| Objective:Papillary Thyroid Carcinoma can cause lymph node metastasis in the neck.When lymph node metastasis occurs after surgery,it will be more difficult to continue surgical treatment and may be accompanied by various complications.Overall,the accuracy of preoperative assessment is particularly important in determining whether lymph node metastasis is performed,lymph node dissection,and the extent of dissection.By retrospective analysis of the individual characteristics of patients with central lymph node metastasis of thyroid papillary carcinoma,we can better understand the risk factors associated with lymph node metastasis,and then accurately evaluate the individual characteristics and related risk factors of patients.In order to clarify the indications and scope of the dissection of the central lymph node,and to conduct clinical research and analysis on the basic ultrasound examination which is indispensable for thyroid examination and diagnosis.Finally,this study will provide an effective and beneficial reference for further optimizing the individualized and accurate diagnosis and treatment process of patients in clinical practice.This retrospective study aims to provide reference for the selection of surgical protocols for central lymph nodes by studying the relationship between the general data of patients with papillary thyroid carcinoma,the features of ultrasonic images and risk factors related to central lymph node metastasis.Methods:A total of 431 patients admitted to the Department of Head and Neck Surgery,Affiliated Cancer Hospital of University of Electronic Science and Technology of China from January 2022 to July 2022,who met the inclusion criteria and were pathologically diagnosed as papillary carcinoma of thyroid after surgery,were collected and retrospectively analyzed.Unilateral glandular lobe and isthmus resection plus unilateral central lymph dissection or total thyroidectomy plus bilateral central lymph node dissection were performed in all cases.The clinical data of 431 patients with thyroid papillary carcinoma were retrospectively analyzed.For example,analysis of gender,age,height,weight,preoperative thyroid-stimulating hormone,preoperative blood glucose level,color doppler ultrasonography of thyroid nodule location,location,number,relationship with capsule,maximum diameter of nodule,nodule echo level,nodule boundary nodule blood flow signal,nodule calcification,thyroid background,lymph node condition in ultrasound,and postoperative pathology of central lymph node transfer the above situation.Data management and analysis are carried out for the above characteristics.The clinical characteristics of patients and the evaluation effect of preoperative ultrasound images were evaluated.There were 147 patients with left lesion and204 patients with right lesion.The above features of the primary lesions of different sides and whether or not the central lymph node metastases and the number of metastases were analyzed retrospectively.Finally,the purpose of further specific analysis of central lymph node metastasis is to provide evidence for guiding central lymph node dissection indication and scope.Results:The male to female ratio of 431 patients with papillary thyroid carcinoma in this study was 1:3.31.375 patients were younger than 55 years old,and 56 patients were older than 55 years old,with an average age of40.33±11.17 years old.The positive rate of central lymph nodes in thyroid papillary carcinoma was 44.55%(192/431).Univariate analysis of central lymph node metastasis in patients with thyroid papillary carcinoma showed the following results: Men,less than 55 years old,tumor located in bilateral,tumor located in glands under a third group,the infringement of capsule,tumor diameter greater than 2 cm,multiple lesions and normal thyroid parenchyma and blood flow signal and calcification,colour to exceed,swollen lymph nodes are more likely to occur in the central of lymph node metastasis(P ＜ 0.05).Multivariate Logistic regression analysis was performed on the status of central lymph node metastasis.The results showed that the independent risk factors for central lymph node metastasis were younger than 55 years old,tumors larger than 1 centimeter in diameter,lower-middle tumor location,multiple lesions,normal thyroid parenchyma,and calcification.Hashimoto’s thyroiditis and nodular goiter are relative protective factors for central lymph node metastasis.The Hosmer-Lemeshow test of the regression model showed that P=0.626 and AUC was 0.745.147 patients with left lesion and 204 patients with right lesion were analyzed respectively.Left central lymph node metastasis rate of 41.50%;Superficial lymph node metastasis rate of right recurrent laryngeal nerve36.76%;Deep lymph