Value Of Ultrasonographic Features And Serological Indicators In Assessing The Risk Of Lymph Node Metastasis From Papillary Thyroid Carcinoma

Objective: To investigate the value of ultrasonographic characteristics,blood flow ultrasonographic characteristics and combined with serum TSH and VEGF expression levels in predicting the risk of lymph node metastasis of papillary thyroid carcinoma.Methods: Selection of thyroid papillary carcinoma of the lymph node surgery to remove the 62 patients with thyroid papillary carcinoma and preoperative patients with access to ordinary clinical data such as gender,age,serological TSH and VEGF expression level,at the same time in preoperative ultrasound scanning in patients with carcinoma nodules seized position,number,size,edge,inner echoes,internal calcifications type,nodular and capsular relations,nodule number of internal blood flow,blood flow spectrum parameters RI,PI and PSV value.Postoperative pathological data of dissected lymph nodes of all patients were obtained,including benign and malignant lymph nodes and clinical divisions of metastatic lymph nodes.All patients were divided into cervical lymph node metastatic group and non-metastatic group,as well as central lymph node metastatic group and non-metastatic group,LNM was associated with lymph node metastasis in any region or region of the neck,while CLNM was associated with central lymph node metastasis with or without lateral cervical lymph node metastasis.Using chi-square contrast between neck lymph node metastasis group and lymph node metastasis in central counting data differences between groups,using t test or nonparametric the Mann-Whitney U rank and inspection contrast between neck lymph node metastasis group and the central counting data difference between lymph node metastasis group,will have the information statistically analyzed many factors,it is concluded that the neck lymph node metastasis and the transfer of the independent risk factors of lymph node in central region.At the same time,the ROC curve was used to calculate the cut-off value and diagnostic efficiency of statistically significant measurement data in the diagnosis of cervical lymph node metastasis and central lymph node metastasis,and the area under the curve was compared.Results: Of the 62 patients,36 patients developed LNM(58.1%),26 patients did not(41.9%),24 patients developed CLNM(38.7%),and 38 patients did not develop CLNM(61.3%).Multivariate analysis showed that male,> 10 mm in diameter,≥2lesions,and elevated serum TSH expression were independent risk factors for LNM in PTC nodules.Age ≤45 years old,distance between PTC nodules and capsule≤5mm,pointlike calcification foci were independent risk factors for CLNM of PTC nodules.The ROC curve showed that there was no statistical difference in diagnostic efficacy between the spectral Doppler parameters and the serological parameters(P >0.05),and the combination of the spectral Doppler parameters and the serological parameters had the highest diagnostic efficacy in predicting cervical lymph node metastasis(sensitivity: 0.861,specificity: 0.885,AUC: 0.913,95% confidence interval: 0.836-0.980).Conclusion:1.Young male PTC patients have a higher risk of lymph node metastasis,so attention should be paid to cervical lymph nodes,especially the central lymph nodes,during ultrasound scanning,and more active treatment strategies should be adopted,such as surgery and cervical lymph node dissection.2.During the ultrasound scanning,PTC nodule diameter > 10 mm or lesion number 2 or more,or serological detection prompt TSH > 2.145U/ml,we should carefully scan cervical lymph nodes in each partition,in order to avoid omissions suspicious metastasis lymph node lesions,PTC nodules appear at the same time the internal point calcifications or cancer nodules from the sonographic features such as coated distance of 5 mm or less,should pay attention to scan of neck lymph node in central region.3.Spectral Doppler measurements should be performed for PTC nodules of which internal and peripheral arterial blood flow can be detected,If RI and PI values were higher than the cut-off value,if RI > 0.755 and PI >1.075,the risk of cervical lymph node metastasis can be comprehensively assessed by combining the expression levels of TSH and VEGF with patients’ serological indicators,and doppler parameter,so as to provide a reliable basis for clinical treatment of papillary thyroid carcinoma.