Construction Of Papillary Thyroid Carcinoma Lateral Cervical Lymph Node Metastasis Risk Classification System

Background:Thyroid papillary carcinoma originates from filter bubbles and is the most common type in thyroid malignant tumors,accounting for 80%-90%of all thyroid cancer.Despite the high degree of PTC degree,slow progress,but the lymph node rate of the neck can reach22%-80%.Among them,the incidence of lateral neck lymph node metastasis in well differentiated reaches 30%to 60%.Whether the neck lymph node is transferred to the surgical method and the scope of the surgical range.Therefore,preoperative diagnosis of neck lymph node metastasis is critical in clinical treatment.At present,ultrasound is the main inspection method for the evaluation of thyroid tumor,which has a high sensitivity to diagnosis-side neck lymph node metastasis.In recent years,ultrasound guidance under ultrasound,puncture,puncture,BRAF gene detection,puncture tissue,thyroglobulin detection,high sensitivity,high height is applied to diagnosis of thyroid cancer neck lymph However,as a creative examination,the application of fine needle puncture technology needs to be evaluated.This study combines the current domestic and foreign metastatic neck lymph node ultrasound symbols,ultrasound guidance,fine needle penetration test and clinical application status,aiming to establish a relatively complete PTC side neck lymph node metastasisPurpose:（1）To explore the diagnostic efficacy of color Doppler ultrasound and ultrasound,fine needle puncture live insurgents on lateral cervical lymph node metastases in the diagnosis of thyroid papillary cancer;（2）According to the clinical information of PTC,ultrasonic characteristics of metastasis lymph nodes and puncture results were constructed before the treatment of PTC side neck lymph node transfer risk classification model.MethodsCollection January 2018-August 2018 in the first hospital of Jilin University Adopting ultrasonic diagnostic,guide the patient to take the supine position,so that the head is rear,the mandibular is lifted,fully exposed the neck,and the neck of the patient has a routine cross-cut,longitudinal,slope,etc.And 103 lymph-based ultrasound,fine needle puncture,in ultrasound guidance,the lymph node,negative pressure suction lesions,3 to 4 times,repeated puncture needle 3 to 4 times,acquisition The risk layering model is constructed under the patient’s clinical information,ultrasonic signs and ultrasound guidance.Data processing application SPSS26.0 software is done.Single factor analysis adoptsχ~2test,Fisher precise test,P<0.05 is statistically significant.Multi-factor test uses two-class Logistic regression analysis;establishing a ROC curve model,using specificity,sensitivity,and curve as an evaluation risk layered diagnostic performance index.ResultHigh-frequency color Doppler ultrasound detects 508 target lymph nodes,with postoperative pathology and fine needle puncture live in surgery（cytology,puncture cleansing Tg,BRAF gene joint test）result is gold standard,It was confirmed that the positive lymph nodes were 439,and the negative lymph nodes were confirmed;65 lymph nodes were located in the II,and 195 lymph nodes were located in III,246 lymph nodes in IV.2 lymph nodes in V zone;475 can be seen that the internal echo is uneven,207 can be seen that the lymphatic door structure disappeared/unclear,168 visible pulp structure disappeared,202 visible near circles,283 Visible calcification,69 visible volatility,122visible blood flow signals;101 thin needles under the ultrasound guide,including 82 positive lymph nodes,19 positive;high frequency Color Doppler ultrasound diagnosis of PTC side neck lymph node metastasis sensitivity,special ratio,with a compliance rate of 72.7%,65.2%,86.4%,FNAC diagnostic sensitivity,specificity,Positive predictive value,negative predictive value,accuracy is 96%,64%,91%,82%,89%,FNA-BRAF diagnostic sensitivity,specificity,positive predictive value,negative The predicted value,the accuracy is 85%,95%,99%,64%,87%,FNA-Tg diagnostic sensitivity,specificity,positive predictive value,negative predicted value,accuracy,respectively,96%,100.0%,100%,88%,97%,FNAC combined with BRAF diagnostic sensitivity,specificity,accuracy rate of 96%,86%,94%,FNAC combined with FNA-Tg the diagnostic sensitivity,specificity,accuracy rate of 100%,86%,97%,FNAC combined with FNA-BRAF,FNA-Tg detection diagnostic sensitivity,specificity,accuracy of 100%,91%,98%;risk layered model ROC curve under the area（AUC）is 0.867（95%CI=0.819-0.915）,sensitive 81.3%,specificity 75.4%.Conclusion（1）High-frequency color Doppler ultrasound has high sensitivity,specificity and accuracy of the diagnosis of thyroid papillary carcinoma,and the transfer lymph node has a certain ultrasound characteristic.（2）Ultrasound guided fine needle puncture cytology,BRAF gene,puncture Tg combined detection diagnosis value is higher than high frequency color Doppler ultrasound and ultrasonic guidance under fine needle puncture cytology,BAAF gene joint testing,The TG single test of the puncture liquid was significantly improved,which significantly improved the accuracy of diagnosis of thyroid papillary cancerous neck node metastasis.（3）According to the patient’s gender,age,lymph node ultrasound changes,the preoperative diagnosis lymph node metastasis risk layered model constructed under ultrasound guidance,simple and easy,high diagnostic value,contributing to clinical evaluation Papillary thyroid carcinoma neck transfer lymph nodes malignant risks.