Efficacy of ultrasonic examination in predicting cervical lymph node metastasis in elderly patients with papillary thyroid carcinoma and analysis of related ultrasound signs

doi:10.16150/j.1671-2870.2022.03.009

Abstract

Abstract:

Objective: To explore the efficacy of ultrasonic examination for diagnosing cervical lymph node metastasis in elderly patients with papillary thyroidc arcinoma(PTC), and to analyze the related ultrasonographic characteristics. Methods: A total of 232 patients ≥60 years with PTC admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between January 2021 and October 2021, were included in the retrospective analysis. According to postoperative pathology, the efficacy of ultrasound in predicting cervical lymph node metastasis were calculated. Multivariate logistic regression model was used to analyze the risk factor for cervical lymph node metastasis and risk factors were used to construct multi-factor model of risk for predicting cervical lymph node metastasis. Receiver operator characteristic (ROC) curves was used to evaluate the value of the model for predicting lymph node metastasis in elderly participants with PTC. Results: Rate of cervical lymph node metastasis was 30.6% (71 cases). The sensitivity, specificity, positive predictive va-lue and negative predictive value of ultrasound for cervical lymph node metastasis were 40.8%(29/232), 93.2% (150/232), 72.5% (29/40) and 78.1% (150/192). Univariate analysrs showed that the cervical lymph node metastasis rate was higher in patients with nodule size ≥10 mm, microcalcification, abundant color Doppler flow imaging (CDFI) blood flow, or the distance between the nodule and capsule <1 mm by preoperative ultrasound scanning (P<0.05). Multivariate logistic regression analysis demonstrated that preoperative ultrasonographic nodule size ≥10 mm (odds ratio[OR]=4.093, 95%CI: 1.933-8.666, P<0.001) and the distance between the nodule and capsule<1 mm (OR=2.177, 95%CI: 1.101-4.302, P=0.025) were independent risk factors for lymph node metastasis in elderly participants with PTC. The area under the curve(AUC) of combined these two independent risk factors for diagnosing cervical lymph node metastasis was 0.709. The AUC value was larger than either a risk factor. (AUC for the distance between the nodule and capsule<1 mm, was 0.602, and AUC for preoperative ultrasonographic nodule size ≥10 mm was 0.668). Conclusions: Proportion of cervical lymph node metastasis in the elderly patients with PTC. Large nodule size (≥10 mm) and close distance between the nodule and capsule (<1 mm) are independent risk factors for cervical lymph node metastasis for elderly patients with PTC.

Key words: Ultrasonography, Papillary thyroid carcinoma, Lymph node metastasis, Elderly

CLC Number:

R736.1

XU Chenying, LI Yanran, NI Xiaofeng, XU Shangyan, LIN Qing. Efficacy of ultrasonic examination in predicting cervical lymph node metastasis in elderly patients with papillary thyroid carcinoma and analysis of related ultrasound signs[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 343-348.

