Correlation Analysis Of Ultrasonic Findings And Cervical Lymph Node Metastasis In Multifocal Papillary Thyroid Carcinoma And Construction Of Prediction Model

Objective:To analyze the ultrasonographic features and clinical parameters of Multifocal papillary thyroid carcinoma（MPTC）,and to explore its relationship with Cervical Lymph Node Metastasis（Cervical Lymph Node Metastasis,MPTC）.In order to screen out the high-risk factors of CLNM,improve the effective prediction rate of CLNM before operation,and provide information for clinical diagnosis and treatment strategies.Methods:Between January,2021 and December,2022,389 patients with MPTC confirmed by thyroid surgery and postoperative pathology in our hospital were included in this study.According to the postoperative pathological results,the patients were divided into the cervical lymph node metastasis group and the non-metastasis group.Univariate and multivariate analyses were performed to evaluate the predictive model of CLNM.Results:Univariate analysis showed that:Gender,number of lesions,BRAF^V600Egene mutation,Total tumor diameter（TTD）,Hashimoto’s Thyroiditis（HT）,Nodular goiter（NG）,calcification type,the sum of ACR（American College of Radiology）scores of all nodules in single case,and the highest ACR score in single case were correlated with CLNM,and the difference was statistically significant（P<0.05）.The number of MPTC lesions was positively correlated with capsular invasion and extrathyroidal extension.With the increase of the number of lesions,the invasion of MPTC was significantly enhanced.Multivariate analysis showed that the number of lesions≥3,BRAF^V600Egene mutation,microcalcification,highest ACR score>11,TTD>1.6cm were closely related to cervical lymph node metastasis.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value and negative predictive value of the CLNM prediction model were 84.24%,70.97%,2.9,0.22,76%,80.5%,and the maximum Youden index was 0.5520.The coincidence rate was 77.89%.The Kappa value was 0.572,indicating that the prediction results of the model were consistent with the pathological results.The AUC was 0.856,Hosmer-Lemeshow goodness of fit test showed?²=12.181,P=0.143,P>0.05,suggesting that the discrimination ability and accuracy of the model were good,and the predictive efficacy of the model was high.Conclusion:The prediction model based on preoperative ultrasound and clinical features of MPTC has a certain value in predicting CLNM.The clinical application is simple,convenient and non-invasive,which can effectively improve the preoperative diagnostic efficiency.