Comparison Between The Imaging Features And Pathological Results Of Metastatic Cervical Lymph Nodes In Patients With Papillary Thyroid Carcinoma

Objective:The papillary thyroid carcinoma,accounts for about80%in alltypes of thyroid cancer,is one kind of very common thyroid malignanttumors.Additionally,it has a a higher rate of lymph nodes metastasis. Cervicallymph nodes metastasis is also an important factor affecting the prognosis ofthe patients with head and neck tumors，therefore，it is essential to accuratelyassess cervical lymph nodes in patients with papillary thyroidcarcinoma.Metastatic lymph nodes of thyroid carcinoma have a certainimaging features,it is important to improve the accuracy of diagnosis byunderstanding its imaging performance.This research was carried out toinvestigate the value of ultrasonography and computed tomography indiagnosis of the cervical lymph nodes metastasis of papillary thyroidcarcinoma.Method:Clinical data of79patients between March2013and October2013in department of otorhinolaryngology head and neck surgery in FourthAffiliated Hospital of Hebei Medical University,consisting of66cases ofinitial surgery,13cases of secondary surgery.Patients were divided into3groups:group1,36cases(38sides)with palpable cervical lymph nodespreoperative and group2,37cases(44sides)with impalpable nodes but positivefor nodal metastasis ultrasonically,group3,6cases with impalpable negativefor nodal metastasis ultrasonically,but pathologically confirmed lymph nodesmetastasis.All cases in our group performed preoperative ultrasonography,24cases of them performed contrast enhanced functional computed tomographysimultaneously.According to the results of thyroid primary tumor and lymphnodes in intraoperative frozen pathology,in accordance with China thyroidnodules and differentiated thyroid cancer treatment guidelines,providing the appropriate surgery treatments.Postoperative pathological specimens wereinspection,we compare the characteristic imaging performances of metastaticlymph nodes with pathological results to draw conclusion.Result:1The sensitivity,specificity and accuracy rate of metastatic lymph nodeswith the feature aspect ratio (L/S)＜2is82.2%,57.1%and74.2%.Lymph nodescan be seen microcalcifications is56.6%,91.6%and75.7%.Loss of hilararchitecture is85.4%,72.2%and81.8%.Cystic appearance is36.5%,92.8%and48.4%.The chi-square test confirmed that the differences of ultrasonic indexbetween the papillary thyroid carcinoma metastatic lymph node group andnon-metastatic was statistically significant(P＜0.05).The sensitivity,specificity and accuracy rate of metastatic lymph nodeswith two or more features which taken above is92.1%,60.7%and78.7%.arehigher than in single ultrasonographic features of diagnostic criteria.2The distribution area of metastatic lymph nodes that preoperativediagnosed by ultrasonography and postoperative confirmed pathologically:Ⅱ(50.9%), Ⅲ (71.7%),Ⅳ (67.9%), Ⅴ (30.2%),Ⅵ (45.3%).3The sensitivity,specificity and accuracy rate of recurrent metastaticlymph nodes in secondary surgery papillary thyroid carcinoma less than theinitial surgery.4The accuracy,the sensitivity and specificity of CT in diagnosing ofpapillary thyroid carcinoma with lymph nodes metastasis is100%,50%and87.5%respectively.Its characteristic imaging features conclude:calcification,cystic necrosis area,significantly enhanced edge whin enhancedscanning,diameter of lymph node>5mm in area Ⅵ.Conclusion：1Ultrasonography in diagnosing the papillary thyroid carcinoma withcervical lymph nodes metastasis has sonographic features: L/S<2, loss oflymph hilar structure,microcalcifications, cystic appearance,taken the pluralityof features into account,It not only contributes to improve diagnostic accuracy,but also has great singificant for making clinical decision. 2Ultrasonography has an important clinical significance in the diagnosisand differential diagnosis of lymphadenopathy after thyroid cancer secondarysurgery. It is an important means of monitoring thyroid cancer during follow-up,we should perform fine needle aspiration cytology on suspicious lymphnodes which having the ultrasonographic features taken above.3Computed tomography characteristic imaging features conclude:calcification,cystic necrosis area,significantly enhanced edge whin enhancedscanning,diameter of lymph node>5mm in area Ⅵ. It has great significant indetermining cervical lymph nodes metastasis of papillary thyroid cancer,it canimprove the sensitivity of lymph nodes metastasis, find lymph nodes precisedistribution,should be classified as a routine examination.4The combination of Ultrasonography and Computed tomography indiagnosing the papillary thyroid carcinoma with lymph nodes metastasis,as acomplement to each other will bring more benefits to clinical.