| This study analyzed the ultrasonic image and relevant clinic pathological features of the primary lesion and cervicall metastatic lymph nodes of 120 patients with differentiated thyroid carcinoma(DTC).The purpose of the study is to investigate the relationship between ultrasonographic features,general clinicopathological features and cervical lymph node metastasis,to figure out the independent risk factors of LNM of DTC.This will further provide diagnostic means for cervical lymph node metastasis of DTC,so as to optimize the surgical plan,minimize the postoperative complications of patients,and improve the quality of life and prognosis of DTC patients.This study has a retrospective selection of 120 patients with differentiated thyroid carcinoma who were hospitalized in surgical department at the Affiliated Hospital of Inner Mongolia Minzu University from January 2019 to December 2022 and also met the inclusion criteria of the study.The relevant clinicopathological data of 120 patients with differentiated thyroid cancer were recorded,and the ultrasonographic features of the primary tumor and cervical Lymph nodes(LN)were recorded,Such as gender,age,extrathyroidal infiltration,and Hashinotos Thyroiditis,HT),nodular nodules,maximum diameter,number,tumor distribution,margin,morphology,calcification,Anteroposterior to transverse diameter ratio of the primary lesions,Anteroposterior to transverse diameter ratio,and anteroposterior to transverse diameter ratio of the primary lesions.A/T),the relationship with the capsule,the hilar and medullary structure of LN,the morphology of LN,and the blood flow signal of LN.According to the type of thyroid cancer and the pathological results of cervical lymph nodes,the patients were divided into three groups,They were: 1.Differentiated thyroid carcinoma with or without cervical lymph node metastasis;2.Papillary thyroid carcinoma(PTC)with or without cervical lymph node metastasis;3.Follicular thyroid carcinoma(FTC)with or without cervical lymph node metastasis.Univariate and multivariate analysis were used to investigate the correlation between the general clinicopathological characteristics and ultrasound image features of patients with differentiated thyroid cancer,papillary thyroid cancer and follicular thyroid cancer and cervical lymph node metastasis.Results of study1.It is found in the univariate analysis of patients with DTC that the differences between the two groups were statistically significant(P<0.05),in which those single factors include the number,tumor distribution,maximum diameter,A/T and calcification of primary lesions,extraglandular infiltration,the relationship with the integument,combined Hashimoto’s thyroiditis(HT),cervical lymph node metastasis suggested in ultrasonic image,portal medulla structure of LN,near circle of LN,blood flow signal of LN,age and sex.There was no significant difference(P>0.05)between the two groups in the boundary and shape of the primary lesion and the combination of thyroid nodules(see Table 3.2).A logistic regression analysis was conducted to various factors affecting the metastasis of cervical lymph nodes of DTC.It is indicated from the results of the analysis that those male cases(age<55)with the maximum diameter of the primary lesion greater than 10 mm and the aspect ratio of the primary lesion≥1 have multiple primacy lesions which are close to the integument in ultrasound image.The ultrasound detection results showed that lymph node metastasis was an independent risk factor for the metastasis of cervical lymph nodes of DTC.2.According to a univariate analysis of the patients with papillary thyroid carcinoma(PTC),it is found that there is statistically significant difference(P<0.05)between the two groups,including the number,tumor distribution,maximum diameter,A/T and calcification of primary lesions,extraglandular infiltration,combined Hashimoto’s thyroiditis(HT),cervical lymph node metastasis suggested in ultrasonic image,portal medulla structure of LN,near circle of LN,blood flow signal of LN,age and sex.There was no significant difference(P>0.05)between the two groups was found in terms of the boundary and shape of the primary lesion and the combination of thyroid nodules(see Table 3.4).A logistic regression analysis was also conducted to various factors affecting the cervical lymph node metastasis of PTC.It is showed from the results that those male cases(age<55)with the maximum diameter of the primary lesion greater than 10 mm have lymph node metastasis and multiple primacy lesions which are close to the integument indicated in ultrasound image.Extraglandular infiltration was an independent risk factor for the metastasis of cervical lymph nodes of PTC.3.A univariate analysis was also made for those patients with follicular thyroid carcinoma(FTC).It is found that the metastatic rate of cervical lymph node of patients with primary lesion A/T<1 was lower than that of patients with primary A/T ≥1.And those patients with regular LN blood flow signals have a lower metastasis rate of neck lymph node than patients with irregular LN blood flow signals,with a statistically significant difference(P<0.05)(see Table 3.6).No statistically significant difference between the two groups was found in terms of the number,tumor distribution,shape,maximum diameter and calcification of primary lesions,the relationship with the integument,extraglandular infiltration,combined Hashimoto’s thyroiditis(HT),combined thyroid nodules,cervical lymph node metastasis suggested in ultrasonic image,portal medulla structure of LN,near circle of LN,blood flow signal of LN,age and sex(all P>0.05).Conclusion:1.The independent risk factors of neck LNM in DTC are male,age < 55 years,maximum diameter of primary lesion > 10 mm,A/T≥1,close to the capsule,multifocus,and neck LNM on ultrasound.2.The independent risk factors of cervical LNM in PTC are male,age < 55 years,maximum diameter of the primary tumor > 10 mm,adjacent to the capsule,extrathyroidal invasion,multifocality,and cervical LNM on ultrasound.3.The risk factors of neck LNM in FTC are A/T≥1 of primary lesion and irregular blood flow signal of neck LN in ultrasound image features. |
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