC of 0.938 and 0.905 in the training and internal validation cohorts, respectively. The AUC for the two external validation cohorts were 0.881 and 0.903, respectively. The clinical utility of the nomograms was confirmed by the decision curve analysis.ConclusionThe nomograms proposed here have favorable performance for preoperatively predicting cervical LNM, hold promise for optimizing the personalized treatment, and might greatly facilitate the decision-making in clinical practice.

Extension of Prophylactic Surgery in Medullary Thyroid Carcinoma. Differences Between Sporadic and Hereditary Tumours According to Calcitonin Levels and Lymph Node Involvement

IntroductionCurrently, there is no consensus on the indication of prophylactic surgery of the nodal compartments in the treatment of medullary thyroid carcinoma (MTC). The aim of our study was to perform a correlation study between preoperative calcitonin (basalCT) values and lymph node involvement to establish a criterion on which to base prophylactic surgery in these patients.Material and MethodsWe conducted an observational, retrospective and multicentre study with 29 hospitals. Patients over 18 years of age with a diagnosis of MTC with a pre-surgical calcitonin registry were included. The minimum surgery in all patients had to have been total thyroidectomy (TT) with central compartment lymph node dissection (CCLND). Receiver operating characteristic (ROC) curve analysis was used to establish basalCT cut-off values as predictors of postoperative lymph node involvement.ResultsA total of 244 patients were included. Baseline calcitonin (basalCT) was a good predictor of nodal involvement (AUC 0.718 and 95%CI 0.66–0.978). Heritability was identified as a preoperative factor correlated with baseline tumour CT values (p = 0.000). With a probability of lymph node involvement below 10%, new cut-off points were established. A prophylactic bilateral lateral lymph node dissection in sporadic tumours should be performed at a basalCT > 600 pg/mL; in the case of RET-mutated tumours this value would be 200 pg/mL.ConclusionThe baseline CT value is a good predictor of postoperative lymph node involvement in MTC, however, cut-off points should depent on the hereditary nature of the tumour.

Exploring Central Vascular Anatomy With Axial Computed Tomography During Surgery for Sigmoid Colon and Rectal Cancer: New Insights Into the Anatomical Relationship Between the Inferior Mesenteric Artery and the Duodenum

Background: In some individuals, the inferior mesenteric artery (IMA) originates from the aorta above the lower edge of the duodenum. This anatomical feature has rarely been reported but may be important in guiding central vascular ligation and lymph node dissection in colorectal surgery. This retrospective study aimed to explore the anatomical relationship between the IMA and the duodenum and evaluate its potential impact on the efficacy of D3 lymph node dissection.Methods: A total of 439 patients undergoing laparoscopic colorectal surgery at the Department of General Surgery, Qilu Hospital of Shandong University, were retrospectively enrolled. Clinical data from axial computed tomography (CT) scans were collected and analysed.Results: In 27.69% of patients, the IMA originated at or above the lower edge of the duodenum (median distance: −8 mm). These patients were characterised by a shorter superior mesenteric artery to aortic bifurcation distance, a superiorly located IMA origin, and a greater distance between the IMA and both the left colic artery and the inferior mesenteric vein. The number of harvested lymph nodes was not significantly associated with the distance between the IMA and the duodenum (P = 0.858).Conclusions: Preoperative axial CT scans can provide a great deal of information regarding central vascular anatomy in the context of sigmoid colon and rectal cancer surgery. Nearly one-third of patients have the IMA originating at or above the duodenum. Whether this anatomical feature affects D3 lymph node dissection warrants further investigation.

Utility and significance of clinical risk factor scoring model in predicting central compartment lymph node metastasis (CLNM) in patients with papillary thyroid cancer (PTC)

ABSTRACTObjectives:To establish and discuss the significance of a clinical risk factor scoring model in predicting central compartment lymph node metastasis (CLNM) (level VI) in patients with papillary thyroid cancer (PTC).Methods:A retrospective analysis was performed on 412 patients who underwent surgical treatment for PTC who were admitted to the Second Hospital of Hebei Medical University between July 2016 and May 2017, with the patients being divided into a CLNM group and a non-metastasis (NM) group. Risk factors such as sex, age, tumor diameter, capsular invasion, multifocality, and tumor location were recorded for scoring via maximum likelihood estimation (MLE)-based discriminant analysis. The scoring model was used for prospective analysis of CLNM in another 104 patients. Besides, the discriminant function that was developed using the risk factors based on the retrospective data derived from the 412 patients was evaluated by plugging the retrospective data in for specified variables, with a higher score indicating a greater risk of developing CLNM. Clinical diagnosis of CLNM was based on postoperative paraffin section pathology, which was adopted as the criterion to assess discriminative accuracy in the prospective and retrospective groups.Results:The discriminative accuracy of the scoring model was 71.8% in the retrospective group and 72.2% in the prospective group.Conclusions:The scoring model enables simplified, quantitative analysis of CLNM in PTC patients. The scoring model has clinical significance in that it provides a basis for the choice of operation, personalized postoperative treatment, and prognosis of PTC.

