| Objective: A retrospective analysis of clinical and ultrasound imaging data from 1190 patients with PTMC in a single center was conducted with the aim of exploring the correlation between clinical and imaging features and other factors and the risk of lymph node metastasis in patients with PTMC,and providing a reference for predicting lymph node metastasis in the neck in patients with PTMC.Methods: Through the HIS system workstation and PACS system,1190 PTMC patients who had thyroid ultrasound examination with complete surgical pathology results at Peking University Shenzhen Hospital from January 2018 to December 2020 were included in the study.Basic clinical information,ultrasound information and pathology information results of patients were collected,and the correlation between ultrasound image characteristics of tumors and lymph node metastasis was analyzed using statistical methods with surgical and puncture biopsy pathology as the gold standard,and the diagnostic efficacy of the model was assessed by subject operating characteristic curve(ROC).Results: A total of 1190 patients with PTMC were included in this study,with a male to female ratio of 1:2.83;age range 19-70 years,mean age(38.26±10.25)years;maximum diameter of malignant nodules was 2.0-10.0 mm,mean diameter(6.84±1.71)mm.regional distribution of metastases: 0 in region I,55 in region II,116 in region III,99 in region IV,and 15 in Zone V,and 2 in Zone VII.The sensitivity of ultrasound diagnosis of lymph node metastasis was 41.3%(258/625),specificity 83.5%(472/565),positive predictive value 73.5%(258/351)and negative predictive value 56.3%(472/839).The sensitivity of ultrasound suggestive of lymph node metastasis in the central region was25.9%(156/603),specificity 88.2%(518/587),positive predictive value 69.3%(156/225),and negative predictive value 53.7%(518/965).The sensitivity of ultrasound suggestive of lymph node metastasis in the lateral region was 40.3%(64/159),the specificity was94.4%(973/1031),the positive predictive value was 52.5%(64/122),and the negative predictive value was 91.1%(973/1068).The univariate and multifactorial analyses revealed that age ≤35 years,male,number of malignant tumors with multiple foci,breakthrough of envelope,punctate calcification,and no nodular goiter were independent risk factors for lymph node metastasis in the neck of PTMC,and the ROC curve was plotted to evaluate the diagnostic efficacy of the model,and the area under the ROC curve was obtained as 0.707,which can effectively evaluate the metastasis of lymph nodes in the neck.Conclusion: Age ≤35 years,male,number of malignant tumors as multifocal,breach of envelope,punctate calcification,nodular goiter without nodular metastasis and PTMC neck lymph node metastasis were closely associated.This model can effectively assess the cervical lymph node metastasis in PTMC.Treatment plans should be prepared carefully when patients have the above factors.However,the results of multifactorial analysis of tumor size and location showed no correlation with neck metastasis,probably because of the single-center approach.It is hoped that more multi-center studies with large samples and long-term follow-up can be implemented in the future to better understand the surgical risk and risk factors of thyroid cancer. |
PDF Full Text Request