Analysis Of Risk Factors For Central Lymph Node Metastasis In Papillary Thyroid Microcarcinoma

Objective: To investigate the risk factors of central lymph node metastasis in papillary thyroid microcarcinoma(PTMC).To assess the reliability of different risk factors for the prediction of PTMC cervical lymph node metastasis,and to provide clinical evidence for standardized preventive cervical lymph node dissection.Methods: We retrospectively analyzed the clinical data of 700 cases of thyroid micropapillary carcinoma from January 2015 to July 2017 in Sichuan Cancer Hospital.The clinical data of these patients were entered into statistical software analysis.The analysis of risk factors for the central area single factor?2 test,multivariate logistic regression analysis and ROC curve analysis to predict the possibility of cervical lymph node metastasis.Results:The rate of central lymph node metastasis(CLNM)was 48.2%.Preoperative color Doppler ultrasound showed that the sensitivity of central lymph node metastasis was 6.5%,specificity was 83.4%,and the accuracy rate was 46.3%.Aged ? 45 years old,male,multiple cancers,invading(out)capsules,focal calcifications,and tumor diameter ? 5 mm were independent risk factors for lymph node metastasis in the central area of PTMC.In the prediction of central lymph node metastasis risk,the best critical value in diameter prediction is 7mm.The area under the curve(AUC)is 0.647.The best cut-off in age prediction was 41 years,and the AUC of the ROC curve was0.597.The gender ROC curve was AUC=0.588,the ROC curve of the tumor volume was AUC=0.627,the position ROC curve was AUC=0.613,and the calcification ROC curve was AUC=0.603.Based on the age,sex,diameter,location,number of foci and calcification,the ROC curve of central lymph node metastasis was analyzed,AUC=0.768.Conclusion: Aged ? 45 years old,male,multiple cancers,cancer invasion(out)capsule,calcification,tumor diameter ? 5mm are independent risk factors for lymph node metastasis in the central area of PTMC.Diameter prediction of central lymph node metastasis is the best critical value of 7mm.The age-predicted threshold for lymph node metastasis in the central region was 41 years.When the age of ? 41 years,men,multiple cancers,cancer adjacent to the capsule or invade(out)capsule,calcification,tumor diameter? 7mm and other multiple risk factors accumulated above,the risk of lymph node metastasis increased,it should be more active in accordance with the "two At least " surgical treatment,while paying attention to the evaluation of contralateral cervical lymph node metastasis,but it is not recommended for prophylactic lateral neck dissection.Conservative observation of low-risk PTMC is acceptable,but care should be taken to include and maintain long-term dynamic observation of follow-up and timely preparation for surgical intervention.Among the low-risk indicators,c N0 phase should not be used as one of the indicators of PTMC conservative observation.