"Number of Foci Increases Risk of Central Compartment Lymph Node Metastasis in Papillary Thyroid Cancer"

"Number of Foci Increases Risk of Central Compartment Lymph Node Metastasis in Papillary Thyroid Cancer"

Metastases of papillary radioiodine-refractory thyroid cancer in the parapharyngeal lymph node: clinical case

Introduction. Papillary thyroid cancer (PTC) usually metastasizes into the central and lateral lymph nodes (LNs) of the neck. Metastases into the retropharyngeal and parapharyngeal LNs are rare. Their presence attests to aggressive PTC.The study objective is to describe a rare case of metastases of papillary radioiodine-refractory PTC into the parapharyngeal LN.Clinical case. In 2015, female patient K., 40 years old, underwent thyroidectomy due to PTC. Histological examination verified papillary PTC with growth through the capsule and ingrowth into the surrounding tissues and muscles. In a separately admitted LN, metastases of the same cancer were observed. One year later, regional metastases in the lateral neck LNs were detected. Radioiodine therapy (activity 131I 4.5 GBq) was performed followed by fascial circular section of the neck tissues on the right per thyroid type. Morphological examination verified presence of papillary PTC metastases in 4 LNs. In January of 2018, positron emission tomography showed metastases in the paratracheal LNs. Central neck lymph node dissection was performed. Per histological conclusion, fat tissue and LN contained multiple metastases of papillary PTC. In October of the same year, repeat radioiodine therapy (activity 131I 3.0 GBq) was performed. Thyroglobulin levels increased. In June of 2020, repeat positron emission tomography showed a single metastasis in the parapharyngeal LN. Due to small size of the metastasis and absence of signs of progression, dynamic follow-up and hormone therapy were suggested to the patient.Conclusion. Metastatic involvement of parapharyngeal LNs is rare, especially in radioiodine-refractory PTC. They can be detected both during primary diagnosis and after the treatment during dynamic follow-up, as well as a single manifestation of PTC, which should be taken into account during differential diagnosis.

Clinical outcome of patients with differentiated thyroid cancer and raised antithyroglobulin antibody levels: a retrospective study

BackgroundThyroglobulin (Tg) is a specific tumor marker for differentiated thyroid cancer (DTC). However, in the presence of an antithyroglobulin antibody (TgAb), it becomes unreliable. The purpose of the study was to assess the long-term outcome of DTC patients with raised TgAb.MethodIn a retrospective study, we included patients with DTC who had raised TgAb following total thyroidectomy. We excluded patients with persistently raised Tg (≥ 1 ng/ml) or radioiodine avid disease. Serial TgAb levels, excellent response (ER), incomplete response (IR), and anatomical recurrence were evaluated.ResultsA total of seventy-six patients were included in the study. Patients with IR had higher baseline TgAb (1071.27 ± 1216.17 vs. 99.61 ± 91.29 IU/ml, p < 0.001) and central compartment lymph node metastases (70.8% vs. 46.4%, p = 0.035) in comparison to those in the ER group. In the first follow-up, 64 (84.2%) patients had a stable or fall in the TgAb (0 to − 98.3%). Sixty-eight patients received high-dose radioiodine therapy (RIT). Out of these, 59 (86.5%) had transient, and 51 (75%) had a long-term fall in TgAb. After a follow-up period of 58.74 ± 26.26 months, 63.2% (48 out of 76) patients had IR. Nine (11.8%) patients had a rising TgAb level (3.7–170.9%) from baseline. Eleven patients underwent 18F-FDG PET/CT, and five of them demonstrated metabolically active recurrent disease. Three patients underwent cervical lymph nodes dissection. None of the patients died during the follow-up period.ConclusionHigh post-operative TgAb levels and central compartment lymph nodal metastases are risk factors for IR. RIT leads to a significant fall in the TgAb in these patients. The low level of raised TgAb is associated with an excellent outcome. Patients with recurrences had very high baseline TgAb > 1000 IU/ml. Raised TgAb was associated with good clinical outcomes and not associated with increased mortality.

