Clinical Features And Diagnostic Efficiency Analysis Of Papillary Thyroid Carcinoma With Hashimoto’s Thyroiditis

Objective: To investigate the clinical characteristics,lymphatic metastasis features,diagnostic efficiencies of preoperative thyroid peroxidase antibody(TPO-Ab)and Thyroglobulin antibody(TG-Ab),and ultrasound-guided fine needle aspiration cytology(FNAC)for papillary thyroid carcinoma(PTC)with Hashimoto thyroiditis(HT),providing valuable information for clinical diagnosis and treatment in the future.Methods: According to the relevant inclusion and exclusion criteria,142 cases with PTC,including 41 cases of papillary thyroid carcinomawith Hashimoto’s thyroiditis(HTPTC)and 101 cases of simple PTC,were selected from the Affiliated Tumor Hospital of Guangxi Medical University from June2019 to October 2020.Clincal materials of these HTPTC and simple PTC cases,including sex,age,maximum diameter of the primary lesions,microcarcinoma multiple lesions,capsular invasion,combination with HT,preoperative,Preoperative TNM staging,TSH,TT4,TT3,FT4,FT3,TPO-Ab level and TG-Ab level.We consequently compared the differences of these indexes between the two groups,and analyzed the sensitivity and specificity of TPO-Ab and TG-Ab in HTPTC diagnosis using Receiver operating characteristic curve(ROC).We further investigate the effects of sex(male or female),age(≤44 years or > 44 years),maximum diameter of the primary lesions(≤2cm or >2cm),microcarcinoma(yes or not),multiple lesions(yes or not),capsular invasion(yes or not),combination with HT(yes or not),TPO-Ab level and TG-Ab level on the lymphatic metastasis features in central neck in HTPTC and PTC cases,including lymphatic metastasis risk,proportion and the number of metastatic lymph node.We also study the relationship between TPO-Ab and TG-Ab level using Spearman correlation analysis.Among the 142 cases studied,104 cases including 29 with HTPTC and 75 with merely PTC received FNAC in our hospital or in other medical institutes.In the following study,we collected the positive rate of malignancy or suspicious malignant diagnose between the HTPTC and PTC cases and analyzed the possible effect of HT presence on the FNAC diagnostic efficiency.Statistical analyses were performed using SPSS statistical software.Results: Altogether 142 patientswere selected for the study,among whom there were 101 cases with PTC and 41 cases HTPTC.And the corresponding results showed below.1.The differences of the general characteristics of the two groups: compared with simple PTC patients,the proportion of female patients significantly increased(85.4% vs 68.3%,P = 0.039)among those HTPTC patients;the risk of the neck central lymph node metastasis(51.2 % vs 30.7 %)(P=0.021)was significantly higher among HTPTC cases than that among those with PTC;the preoperative positive rates of TPO Ab(61.0% vs 17.8%,P<0.001)and preoperative TG Ab(73.2% vs 23.8%,P<0.001)were both significantly higher among HTPTC cases than those among the PTC cases.We also found that level of preoperative FT3 in HTPTC patients was significantly lower than that in PTC patients(4.65±0.44 vs 4.84±0.64,p=0.040).2.The possible link between TPO-Ab and TG-Ab.Among HTPTC and PTC patients,the preoperative levels of TPO-Ab were both in significantly positive correlation with preoperative TGAb level.3.The diagnostic effiencies of TPOAb and TGAb in HTPTC: AUC for TPO-Ab using ROC was 0.725,and the cut-off value was 4.035 m IU/L when the Youden index was the largest,with the corresponding sensitivity and specificity being 61.0% and 82.2%,respectively(P<0.001);and the AUC for TG-Ab was 0.810,with the optimum cut-off value,sensitivity and specificity being 10.53 m IU/L,68.3% and 85.1%,respectively(P<0.001).4.Possible effect of the clinical characteristics on the lymphatic metastasis in PTC patients: our univariate analysis showed that HT presence(40.4% vs 22.2%,P=0.021)、age(71.2% vs 40.0%,P<0.001)、microcarcinoma(44.2% vs 72.2%,P=0.001)were significantly linked to the risk of central metastasis of lymph node of PTC,and the subsequent multivariate analysis showed that microcarcinoma(OR=0.319,95% CI=0.148-0.688,P=0.004)may be a independent protective factor for lymph node involvement.HT presence(OR=2.515,95%C.I.=1.141-5.545,P=0.022)may be a independent risk factor for lymph node metastasis.The analysis of central lymph node metastasis in HTPTC showed that microcarcinoma(42.9% vs 80.0%,P = 0.015)might be an independent protective factor for central lymph node metastasis in htptc.We further performed inspected the possible factors related to the number of metastatic lymph node and the proportion of the metastatic lymph node(metastatic lymph node number/without metastasis lymph node number)in the central neck region.And the results indicated that,among the male patients(33.7% vs 25.6%,P=0.036)、those with capsular invasion(42.1% vs 18.0%,P <0.001)、maximum diameter of the primary lesion >2cm(39.0% vs 25.7%,P=0.005),the proportion of metastatic lymph node in central neck region were significantly higher.Among those with microcarcinoma(18.0% vs 41.8%,P<0.001),the proportion of metastatic lymph node was significantly higher than that among those with non-microcarcinoma.As for the number of metastatic lymph nod,we found that its was significantly higher among those with capsular invasion [3.00(2.00,4.00)vs 1.00(1.00,2.75),P=0.029]、HT presence [4.00(1.50,5.00)vs 2.00(1.00,3.00),P=0.039] than that among those without capsular involvement and HT,respectively.Our data also showed that,TPO-Ab level in the HTPTC group was negatively associated with the proportion of metastatic lymph node in the central neck region(r=-0.337,P=0.036),but it was not the case for TG-Ab level.In the PTC,both TPO-Ab and TG-Ab level were not significantly associated with the proportion of metastatic lymph node in the central neck region.In the study investigating the effect of HT on the diagnostic efficiency,we analyzed the results of the preoperative FNAC,and found that correct diagnosis rate in the HTPTC group was significantly lower than that in the PTC group(55.2% vs 76.0%,P=0.037).Conclusion:The proportion of women in HTPTC is higher than that in those with PTC;The risk of central neck lymph node metastasis in patients with HTPTC may be higher than that in patients with PTC,HT presence may be a independent risk factor for lymphatic metastasis in central neck region in PTC;Level of preoperative TPO-Ab and TG-Ab may be in positive correlation among both HTPTC and PTC patients;Microcarcinoma may be independent protective factor for lymphatic metastasis in central neck region in HTPTC patients;The increase of TPO-Ab and-TG Ab in peripheral blood of PTC patients may indicate the presence of HT with relatively higher sensitivity and specificity;Preoperative TPO-Ab level may present a negatively association with the proportion of metastatic lymph node in central neck region in HTPTC;HT may reduce the preoperative diagnostic rate of PTC using ultrasound-guided FNAC.