Figures/Tables 4

临床特征	总数（n=232）	颈部淋巴结转移[例（%）]		P值
临床特征	总数（n=232）	有（n=71）	无（n=161）	P值
年龄（岁）	65.06±3.94	64.65±3.91	65.24±3.95	0.290
60~69	199（85.9%）	62（87.3%）	137（85.1%）	0.654
≥70	33（14.2%）	9（12.7%）	24（14.9%）
性别				0.980
男	39（16.8%）	12（16.9%）	27（16.8%）
女	193（83.2%）	59（83.1%）	134（83.2%）
BMI（kg/m²）	24.39±3.26	24.56±3.26	24.32±3.27	0.599
恶性肿瘤家族史				0.427
有	18（7.8%）	7（9.9%）	11（6.8%）
无	214（92.2%）	64（90.1%）	150（93.2%）
结节部位				0.052
单侧	173（74.6%）	47（66.2%）	126（78.3%）
多侧	59（25.4%）	24（33.8%）	35（21.7%）
结节个数				0.155
单个	162（70.3%）	45（63.4%）	117（72.7%）
多个	70（29.7%）	26（36.6%）	44（27.3%）
结节大小（mm）	10.01±6.92	13.40±8.74	8.52±5.33	<0.001
<10	152（65.5%）	30（42.3%）	122（75.8%）	<0.001
≥10	80（34.5%）	41（57.7%）	39（24.2%）
结节方位				0.063
垂直	151（65.1%）	40（56.3%）	111（68.9%）
水平	81（34.9%）	31（43.7%）	50（31.1%）
结节内部结构				0.578
实性	223（96.1%）	69（97.2%）	154（95.7%）
非实性	9（3.9%）	2（2.8%）	7（4.3%）
结节内部回声				0.220
极低回声	13（5.6%）	2（2.8%）	11（6.8%）
非极低回声	219（94.4%）	69（97.2%）	150（93.2%）
结节边缘				0.281
不规则	197（84.9%）	63（88.7%）	134（83.2%）
规则	35（15.1%）	8（11.3%）	27（16.8%）
微钙化				0.022
有	141（60.8%）	51（71.8%）	90（55.9%）
无	91（39.2%）	20（28.2%）	71（44.1%）
慧星尾征				1.000
有	0（0）	0（0）	0（0）
无	232（100%）	71（30.6%）	161（69.4%）
CDFI血流				0.004
丰富	25（10.8%）	14（19.7%）	11（6.8%）
非丰富	207（89.2%）	57（80.3%）	150（93.2%）
紧贴包膜				0.004
有	111（47.8%）	44（62.0%）	67（41.6%）
无	121（52.2%）	27（38.0%）	94（58.4%）
C-TIRADS分类				0.089
3	1（0.4%）	0（0）	1（0.4%）
4A	6（2.6%）	3（4.2%）	3（1.9%）
4B	47（20.3%）	8（11.3%）	39（24.2%）
4C	173（74.6%）	59（83.1%）	114（70.8%）
5	5（2.2%）	1（1.4%）	4（2.5%）