Central neck lymph node metastasis in oral squamous cell carcinoma at the floor of mouth

sBackgroundOur goal was to analyze the incidence of level VI metastasis in previously untreated oral squamous cell carcinoma (SCC) patients and their clinicopathological and prognostic characteristics.MethodsOral SCC patients with level VI metastasis were retrospectively enrolled, and their demographic and pathologic features as well as their survival data were descriptively analyzed.ResultsA total of 13 cases from 1875 patients were included, all patients had SCC at the floor of mouth (SCCFOM). Eight (61.5%) patients had a pT4 tumor, and all patients had a pathological N3 neck with multiple positive lymph nodes. Adverse pathologic features were present in 100% of the patients. The size of the metastatic foci in level VI ranged from 2.6 cm to 4.5 cm with a mean value of 3.2 cm, and 5 patients showed a soft tissue deposit with no lymph node component. Recurrence occurred in all patients, and 11 patients died of uncontrolled cancer within 5 years after surgery.ConclusionLevel VI metastasis in primary oral SCCFOM is rare, and its prognosis is poor.

Extreme Gradient Boosting Model to Assess Risk of Central Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma: Individual prediction using SHapley Additive exPlanations

Extreme Gradient Boosting Model to Assess Risk of Central Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma: Individual prediction using SHapley Additive exPlanations

DETECTION OF SENTINEL LYMPH NODES IN PATIENTS WITH THYROID CANCER WITH THE USE OF TOLUIDINE BLUE

Introduction. Treatment of patients with thyroid cancer (TС) with clinically undetected metastases to regional lymph nodes remains an unsolved problem of modern oncology. The search for reliable diagnostic methods, which underlie the decision to perform an adequate lymphadenectomy for TC, is one of the priorities of oncosurgery. The aim of the research: to find an effective method of intraoperative contrasting of sentinel lymph nodes (SLN) in patients with TC using toluidine blue and to evaluate its effectiveness. Methods. A study of 123 patients with TC who underwent surgical treatment using the contrast-visual method in the amount of thyroidectomy with central and bilateral selective cervical lymph node dissection (levels VI; IIA; III; IV). During surgery, a 1% solution of toluidine blue was injected into the tumor using a syringe. Surgical treatment was performed in two stages. At the first stage – thyroidectomy was performed in a block with a central lymphatic collector of the neck (level IV), which included removal of paratracheal, prelaryngeal, parathyroid tissue of the neck. Urgent intraoperative histological examination of thyroid tumor and distant SLN was performed. In the second stage of the operation performed cervical lymph node dissection with removal of fiber IIA; III; IV levels of the neck, with mandatory revision of the level of VB. After the operation, the final histological examination of the removed specimen with the tumor and all lymph nodes was performed. Results. After the application contrasting technique, SLN were found in 120 (97.6%) patients. Their number varied from 2 to 12. These lymph nodes were mainly localized in the central collector of the neck on the side of the primary tumor (central, ipsilateral SLN) in 91 (75.8%) patients. Based on the results of an intraoperative study of SLN, metastases were found in 33 (27.5%) of 120 patients. In most cases (83.3%) SLNs were detected in the central lymphatic collector of the neck (level VI). In 76 (63.3%) patients, staining of the lymph nodes of the III level of the neck (middle ipsilateral jugular lymphatic collector) occurred, in 11 (9.2%) SLNs were found only at levels III, IV and VB of the neck. Very rarely (5.8%), the lymph nodes of the anterior-superior mediastinum were contrasted. Conclusions. The method of contrast visualization of the regional collector in patients with TC using a 1% solution of toluidine blue is a highly informative study that allows to determine the regional lymph nodes affected by metastases and to differentiate the choice of the volume of lymph node dissection in the early stages of tumors. The method is simple to implement, does not involve considerable costs and can be recommended for use in oncology clinics.

