Ultrasonography In The Preoperative Diagnosis And Prediction Of Cervical Lymph Node Metastases In Patients With Papillary Thyroid Carcinoma

Chapter Ⅰ Analysis of ultrasonographic risk factors predicting cervical nodal metastases in patients with papillary thyroid cancerPurposeTo evaluate the usefulness of tumor characteristics on conventional ultrasonography, elastosonography and contrast-enhanced ultrasonography for predicting cervical nodal metastases in patients with papillary thyroid cancer.Material and methodsThis study enrolled215patients with225PTC who underwent surgery between January2012and November2013. The preoperative ultrasonographic findings of each case were analysed. Results1. A total of215patients with225PTC who underwent thyroidectomy and central compartment neck dissection. There were129patients with PTC≤10mm and96patients with PTC>10mm. With regarding to lymph node metastasis, ipsilateral central lymph node involvement comprised40.9%, whereas contralateral lymph node involvement comprised4.9%of the total patients.(1) An age of<45years, size, microcalcifications, vascularity, centripetal enhancement, hyper-or isoechoic PI intensity, hyper-or isoechoic wash-in intensity, dP>0were significantly associated with central lymph node metastasis in patients with PTC.(2) An age of<45years, vascularity, hyper-or isoechoic PI intensity dP≥0were significantly associated with central lymph node metastasis in patients with PTMiC.(3) An age of<45years, size, male, A/T≥1, microcalcifications and vascularity were significantly associated with central lymph node metastasis in patients with PTMaC.2. A total of56patients with PTC who underwent lateral compartment neck dissection. Lateral lymph node involvement comprised64.3%. Only size and central lymph node involvement were significantly associated with lateral lymph node metastasis in patients with PTC.3. Fifty-seven (25.3%) of the225PTC had the presence of thyroid capsular invasion. An age of≥45years, size, centripetal enhancement, hypoechoic PI intensity, PI、Sharpness、dP、dT、dP<0were predictive for the presence of thyroid capsular invasion. ConclusionsPreoperative tumor characteristics on ultrasonography correlated with cervical lymph node metastases and thyroid capsular invasion for papillary thyroid carcinoma and may serve as preoperative supplementary markers for determining the optimal extent of surgery. Chapter Ⅱ Diagnostic criteria of ultrasonographic examination for cervical lymph node metastasis of papillary thyroid carcinomaPurposeThe purpose of this sthudy was to evaluate the diagnostic properties of conventional ultrasonography, sonoelastography, and contrast-enhanced ultrasonography in the detection of cervical lymph node metastasis in patients with PTC.Materials and methodsThis study enrolled130patients with PTC who underwent surgery between April2012and November2013. We analyzed the preoperative ultrasonographic findings using conventional ultrasonography, sonoelastography, and contrast-enhanced ultrasonography.Results1. Two hundreds twenty-five of215patients with PTC were analyzed. A total of88lymph nodes were metastatic, and89were benign (normal or reactive).2. Irregular margins, L/S ratio≤2, absence of echogenic hilum, hyperechogenicity, cystic changes, microcalcifications, peripheral vascularization and level2of vascularity are features of metastatic nodal involvement with PTC. Absence of echogenic hilum had the highest sensitivity, cystic changes had the highest specificity.3. In55.7%of the metastatic nodes and16.9%of the benign nodes sonoelastographic pattern was hard (P=0.000). Sonoelastography yielded a sensitivity of55.7%, specificity of83.1%, PPV of76.6%, NPV of65.5%, and diagnostic accuracy of82%.4. On contrast-enhanced ultrasonography, centripetal enhancement, centripetal or mixed enhancement, hyper-or isoechoic peak intensity, hyperoechoic intensity in part of node, irregular margin, absent intranodal enhancement, and larger enhancement area are features of metastatic nodal involvement with PTC. Centripetal or mixed enhancement had the highest sensitivity, hyperoechoic intensity in part of node and absent intranodal enhancement had the highest specificity.5. On quantitative contrast-enhanced ultrasonography, the PIs were24.27±9.16for metastatic nodes and20.41±7.88for benign nodes (P=0.003); the Sharpness were0.266±0.082for metastatic nodes and0.302±0.088for benign nodes (P=0.005)ConclusionsCervical lymph nodes can be characterized as metastatic or benign with a high degree of diagnostic accuracy evaluated by conventional ultrasonography, sonoelastography, and contrast-enhanced ultrasonography. Chapter Ⅲ Clinical implication of detection of the BRAFV600E Mutation in Fine-Needle Aspirations of papillary thyroid carcinomaPurposeTo evaluate the usefulness of detection of the BRAFV600E Mutation in fine-needle aspirations for diagnosis and invasion of papillary thyroid carcinoma.Materials and methodsA total of44patients with thyroid nodules were enrolled in this study between March2013and August2013.All patients underwent US-guided fine-needle aspiration (FNA).The presence of the BRAF V600E mutation in FNA specimens was determined by ADx-ARMS-BRAF technique. Finally, twenty-four patients underwent surgery.ResultsOf the24patients who underwent surgery, there were21PTC and3benign nodules (2Nodular goiter,1Hashimoto’s thyroiditis). The BRAF V600E mutation was identified in16PTCs. For3benign thyroid nodules, the BRAF V600E mutation was not identified.The sensitivity of the diagnosis of a PTC using detection of the BRAFV600E Mutation in fine-needle aspirations was76%, the specificity was100%, the PPV was100%, and the NPV was38%.Of the16PTC with positive BRAFV600E Mutation,7patients had the presence of central lymph node metastasis; Of the5PTC with negative BRAFV600E Mutation,4patients had the presence of central lymph node metastasis (P=0.157). ConclusionsThe application of the BRAF V600E mutation analysis in FNA specimens is effective for the diagnosis of PTC, but may be not a useful tool for predicting biological behavior of PTC.