The Relationship Between Ultrasonographic Characteristics Of Papillary Thyroid Microcarcinoma And HPSE、VEGFC-C With Cervical Lymph Node Metastasis

Background With the widespread application of high-frequency ultrasound and fine-needle aspiration biopsy,the detection rate of papillary thyroid microcarcinoma is increasing year by year,becoming the fastest-growing endocrine tumor in the world.It is of great significance to judge whether it is inert growth or aggressive growth before operation to guide clinical treatment.Objective To analyze the ultrasonographic features of thyroid papillary microcarcinoma（thyroid papillary microcarcinoma,PTMC）nodules and the relationship between the expression of vascular endothelial growth factor C（vascularendothelialgrowthfactor C,VEGF-C）,heparanase（Heparanase,HPSE）and cervical lymph node metastasis,and to explore the predictors of cervical lymph node metastasis so as to provide valuable information for clinical treatment.Methods（1）A total of 60 patients who underwent radical PTMC operation in our hospital were collected,including 30 patients with cervical lymph node metastasis and 30patients without cervical lymph node metastasis confirmed by pathology.They were divided into two groups:cervical lymph node metastasis group and non-metastasis group.（2）The ultrasonographic images of patients with PTMC were extracted before operation,and the following features of each case were recorded:nodule location,size,shape,boundary,aspect ratio,multifocal,internal echo,calcification,blood supply pattern,invasion of thyroid capsule.（3）Analyse the relationship between the location,size,shape,boundary,aspect ratio,multifocality,internal echo,calcification,blood supply pattern,invasion of thyroid capsule and cervical lymph node metastasis.（4）Immunohistochemical En Vision method was used to detect the expression of HPSE and VEGF-C in PTMC tissues.（5）The expressions of HPSE and VEGF-C in cancer tissue,adjacent tissue,cervical lymph node metastasis group and non metastasis group were analyzed.（6）The indexes with statistical significance in univariate analysis were included in multivariate Logistic regression analysis.Results（1）Univariate analysis showed that the age of the patient was less than 46 years old(c^（17）=2.730,P=0.006),the nodule was located in the middle thyroid(c^（17）=11.431,P=0.003),the length and diameter of the nodule≥0.5cm(c^（17）=2.844,P=0.004),multiple nodules(c^（17）=15.152,P<0.001),calcification inside the nodule(c^（17）=4.267,P=0.039),and the blood flow pattern of the nodule(c^（17）=8.271,P=0.041)was correlated with cervical lymph node metastasis,which were the risk factors of cervical lymph node metastasis in PTMC.（2）The expression of HPSE in cancer tissue was higher than that in paracancerous tissue（z=-3.302,P=0.001）,and the expression of VEGF-C in cancer tissue was higher than that in paracancerous tissue（z=-2.860,P=0.004）.（3）the expression of HPSE in cervical lymph node metastasis group was higher than that in non-metastasis group（z=-3.467,P=0.001）,and the expression of VEGF-C in cervical lymph node metastasis group was higher than that in non-metastasis group（z=-3.087,P=0.002）.（4）Age<46 years old（OR=4.994,P=0.020,95%CI=1.290～19.342）,nodules≥0.5cm（OR=7.039,P=0.006,95%CI=1.772～27.955）,nodules with multiple foci（OR=5.142,P=0.008,95%CI=1.522～17.364）,nodules with calcification（OR=7.423,P=0.011,95%CI=1.595～34.539）,positive expression of VEGF-C（P<0.05）and positive expression of HPSE（P<0.05）were independent risk factors for cervical lymph node metastasis of PTMC.Conclusion The age of patients<46 years old,PTMC nodules≥0.5cm,multiple nodules,calcification in nodules,positive expression of VEGF-C in PTMC cancer tissue,positive expression of HPSE in PTMC cancer tissue are independent risk factors of PTMC cervical lymph node metastasis,and are important predictors of PTMC lymph node metastasis.PTCM with these characteristics had strong invasiveness and metastasis.