References 25

[1]	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. doi: 10.3322/caac.21660 URL
[2]	Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J]. Chin Med J (Engl), 2022, 135(5):584-590.
[3]	杨雷, 王宁. 甲状腺癌流行病学研究进展[J]. 中华预防医学杂志, 2014, 48(8):744-748.
	Yang L, Wang N. Thyroid cancer epidemiolog, reviem[J]. Chin J Prev Med, 2014, 48(8):744-748.
[4]	Gambardella C, Tartaglia E, Nunziata A, et al. Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients[J]. World J Surg Oncol, 2016, 14(1):247. doi: 10.1186/s12957-016-1003-5 pmid: 27644091
[5]	Zaydfudim V, Feurer ID, Griffin MR, et al. The impact of lymph node involvement on survival in patients with papil-lary and follicular thyroid carcinoma[J]. Surgery, 2008, 144(6):1070-1077. doi: 10.1016/j.surg.2008.08.034 URL
[6]	Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002[J]. Jama, 2006, 295(18):2164-2167. doi: 10.1001/jama.295.18.2164 URL
[7]	张伟红, 闫红莲, 魏云, 等. 超声检查诊断甲状腺癌合并淋巴结转移的临床研究[J]. 实用癌症杂志, 2021, 36(6):954-958.
	Zhang WH, Yan HL, Wei Y, et al. Clinical research on ultrasonic examination in the diagnosis of thyroid cancer combined with lymph node metastasis[J]. The Pract J Cancer, 2021, 36(6):954-958.
[8]	Kuna SK, Bracic I, Tesic V, et al. Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer[J]. J Ultrasound Med, 2006, 25(12):1531-1537. doi: 10.7863/jum.2006.25.12.1531 URL
[9]	Leenhardt L, Erdogan MF, Hegedus L, et al. 2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer[J]. Eur Thyroid J, 2013, 2(3):147-159. doi: 10.1159/000354537 pmid: 24847448
[10]	杨雷, 郑荣寿, 王宁, 等. 2013年中国甲状腺癌发病与死亡情况[J]. 中华肿瘤杂志, 2017, 39(11):862-867. pmid: 29151294
	Yang L, Zheng RS, Wang N, et al. Analysis of incidence and mortality of thyroid cancer in China,2013[J]. Chin J Oncol, 2017, 39(11):862-867. doi: 10.3760/cma.j.issn.0253-3766.2017.11.010 pmid: 29151294
[11]	Edafe O, Wadsley J, Harrison BJ, et al. Treatment related morbidity in differentiated thyroid cancer-a survey of clinicians[J]. Thyroid Res, 2014, 7(1):3. doi: 10.1186/1756-6614-7-3 pmid: 24618295
[12]	Sosa JA, Hanna JW, Robinson KA, et al. Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States[J]. Surgery, 2013, 154(6):1420-1426. doi: 10.1016/j.surg.2013.07.006 URL
[13]	Peterson E, De P, Nuttall R. BMI, diet and female reproductive factors as risks for thyroid cancer: a systematic review[J]. PLoS One, 2012, 7(1):e29177. doi: 10.1371/journal.pone.0029177 URL
[14]	Conzo G, Avenia N, Bellastella G, et al. The role of surgery in the current management of differentiated thyroid cancer[J]. Endocrine, 2014, 47(2):380-388. doi: 10.1007/s12020-014-0251-9 URL
[15]	Liu C, Xiao C, Chen J, et al. Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: a study of 966 patients[J]. BMC Cancer, 2019, 19(1):622. doi: 10.1186/s12885-019-5835-6 URL
[16]	Ahn BH, Kim JR, Jeong HC, et al. Predictive factors of central lymph node metastasis in papillary thyroid carcinoma[J]. Ann Surg Treat Res, 2015, 88(2):63-68. doi: 10.4174/astr.2015.88.2.63 URL
[17]	Shah Y, Verma A, Marderstein AR, et al. Pan-cancer analysis reveals molecular patterns associated with age[J]. Cell Rep, 2021, 37(10):110100. doi: 10.1016/j.celrep.2021.110100 URL
[18]	Attard A, Paladino NC, Lo Monte AI, et al. Skip metastases to lateral cervical lymph nodes in differentiated thyroid cancer: a systematic review[J]. BMC Surg, 2019, 18(Suppl 1):112. doi: 10.1186/s12893-018-0435-y URL
[19]	Xu JM, Xu HX, Li XL, et al. A risk model for predicting central lymph node metastasis of papillary thyroid microcarcinoma including conventional ultrasound and acoustic radiation force impulse elastography[J]. Medicine (Baltimore), 2016, 95(3):e2558. doi: 10.1097/MD.0000000000002558 URL
[20]	Liu Z, Wang L, Yi P, et al. Risk factors for central lymph node metastasis of patients with papillary thyroid microcarcinoma: a meta-analysis[J]. Int J Clin Exp Pathol, 2014, 7(3):932-7.
[21]	Mazzaferri EL. Management of low-risk differentiated thyroid cancer[J]. Endocr Pract, 2007, 13(5):498-512. doi: 10.4158/EP.13.5.498 pmid: 17872353
[22]	Ito Y, Miyauchi A, Inoue H, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients[J]. World J Surg, 2010, 34(1):28-35. doi: 10.1007/s00268-009-0303-0 URL
[23]	Kim JW, Roh JL, Gong G, et al. Extent of extrathyroidal extension as a significant predictor of nodal metastasis and extranodal extension in patients with papillary thyroid carcinoma[J]. Ann Surg Oncol, 2017, 24(2):460-468. doi: 10.1245/s10434-016-5594-4 URL
[24]	Kamaya A, Tahvildari AM, Patel BN, et al. Sonographic detection of extracapsular extension in papillary thyroid cancer[J]. J Ultrasound Med, 2015, 34(12):2225-2230. doi: 10.7863/ultra.15.02006 pmid: 26518279
[25]	Zhou J, Yin L, Wei X, et al. 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodu-les: the C-TIRADS[J]. Endocrine, 2020, 70(2):256-279. doi: 10.1007/s12020-020-02441-y URL