Value of Combining Clinical Factors, Conventional Ultrasound, and Contrast-Enhanced Ultrasound Features in Preoperative Prediction of Central Lymph Node Metastases of Different Sized Papillary Thyroid Carcinomas

BackgroundPapillary thyroid cancer (PTC) in clinically lymph node-negative (cN0) patients is prone toward lymph node metastasis. As a risk factor for tumor persistence and local recurrence, lateral lymph node metastasis (LLNM) is related to the number of central lymph node metastases (CLNMs).MethodsWe performed LLNM risk stratification based on the number of CLNMs for cN0 PTC patients who underwent thyroidectomy and lymph node dissection between January 2013 and December 2018. A retrospective analysis was applied to the 274 collected patients with 1-2 CLNMs. We examined the clinicopathological characteristics of the patients and constructed a LASSO model.ResultsIn the 1–2 CLNM group, tumors >10 mm located in the upper region and nodular goiters were independent risk factors for LLNM. Specifically, tumors >20 mm and located in the upper region contributed to metastasis risk at level II. Hashimoto’s thyroiditis reduced this risk (p = 0.045, OR = 0.280). Age ≤ 30 years and calcification (microcalcification within thyroid nodules) correlated with LLNM. The LASSO model divided the population into low- (25.74%) and high-risk (57.25%) groups for LLNM, with an AUC of 0.715.ConclusionsFor patients with 1–2 CLNMs, young age, calcification, nodular goiter, tumor >10 mm, and tumor in the upper region should alert clinicians to considering a higher occult LLNM burden. Close follow-up and therapy adjustment may be warranted for high-risk patients.

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RISK FACTORS FOR CENTRAL LYMPH NODE METASTASES IN PATIENTS WITH PAPILLARY THYROID MICROCARCINOMA

Endocrine Practice ◽

10.4158/ep-2018-0305 ◽

2018 ◽

Vol 24 (12) ◽

pp. 1057-1062 ◽

Cited By ~ 8

Author(s):

Xin Wu ◽

Binglu Li ◽

Chaoji Zheng ◽

Xiaodong He

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastases ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Central Lymph Node ◽

Thyroid Microcarcinoma ◽

Node Metastases ◽

Central Lymph

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Sonographic Characteristics of Papillary Thyroid Carcinoma with Coexistent Hashimoto's Thyroiditis: Conventional Ultrasound, Acoustic Radiation Force Impulse Imaging and Contrast-Enhanced Ultrasound

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2018.10.020 ◽

2019 ◽

Vol 45 (2) ◽

pp. 471-480 ◽

Cited By ~ 4

Author(s):

Qinghai Peng ◽

Chengcheng Niu ◽

Meixiang Zhang ◽

Qiang Peng ◽

Sijie Chen

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Acoustic Radiation ◽

Radiation Force ◽

Acoustic Radiation Force ◽

Acoustic Radiation Force Impulse ◽

Contrast Enhanced Ultrasound ◽

Papillary Thyroid ◽

Contrast Enhanced ◽

Conventional Ultrasound

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Prediction of cervical lymph node metastasis with contrast-enhanced ultrasound and association between presence of BRAFV600E and extrathyroidal extension in papillary thyroid carcinoma

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920942367 ◽

2020 ◽

Vol 12 ◽

pp. 175883592094236

Author(s):

Jia Zhan ◽

Long-hui Zhang ◽

Qing Yu ◽

Chao-lun Li ◽

Yue Chen ◽

...

Keyword(s):

Cervical Lymph Node ◽

Multivariate Analyses ◽

Cervical Lymph Node Metastasis ◽

Extrathyroidal Extension ◽

Peak Time ◽

Contrast Enhanced Ultrasound ◽

Papillary Thyroid ◽

Node Metastasis ◽

Contrast Enhanced ◽

Ultrasound Features

Objective: This study aimed to evaluate the correlation between cervical lymph node metastasis (CLNM) and each of the ultrasound features, immunohistochemical factors, and B-type Raf (BRAFV600E) mutation. Methods: A retrospective analysis was performed on 405 patients with single papillary thyroid carcinoma (PTC) nodules, all of whom underwent preoperative sonographic examinations, including gray-scale ultrasound, color Doppler ultrasound, and contrast-enhanced ultrasound (CEUS). All PTC patients were evaluated using 14 clinical and sonographic features, eight immunohistochemical factors, and BRAFV600E. Multivariate analyses were performed to identify the risk factors for CLNM, and an equation for CLNM was established. The diagnostic value of each modality was compared with a receiver operating characteristic (ROC) curve. Results: Among the 405 PTC nodules removed surgically, CLNM was confirmed in 138 patients, whereas extrathyroidal extension was confirmed in 185 patients. Multivariate analyses indicated significant differences between CLNM and non-CLNM groups in three conventional ultrasound features ( p < 0.05), whereas other sonographic features, eight immunohistochemical factors, and BRAFV600E did not indicate significant differences. A ROC curve of 0.757 in the equation exhibited a significant difference compared with the solo factors ( p < 0.05 for all). Hyper or isoechoic enhancement at peak time on CEUS was associated with CLNM, whereas the presence of the BRAFV600E mutation was associated with extrathyroidal extensions although BRAF appeared to be uncorrelated with CLNM in the present study. Conclusion: Intensity at peak time, homogeneity, and size are the three most significant features in predicting CLNM in PTC patients, and the presence of the BRAFV600E mutation was associated with extrathyroidal extensions when PTCs showed a hyper or isoechoic enhancement at peak time in CEUS.

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Prevalence of Central Compartment Lymph Node Metastases in Papillary Thyroid Micro-Carcinoma: A Retrospective Evaluation of Predictive Preoperative Features

Cancers ◽

10.3390/cancers13236028 ◽

2021 ◽

Vol 13 (23) ◽

pp. 6028

Author(s):

Marta Tagliabue ◽

Gioacchino Giugliano ◽

Maria Cecilia Mariani ◽

Manila Rubino ◽

Enrica Grosso ◽

...

Keyword(s):

Multivariate Analysis ◽

Lymph Node ◽

Lymph Node Metastases ◽

Binary Logistic Regression ◽

Central Compartment ◽

Good Prognosis ◽

Papillary Thyroid ◽

Central Lymph Node ◽

Node Metastases ◽

Central Lymph

Papillary thyroid micro-carcinomas are considered relatively indolent carcinomas, often occult and incidental, with good prognosis and favorable outcomes. Despite these findings, central lymph node metastases are common, and are related to a poor prognosis for the patient. We performed a retrospective analysis on patients treated with surgery for stage pT1a papillary thyroid micro-carcinomas. One hundred ninety-five patients were included in the analyses. The presence of central lymph node metastases was identified and studied. A multivariate analysis employing binary logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals of possible central lymph node metastases risk factors. In the performed multivariate analysis, male gender, younger age, and histopathological characteristics, such as a tumor sub-capsular localization, were significantly associated with central lymph node metastases in pT1a patients. Central compartment lymph node metastases are present in a non-negligible number of cases in patients with papillary thyroid micro-carcinoma undergoing surgical resection. Studying these factors could be an effective tool for predicting patients’ central lymph node metastases in papillary thyroid micro-carcinomas, defining a tailored surgical treatment in the future.

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