The Study Of The Relationship Between Ultrasound Characteristics Of Thyroid Carcinoma And It’s Metastatic Cervical Lymph Nodes

Objective:To explore the relationship between conventional ultrasonic features 、 ultrasonic elasticity index ratio、contrast-enhanced ultrasound quantitative parameters of the thyroid carcinoma nodules and the metastatic cervical lymph node,and then the sonographic features and distribution of the metastatic lymph nodes.Method:Choose the thyroid carcinoma nodules confirmed by surgical pathology in our hospital. The conventional ultrasound was performed on 89 thyroid nodules in 89 patients,and the size, shape, border, internal echos, type of calcification as well as the distance with shallow and deep thyroid capsule were evaluated by conventional ultrasound.And then observed that if there had abnormal lymph nodes on neck,then recorded its location, size, shape, internal echo and type of microcalcification. Ultrasound elastography was used to 78 thyroid carcinoma nodules of 78 patient,and observed the hardness of lesions and normal gland tissues, then determined the elasticity index ratio of lesions and the surrounding tissue; 43 thyroid carcinoma nodules of 43 patients underwent contrast-enhanced ultrasound, mainly observed the blood perfusion of carcinoma nodules and analyzed the time-intensity-curve(TIC) of carcinoma nodules. Measurement data used t test; Enumeration data used chi-square test.Results:(1) 89 thyroid carcinoma nodules of 89 patients including 2 medullary carcinoma with2 paients and 87 papillary carcinoma with 87 patients were performed conventional ultrasound examination.With metastatic cervical lymph nodes were 49 nodules of 49patients(including 2 medullary carcinomas), without metastatic cervical lymph nodes were40 nodules of 40 patients.(1) With and without metastatic cervical lymph nodes groups,there has statistically significant difference in echo texture(P<0.05); On calcification type, there was statistically significant difference between microcalcification and no calcification(P = 0.002);but there were no statistically significant difference between the two groups in shape, border, aspect ratio, echo level(P>0.05). The logistic regression analysis shows that cancer nodule size,distance from the capsule,the type of calcification is associated with lymph node metastasis(P<0.05).(2) With and without metastatic cervical lymph nodes groups,there were statistically significant difference between them in maximum diameter of thyroid carcinoma nodules,the distance with shallow and deep thyroid capsule(P<0.05).(3)Thyroid carcinoma metastasis most commonly distributed in neck Ⅵ area. Neck metastatic lymph nodes generally characterized by taller than wide <2, irregular shape,inhomogenous internal echoes,microcalcification and cystic degeneration.(2) 78 thyroid carcinoma nodules of 78 patients were performed ultrasound elastography,included 2 medullary carcinoma of 2 paients,76 papillary carcinoma of 76 patients. With neck lymph node metastasis was 41 nodules of 41 cases, without neck lymph node metastasis is 37 nodules of 37 cases.(1) With and without metastatic cervical lymph nodes groups, there were no statistically significant difference between them in elastic hardness of thyroid carcinoma nodules(P>0.05).(2)With and without metastatic cervical lymph nodes groups, there were statistically significant difference between them in elasticity index ratio of thyroid carcinoma nodules(P<0.05).The larger elasticity index ratio of the thyroid carcinoma, the more prone to cervical lymph node metastasis.(3)43 thyroid carcinoma nodules of 43 patients were performed contrast-enhanced ultrasound examination: included 1 medullary carcinoma of 1 patient,42 papillary carcinomas of 42 patients.With metastatic cervical lymph nodes were 28 carcinoma nodules of 28 patients,without metastatic cervical lymph nodes were 15 carcinoma nodules of 15 patients. With and without metastatic cervical lymph nodes groups, There were no statistically significant difference between them in RT, △RT, TTP, △PI(P>0.05),but in respect of PI, there were statistically significant difference(P<0.05).The higher peak intensity of the thyroid carcinoma nodules,the greater the chances for cervical lymph node metastasis.Conclusion:(1)Thyroid carcinoma metastasis most commonly distributed in neck Ⅵ area.Neck metastatic lymph nodes generally characterized by taller than wide <2, irregular shape,inhomogenous internal echoes,microcalcification and cystic degeneration.(2) The maximum diameter of carcinoma nodules,the distance from the thyroid capsule and the calcification type have the correlation with cervical lymph node metastasis,the internal echo of the carcinoma nodules is not independent risk factor for cervical lymph node metastasis.(3)The elasticity index ratio of thyroid carcinoma with lymph node metastasis is higher than group without lymph node metastasis.(4)The ultrasound imaging of the peak intensity of thyroid carcinoma with lymph node metastasis is higher than group without lymph node metastasis..(5)To a certain extent,thyroid carcinoma of the above characteristics can be related to the metastasis lymph nodes suggest the possibility of lymph node metastasis,and it can offer some valuable guidances to decide clinical principles.