Correlation Of Ultrasonic And Clinicopathological Features Of Papillary Thyroid Carcinoma With Cervical Lymph Node Metastasis

Objective:In this study,the correlation between ultrasonic features of cancer nodule and cervical lymph nodes and clinicopathological features and cervical lymph node metastasis?LNM?in 88 patients with papillary thyroid carcinoma?PTC?was analyzed to explore the independent risk factors of cervical LNM for PTC,so as to provide some references for preoperative evaluation of LNM in PTC.Methods:A retrospective study was conducted on 88 patients who were admitted to our hospital from January 2019 to January 2020 and were diagnosed as PTC by postoperative pathology.All patients underwent preoperative ultrasonography of thyroid and cervical lymph nodes,ultrasound-guided fine needle aspiration cytology?FNAC?,BRAF^V600E600E mutation detection,thyroid function test and blood routine examination.Ultrasonic features?maximum diameter,number,location,internal echo,calcification,shape,boundry,anteroposterior to transverse diameter ratio?A/T?,breakthrough of the capsule,blood flow grade of cancer nodule,ultrasound showed lymph node metastasis?and clinicopathologic features including gender,age,whether with nodular goiter,neutrophil-to-lymphocyte count ratio?NLR?,thyroid stimulating hormone?TSH?,BRAF^V600E600E gene mutation of each patient were collected.Participants were grouped three times on the basis of postoperative pathological LNM:1.cervical LNM group and cervical lymph node non-metastasis group;2.central lymph node metastasis group and central lymph node non-metastasis group;3.lateral lymph node metastasis group and lateral lymph node non-metastasis group.Univariate analysis and multivariate Logistic regression analysis were used to investigate the correlation between ultrasonic features of cancer nodule and cervical lymph nodes and clinicopathologic features and cervical LNM,central lymph node metastasis?CLNM?,lateral lymph node metastasis?LLNM?in PTC patients.Results:1.In the 88 PTC cases,42 cases of cervical LNM were diagnosed by postoperative pathology and 26 cases were diagnosed by ultrasound.The specificity,accuracy,sensitivity of ultrasonic diagnosis of cervical LNM were 89.13%,70.45%,50.00%?P<0.05?.2.Univariate analysis for cervical LNM:there was significant difference between two groups in number,breakthrough of the capsule,max diameter,A/T,blood flow classification of cancer nodule,ultrasound showed lymph node metastasis,gender,age,BRAF^V600E600E gene mutation,NLR,TSH?P<0.05?.Multivariate analysis showed that male?OR=5.012,95%CI:1.114²2.542,P=0.036?,age<45years?OR=5.856,95%CI:1.105³1.045,P=0.038?,maximum diameter>10mm?OR=5.387,95%CI:1.201²4.155,P=0.028?,A/T?1?OR=5.799,95%CI:1.309²5.698,P=0.021?,ultrasound showed lymph node metastasis?OR=5.241,95%CI:1.020²6.937,P=0.047?,BRAF^V600E600E gene mutation positive?OR=5.136,95%CI:1.227²1.501,P=0.025?were positively correlated with cervical LNM,and were the independent risk factors of cervical LNM in PTC.3.Univariate analysis for CLNM:there was significant difference between the two groups in maximum diameter,A/T,calcification,blood flow classification of cancer nodule,ultrasound showed lymph node metastasis,BRAF^V600Egene mutation,NLR,TSH?P<0.05?;Multivariate analysis showed that age<45years?OR=6.038,95%CI:1.475²4.715,P=0.012?,nodule unclear boundary?OR=5.313,95%CI:1.190²3.717,P=0.029?,A/T?1?OR=9.686,95%CI:2.089⁴4.906,P=0.004?,blood flow grade 2³?OR=6.460,95%CI:1.252³3.333,P=0.026?,BRAF^V600Egene mutation positive?OR=4.151,95%CI:1.095⁵.735,P=0.036?were positively correlated with CLNM,and were the independent risk factors of CLNM in PTC.4.Univariate analysis for LLNM:there was significant difference between the two groups in number,breakthrough of the capsule,internal echo,A/T,maximum diameter of cancer nodule,ultrasound showed lymph node metastasis and BRAF^V600E600E gene mutation?P<0.05?.Multivariate analysis showed that breakthrough of capsule?OR=17.456,95%CI:1.234²46.896,P=0.034?,ultrasound showed lymph node metastasis?OR=42.494,95%CI:4.515³99.923,P=0.001?were positively correlated with LLNM,and were the independent risk factors of LLNM.Conclusion:1.Maximum diameter of the cancer nodule in ultrasonic features was>10mm,A/T?1,ultrasound showed cervical lymph node metastasis,male patients,age<45 years,BRAF^V600E600E gene mutation?+?were positively correlated with the occurrence of cervical LNM,and were the risk factors for cervical LNM in PTC patients.2.Boundary of the cancer nodule in ultrasonic features was unclear,A/T?1,blood flow grade 2³,age<45 years and BRAF^V600E600E gene mutation?+?were positively correlated with the occurrence of CLNM,and were the risk factors for CLNM in PTC patients.3.In ultrasonic features,the cancer nodule broke through the capsule,ultrasound showed cervical lymph node metastasis were positively correlated with the occurrence of LLNM,and were the risk factors of LLNM in PTC patients.