Imageology Evaluation And Molecular Biology Study On Cervical Lymph Node Metastasis Of Thyroid Carcinoma

Objective 1. To study CT manifestation of lymph node metastasis of thyroid carcinoma and it' s value in thyroid carcinoma diagnosis and choice of operation pattern. 2. To investigate expression of C-MET in palliary thyroid carcinoma with cervical lymph node metastases , palliary thyroid carcinoma without cervical lymph node metastases,follicular thyroid carcinoma and benign thyroid disease and reveal relationship between expression of C-MET by PTC and cervical lymph node metastases and it' s clinical significance. Methods 1. CT appearances of lymph node metastasis of thyroid carcinoma proved by surgery and pathology in 50 patient were reviewed. 2.The expression level of C-MET was examined by immunohistochemical analysis with C-MET monoclonal antibody in 62 sample of PTC with cervical lymph node metastases and 50 sample of PTC without cervical lymph node mestastases and 10 sample of follicular thyroid carcinoma and 30 sample of benign thyroid disease. Result 1. Of these 50 cases , metastatic lymph nodes were located at â…¡+â…¢region( n = 14 ) , IV region ( n - 19 ) , V region ( n = 1) , and VI region ( n = 9) . Of 43 thyriod carcinoma patients, the borderline of metastatic lymph node is regulation (n=39). Of 32 thyroid papillary carcinoma patients , the attenuation of metastatic lymph nodes were similar to that of normal thyroid gland( n = 31) , with cystic formations ( n= 10) , intracystic high attenuation papillary- like nodules ( n = 8) , and fine granular calcifications ( n = 9) . Of 11 fo- llicular carcinoma , medullary carcinoma , and anaplastic carcinoma patients , 10 cases had significant homogeneous or heterogeneous enhanced nodes . and the attenuation was the same as primary or recurrent thyroid tumors. 2. PTC with cervical lymph node metastates specimens expressed significantly greater level of C-MET than other form of thyroid carcinoma and benign thyroid disease(P<0. 001). c-Met expression was significantly different for the following pairs ofthyroid specimens:PTC with cervical lymph node metastates versus PTC without cervical lymph node metastates (P<0. 001), PTC with cervical lymph node metastates versus follicular thyroid carcinoma (P<0. 001), PTC with cervical lymph node metastates versus benign thyroid disease(P<0.001), PTC without cervical lymph node metastates versus follicular thyroid carcinoma (P=0.002), PTC without cervical lymph node metastates versus benign thyroid disease (P<0.001). The distributions of c~Met expression were not significantly different for follicular thyroid carcinoma versus benign thyroid disease (P=0. 209). Conclusions 1. For thyroid carcinoma , the most common locations of metastatic lymph nodes were internal jugular chain , tracheoesophageal groove regions. Marked enhancement similar to normal thyroid gland , cystic formations with intracystic high attenuation papillary-like nodules , and fine discrete granular calcifycations were the character- istic manifestations of metastatic lymph node of papillary carcinoma. Marked homogeneous or heterogeneous enhancement after contrast admini- stration and the same attenuation as the primary or recurrent thyroid tumor were found in follicular carcinoma , medullary carcinoma , and anaplastic carcinoma metastases. These manifestations are helpful to thyroid carcinoma' s diagnosis and choice of surgery . 2. Intense c~Met expression is indicative of the presence of the cervical lymph node metastases and a marker of extracapsular spread and direct extension in PTC. It is significant for preoperative diagnosis of cervical lymph node metastases and choice of operative methods.