| Background and Objectives: As a kind of malignant endocrine cancer,thyroid carcinoma is commonly seen in clinics.At present,the population of thyroid carcinoma continues growing at an accelerated rate.But with rather good prognosis,the patients may be promised a 90% opportunity of 10-year survival.In the "guideline for diagnosis and treatment of thyroid nodules and differentiated thyroid cancer" of 2012,it is mentioned that the cervical lymph node metastasis could apowerful risk factor for cancer recurrence after first operation and low survival rate.It is reported that roughly 20%-90% patients could be found with cervical lymph node metastasis in the first operation,And according to many other articles,the most common spot for the cervical lymph node metastasis is Level VI lymph node compartment,yet of whichthe management is still controversial.Some surgeons tend to adopt the prophylactic central lymph node dissection while some scholars believe that patients should be treated with therapeutic central lymph node dissection only when diagnosed of metastasis during observation.Even if surgeons pay close attention to avoiding the recurrent laryngeal nerve,parathyroid gland and other neural tissue,there might still be chances of complication after operation,such as temporal or permanent hypocalcemia caused by parathyroid gland damage,superior laryngeal nerve damage and etc..Given that ultrasonography is not only the primary choice of thyroid benign or malignant nodule examinations among non-invasive imaging methods also some ultrasonic features of thyroid carcinoma might be used as indicators for cervical lymph node metastasis as reported,before operation it is favorable to scan nodules and the entire neck lymph node compartments thoroughly and analyze the risk for metastasis.In addition,foreign scholars consider some immuno-histo-chemical markers may also be indicative of thyroid malignancy with cervical lymph node metastasis as supplement.This study is aiming at : first,analyzing the diagnostic value of ultrasonography for cervical lymph node metastasis after retrospectively review the sonogram of recruited patients and second,making comparison between patients with and without cervical lymph node metastasis and analyzing the related risk factors of thyroid carcinoma with cervical lymph node metastasis afterwards.Methods: We recruited patients with suspicious thyroid nodules who were hospitalized in the department of thyroid gland and breast surgery of Shenzhen Second People's Hospital from September 2014 to February 2017.And finally,A total of 101 patient and 122 cases of nodules were included in this study.There were 33 males and 78 females,with the average age of 39.0±14.0(range from 14 to 67 years old).All the 122 nodules were performed ultrasonography before needle biospy,and after that tissue was sent to pathologic examination,101 of which were stained with immuno-histo-chemical markers.Every patient was treated by total or near-total thyroidectomy(including the isthmus)and central lymph node dissection with or without lateral compartment dissection.And we chose post-operation pathology results as reference standard.Pathologically confirmed thyroid cancer was divided into cervical lymph node metastasis group and non-cervical lymph node metastasis group.The results were analyzed by SPSS 19.0 statistical software.The measurement data were expressed as mean ± standard deviation.The t test was used.The counting data were analyzed by chi-square test and single factor analysis.Then,the statistical analysis of chi-square test was carried out.Logistic regression analysis of multivariate analysis.When p <0.05 was statistically significant.Results: Among the 122 thyroid nodules,53(43.44%)of cervical lymph node metastases were diagnosed by pathologic diagnosis,31 lymph nodes were diagnosed by ultrasonography,and the diagnostic accuracy of ultrasonography on metastatic lymph nodes was 75.41% and the sensitivity was 50.94%,the specificity was 71.43%,and there was significant difference between the two groups(p = 0.000 <0.05).Through the analysis of the clinical and ultrasonographic features of two groups of thyroid cancer patients,the results showed that patients with age <45 years old,thyroid malignant nodules close to the capsule,ultrasound imaging of the malignant nodules was extremely hypoechoic,internal micro calcification and poor continuity of capsule and lymph node metastasis risk factors(p <0.05).The results of the multivariate logistic regression analysis showed that the type of calcification of thyroid nodules,internal echo and the combination of Hashimoto's Thyroiditis was statistically significant(p <0.05),and the first two were independent risk factors for cervical lymph node metastasis in thyroid cancer.Thyroid malignant nodules within the microcalcification,nodular internal very low echo,the occurrence of cervical lymph node metastasis risk of microcalcification and nodules were low echo were 12.032 times and 21.183 times.Immuno-histo-chemical markers Gal-3,CK19,HBME-1 and TPO were higher in the diagnosis of benign and malignant thyroid nodules,and the accuracy of the combination of four immuno-histo-chemical markers(96.04%),(97.87%)and specificity(81.43%)were higher.There was no significant difference between the four markers and the lymph node metastasis of thyroid carcinoma.(89.34%),sensitivity(77.36%)and specificity(98.55%)were higher in patients with thyroid carcinoma and cervical lymph node metastasis(P <0.05).The diagnostic value of preoperative ultrasound and preoperative immuno-histo-chemical markers was higher 22.64%)is relatively low.Conclusion: Ultrasonography has a high specificity and accuracy of direct scanning of cervical lymph node metastasis,but its sensitivity is low.Thyroid malignant nodules within the microcalcification and nodules were very low echo for the occurrence of cervical lymph node metastasis risk factors,and thyroid cancer patients with HT is a protective factor.Immuno-histo-chemical markers are a sensitive,specific and accurate method for the identification of thyroid benign and malignant,but their significance in assessing the risk of lymph node metastasis of thyroid cancer is further studied.The combination of preoperative ultrasound imaging combined with immuno-histo-chemical markers to reduce the degree of missed diagnosis of cervical lymph node metastases to a certain extent,thus improve the accuracy and sensitivity of the clinician preoperative assessment and development surgical program provides a certain imaging basis. |
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