Динаміка відносного об’єму структурно-функціональних зон паренхіми лімфатичних вузлів бика домашнього (Bos taurus) в ранньому постнатальному онтогенезі

Lymph nodes are peripheral organs of hemo- and lymphopoiesis, their parenchyma is formed by lymphoid tissue and is divided into separate structural and functional lobules, each of which, in turn, is formed by highly and low-specialized cellular zones. The dynamics of age-related changes in the relative volume of the structural and functional zones of the lymph nodes parenchyma lobules in newborn calves of 10-, 30-, 120-day-old was determined. There were examined: superficial cervical, axillary, iliac, popliteal, medial retropharyngeal, caudal mediastinal, medial iliac, iliocolic lymph nodes. The relative volume of the deep cortex central zones units, lymph nodules, interfollicular zone and medullary cords was determined on thin paraffin histosections stained with hematoxylin and eosin. In newborn calves, the lymph nodes lobules were formed, among the structural and functional zones the centers of the deep cortex units were most developed, the relative volume of which was 27–33% and the medullary cords – 21–31%, and the least ones were lymph nodules. The lymph nodules volume without light centers varied within 0.4–1.6%, with light centers – 0.3–1%. The interfollicular zone was 4–11%. During the first ten days of calf life, the greatest growth dynamics was observed in the deep cortex central zones units, the interfollicular zone, and the medullary cords. Until the age of 30 days, the dynamics of an increase in the relative volume of deep cortex units and interfollicular zone stabilized and showed a further tendency of insignificant growth. The most intense increase in the relative volume of lymph nodules was observed in 120-day-old calves. The volume of the medullary cords decreased in all the examined nodes in 30- and 120-day-old calves.

The role of defining the sentinel lymph node in the treatment of low-risk highly differentiated thyroid cancer (review of literature)

The definition of a sentinel lymph node is a technique that appeared at the middle of the 20th century. For a number of malignant neoplasms, the definition of a sentinel lymph node is standard procedure, but for highly differentiated thyroid cancer, the data is conflicting. The role of prophylactic central compartment lymph node dissection in the clinical N0 stage is not established. Sentinel lymph node detection seems to be the possible way to reduce the risk of persistence and recurrence of highly differentiated thyroid cancer.

Do carbon nanoparticles really improve thyroid cancer surgery? A retrospective analysis of real-world data

BackgroundParathyroid protection and central neck dissection (CND) are basic points of thyroid cancer surgery and draw persistent concern. We aimed to evaluate the value of carbon nanoparticles (CNs) for parathyroid gland protection and CND in thyroid surgery for thyroid cancer patients.MethodsA total of 386 consecutive thyroid cancer patients were enrolled in the retrospective study. Three hundred thirty-four patients using CNs intraoperatively were included in the CN group, and 52 patients without using CNs or any other helping agent were included in the control group. Intact parathyroid hormone (iPTH) was examined. Medical records and histopathologic reports were reviewed. Histopathologic examination was performed.ResultsThere were no statistical significances in demographic and basic surgical information, preoperative iPTH, and serum calcium between the two groups (P > 0.05). In the CN group, the thyroid tissue and central neck lymph nodes were stained black by CNs, while the parathyroid glands were not. Histopathological examination showed that the carbon nanoparticles might accumulated in the subcapsular sinus of lymph nodes compared with the none-stained samples. The staining with CNs did not impact the histopathological examination. There were no significant differences in postoperative hypocalcemia and hypoPT at day 1, 1 month, and half year after surgery between the two groups, respectively. There was a big decline of iPTH level after surgery, whereas the perioperative decreasing amplitude of PTH was not statistically different between the CNs and control group (57.2 ± 28.6 vs 55.7 ± 27.8, P = 0.710). There were 43 patients occurring incidental parathyroidectomy in the CN group (43/334, 12.9%) and 7 patients in the control group (7/52, 13.5%), without significant difference (P = 0.907). There was no significant difference in the number of lymph nodes identified by pathology per patient between the CNs and control group regardless of unilateral and bilateral CND.ConclusionsCarbon nanoparticles help highlight parathyroid glands and lymph nodes in thyroidectomy, but generate no significant benefit for parathyroid glands protection and lymph node dissection. The value of carbon nanoparticles in thyroid cancer surgery should not be exaggerated and needs further evaluation.