node metastasis rate of right recurrent laryngeal nerve was 20.59%.The results of univariate analysis of lymph node metastasis in the left central region,superficial layer of right recurrent laryngeal nerve and deep layer of right recurrent laryngeal nerve are as follows.Tumors larger than 2centimeters in diameter,calcification and blood flow signal and colour to exceed lymph node enlargement,the more prone to left central lymph node metastasis(P ＜ 0.05).Infringement of capsule and colour to exceed lymph node enlargement has left the central lymph node metastasis number greater than or equal to the probability of three lead to greater(P ＜ 0.05).Male,younger than55 years old,tumors larger than 2 centimeters in diameter,multiple lesions,normal thyroid parenchyma,right recurrent laryngeal nerve deep lymph node metastasis,right recurrent laryngeal nerve deep lymph node metastasis more than or equal to 3 more likely to present superficial lymph node metastasis of right recurrent laryngeal nerve(P ＜ 0.05).Tumors larger than 2 centimeters in diameter,the greater the colour to exceed in lymph node enlargement is right laryngeal recurrent nerve area of shallow lymph node metastasis number greater than or equal to the probability of three lymph node will be greater(P ＜0.05).Male,invasion of capsule,tumors larger than 2 centimeters in diameter,the lesions located in the middle,nodules,right laryngeal recurrent nerve fuzzy boundaries of shallow lymph node metastasis and transfer number greater than or equal to three lymph nodes is more prone to deep right laryngeal recurrent nerve lymph node metastasis(P ＜ 0.05).Right laryngeal recurrent nerve of shallow lymph node metastasis appeared right laryngeal recurrent nerve deep lymph node metastasis number greater than or equal to the probability of three lymph node will be greater(P ＜ 0.05).The results of multivariate Logistic regression analysis of lymph node metastasis in the left central area,the superficial area of the right recurrent laryngeal nerve and the deep area of the right recurrent laryngeal nerve are shown as follows.Tumors 1 to 2cm in diameter,calcification,and blood flow signal were independent risk factors for left central lymph node metastasis.The independent risk factors for superficial lymph node metastasis of the right recurrent laryngeal nerve were those less than 55 years old,deep lymph node metastasis of the right recurrent laryngeal nerve and multiple lesions.Superficial lymph node metastasis of the right recurrent laryngeal nerve,tumor diameter greater than 2cm and tumor location in the middle and lower parts are risk factors for lymph node metastasis in the deep region of the right recurrent laryngeal nerve.Tumor diameter greater than2 cm was independent risk factor for the number of superficial lymph node metastases in the right recurrent laryngeal nerve.Hosmer-Lemeshow test was0.415 and AUC was 0.754 in the model of left central lymph node metastasis.Hosmer-Lemeshow test was 0.342 and AUC was 0.756 for superficial lymph node metastasis model of right recurrent laryngeal nerve.The Hosmer-Lemeshow test value of the superficial lymph node metastasis model of the right recurrent laryngeal nerve was 0.215,and the AUC was 0.748.Hosmer-Lemeshow test was 0.662 and AUC was 0.877 in the model of lymph node metastasis in the deep region of the right recurrent laryngeal nerve.Conclusion: The central lymph nodes were analyzed by Logistic regression.The results showed that the risk factors of central lymph node metastasis were less than 55 years old,Tumors larger than 1 centimeter in diameter,middle-lower tumor location,normal thyroid parenchyma,multiple lesions and calcification.Tumors 1 to 2cm in diameter,calcification,and blood flow signal were risk factors for left central lymph node metastasis.The risk factors for superficial lymph node metastasis of the right recurrent laryngeal nerve were those under 55 years of age,deep lymph node metastasis of the right recurrent laryngeal nerve and multiple lesions.Superficial lymph node metastasis of the right recurrent laryngeal nerve,tumor diameter greater than2 cm and tumor location in the lower middle were risk factors for lymph node metastasis in the deep region of the right recurrent laryngeal nerve.Tumor diameter greater than 2cm was independent risk factor for the number of superficial lymph node metastases of the right recurrent laryngeal nerve.Ultrasonography plays an important role in the evaluation of central lymph node metastasis,which is more beneficial to the detailed development of individualized and optimized diagnosis and treatment plans for clinical patients and to reduce unnecessary preventive central lymph node dissection. |
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