Application of ultrasound-guided fine-needle aspiration combined with BRAF V600E mutation detection and ultrasound features in estimating central cervical lymph nodes metastasis of classic papillary thyroid cancer

Objective To explore the correlation of ultrasound-guided fine-needle aspiration(US-FNA) combined with BRAF V600E mutation detection and ultrasound features and central cervical lymph nodes metastasis of classic papillary thyroid cancer(PTC) for providing a reliable molecular basis for clinical preoperative evaluation of patients. Methods Ninty-three cases of patients collected from October 2017 to November 2018 in Gansu Province Hospital were enrolled, who underwent general ultrasonic examination TI-RADS ≥4a, the US-FNA highly suspicious of PTC, thyroid surgery including total thyroidectomy and central cervical lymph node dissection, with the postoperative pathologic results of classical PTC and whether the central cervical lymph node metastasis happened in the patients. Part of the specimen applied HE staining for cytological diagnosis, the other part of specimen was used real-time for detection of BRAF V600E gene mutation by fluorescent quantitative polymerase chain reaction (PCR) method. Results Univariate analysis showed that the occurrence of cervical lymph node metastasis for classic PTC were significantly correlated with gender(χ2=10.303, P=0.002), BRAF V600E mutation(χ2=31.204, P=0.000) and extrathyroidal invasion(χ2=12.848, P=0.000). Multi-logistic regression analysis showed that BRAF V600E mutation(OR=13.324, 95%CI=4.058-43.744, P=0.000) and extrathyroidal invasion(OR=5.738, 95%CI=1.766-18.643, P=0.004) were the risk predictors of cervical lymph node metastasis of classic PTC. Gender(OR=0.385, 95%CI=0.112-1.324, P=0.130) was not the risk predictor. Conclusions US-FNA combined with BRAF V600E mutation and extrathyroidal invasion are the risk factors in predicting central cervical lymph node metastasis in classic PTC. Patients with these two risk factors should be elected to undergo prophylactic central cervical lymph node dissection. Key words: Ultrasound-guided fine-needle aspiration cytology; Papillary thyroid cancer, classic; Central cervical lymph node; Metastasis; BRAF V600E

MODERN DIAGNOSTIC AND MINIMALLY INVASIVE TECHNOLOGY IN THYROID SURGERY

Purpose of the study: to evaluate the role of the main instrumental methods of diagnostics and to determine the criteria for selecting patients with surgical diseases of the thyroid gland (TG) for the reasonable implementation of optimal minimally invasive surgical interventions. Materials and methods: the results of the examination and treatment of 340 patients with surgical diseases of the TG, who underwent variety of minimally invasive techniques were analyzed. Results: we compared the sensitivity, specificity, accuracy, positive and negative predictive values of the multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy TG and fine-needle cytology. Minimally invasive video-assisted procedure was performed in 29,4% patients, nonendoscopic - in 38,2%, endoscopic - in 32,4%. Postoperative specific complications were revealed in 4,4% who underwent surgery: transitory recurrent laryngeal nerve palsy - in 1,5%, transient hypoparathyroidism - in 1,6%, hematoma - in 0,8%. It was stated that the main criteria that determine the rationale for minimally invasive interventions on the TG are: the nodule size and the TG volume; hyperfunctioning thyroid and clinical thyroiditis; substernal extension; extrathyroid extension and the necessity of implementation of central neck dissection due to central and laterocervical lymph node metastases. Conclusion: the application of the determined criteria based on the integrated use of modern diagnostic techniques for patients with surgical diseases of the TG can justify the selection of optimal minimally invasive surgical interventions, avoid unreasonable operations, to avoid increasing of the frequency of specific complications, reduces surgical trauma and duration of stay in hospital, improves cosmetic outcome and enhances the quality of life of the patients.

A Case Report of Familial Medullary Carcinoma Thyroid—Seldom Seen by Surgeons

Medullary thyroid carcinoma (MTC) constitutes around 5% of all thyroid cancers with a worse prognosis. It accounts for 13% of thyroid cancer–related deaths. Twenty-three-year-old male presented with 4-year history of progressively increasing thyroid swelling with similar family history. On examination, butterfly-shaped firm swelling of size 7 × 3 cm in the right and 7 × 4 cm in the left can be seen on the anterior aspect of neck with regular margins and nodular surface moving with deglutition extending from the thyroid cartilage to clavicle head and laterally beyond the sternocleidomastoid into the posterior triangle muscle. Pemberton’s sign is negative. CT neck showed enlarged both thyroid lobes with areas of cystic degeneration and 15 mm retrosternal extension of left lobe of thyroid with bilateral IB, II, and V lymphadenopathy. Serum calcitonin level was 4435 pg/ml. FNAC favoured the features of MTC. Total thyroidectomy with central compartment neck dissection was done. Intraoperative frozen sections of bilateral level III were found to be tumour-free, so proceeded with thyroid excision and central compartment neck dissection. Histopathology revealed MTC with bilateral multifocal capsular and lymphovascular invasion and metastatic foci in the right central compartment lymph node. Hence, early diagnosis in family members offers a higher likelihood of cure and long-term survival.

Comparison of ultrasound radiomics with conventional imaging models: diagnosis of central cervical lymph node metastasis in papillary thyroid carcinoma

Objective To compare the difference of diagnostic ability between ultrasound radiomics (USR) and different conventional imaging models of central neck (Ⅵ) lymph node metastasis in papillary thyroid carcinoma (PTC). Methods A training set of 609 cases was set up. USR features were extracted and screened by USR method. A weighted formula was established to calculate the USR score of each patient by ultrasound image. The USR score of the best diagnostic ability was obtained by statistical method and set as the diagnostic criterion. A test set of 326 cases was established to compare the diagnostic ability of USR score with ultrasound (US), computed tomography (CT) and US combined CT. Results The accuracy, sensitivity, specificity, area under ROC curve and Youden index of USR score in test set were 0.804, 0.867, 0.770, 0.766, 0.533, respectively, which were significantly higher than the corresponding values of US, CT and US combined CT(all P=0.000). Conclusions USR score obtained with USR method can effectively predict lymph node metastasis in Ⅵ region of PTC. The diagnostic efficiency and clinical value of USR score were significantly higher than those of conventional medical imaging models. Key words: Ultrasonography; Radiomics; Papillary thyroid carcinoma; Lymph node metastasis; Central neck; Computer tomography

Risk factors of central neck lymph node metastasis following solitary papillary thyroid carcinoma

Objective To evaluate the risk factors in terms of clinical characteristics, serological indicators and sonographic features regarding thyroid papillary carcinoma (PTC) for the central neck lymph node metastasis. Methods One thousand one hundred and seventy-four patients accepted thyroid cancer surgery at Fudan University Shanghai Cancer Center from January to September 2016 were enrolled. All patients were confirmed to be solitary PTC in paraffin wax pathology after thyroidectomy.Meanwhile, the status of central neck lymph node metastasis was determined referring to postoperative pathology. All features of the PTC lesion in terms of clinical, serological and sonographic features were evaluated for the association with central neck lymph node metastasis using univariate and multivariate logistic regression analysis. Meanwhile, a nomogram model was established for the determined risk factors. Results Out of 1 174 patients, 469 patients (39.9%) presented central neck lymph node metastasis, univariate analysis showed that age, gender, preoperative thyroglobulin(Tg) and thyroid peroxidase antibody(TPOAb), maximum diameter, location, close to the thyroid capsule, AP/TR, echo, acoustic halo, and presence of microcalcification were related with CLNM (P<0.05). Multivariate logistic regression analysis demonstrated that less than 55 years-old, male, Tg higher than 20 μg/L, TPOAb less than 1 kU/L, maximum diameter larger than 10 mm, and presence of microcalcification were independent risk factors for CLNM. The nomogram was established based on independent risk factors determined by the logistic regression with the AUC 0.714, specificity 73.1%, and sensitivity 59.7%. Conclusions For patients with single focal PTC lesion, younger age, male, higher Tg, lower TPOAb, and larger lesions containing microcalcificatin on ultrasound are associated with central neck lymph node metastasis. Key words: Ultrasonography; Papillary thyroid carcinoma; Lymph node metastasis; Nomogram

Correlations of neck ultrasound and pathology in cervical lymph node of papillary thyroid carcinoma

Background: High-resolution sonography is becoming a method of choice for the detection and diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC). The purpose of this study is to assess the diagnostic accuracy of neck ultrasound (US) in the detection of lymph node metastases from PTC.Methods: Data for all patients with papillary thyroid cancers and preoperative neck US were reviewed retrospectively. The diagnostic accuracy of US was determined according to whether histologically confirmed cancer was present in surgical cervical lymph node specimens.Results: A total of 206 patients (149 central and 57 central and lateral lymph nodes dissection) were included. Their mean age was 56 years (14–88 years). Central and lateral lymph nodes were involved in 68% (n = 141 patients; 141/206) and 60% (n = 34 patients; 34/57) of cases, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of US in predicting papillary thyroid carcinoma (PTC) metastasis in the central neck were 69%, 71%, 84% and 51% respectively, and in the lateral neck were 85%, 65%, 78% and 75% respectively.Conclusions: Preoperative neck US is a valuable tool in the detection of cervical lymph node metastases from papillary thyroid cancer and can provide reliable information to assist in surgical management.