Cancer Management and Research (Apr 2021)
Value of Combining Clinical Factors, Conventional Ultrasound, and Contrast-Enhanced Ultrasound Features in Preoperative Prediction of Central Lymph Node Metastases of Different Sized Papillary Thyroid Carcinomas
Abstract
Yanfang Wang,1 Fang Nie,1 Guojuan Wang,1 Ting Liu,1 Tiantian Dong,1 Yamin Sun2 1Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, People’s Republic of China; 2Department of Pathology, Lanzhou University Second Hospital, Lanzhou, Gansu, People’s Republic of ChinaCorrespondence: Fang NieMedical Center of Ultrasound, Lanzhou University Second Hospital, Chengguan District, Lanzhou, Gansu Province, 730030, People’s Republic of ChinaTel +86 0931 8942545Email [email protected]: Early and accurate preoperative diagnosis of central lymph node metastasis (CLNM) is crucial to improve surgical management of patients with clinical lymph node-negative papillary thyroid carcinoma (PTC). Towards improving diagnosis of CLNM, we assessed the value of combining preoperative clinical characteristics, conventional ultrasound, and contrast-enhanced ultrasound (CEUS) in preoperative prediction of CLNM of different sized PTCs.Patients and Methods: Patients were divided according to tumor size: a PTC group (> 10 mm) and a papillary thyroid microcarcinoma (PTMC) group (≤ 10 mm). We retrospectively analyzed the clinical and ultrasonographic features of 120 PTC patients and 165 PTMC patients. Multivariate logistic regression analysis was used to screen independent risk factors and establish prediction models. Receiver operating characteristic curves were used to determine the best cut-off values for continuous variables and assess the performance of prediction models.Results: Independent risk predictors of CLNM for the PTC group were extrathyroidal extension in CEUS (OR=7.923), tumor size > 14 mm (OR=5.491), and multifocality (OR=3.235). For the PTMC group, the independent risk factors were the distance from the thyroid capsule =0 mm (OR=4.629), male (OR=3.315), tumor size > 5 mm (OR=3.304), and microcalcification (OR=2.560). The predictive model of combined method had better performance in predicting CLNM of PTC compared with models based on CEUS and conventional ultrasound alone (area under the curve: 0.832 vs 0.739, P=0.0011; 0.832 vs 0.678, P=0.0012). For PTMC, comparing with CEUS, the combined method and conventional ultrasound performed better than CEUS alone in predicting CLNM (area under the curve: 0.783 vs 0.636, P=0.0016; 0.738 vs 0.636, P=0.0196).Conclusion: The predictive models of combined method obtained from significant preoperative clinical and ultrasonographic features can potentially improve the preoperative diagnosis and individual treatment of CLNM in patients with PTC and PTMC. CEUS may be helpful in predicting CLNM of PTC, but CEUS would be ineffective in predicting CLNM of PTMC.Keywords: papillary thyroid carcinoma, lymph node metastasis, prophylactic central neck dissection, ultrasonography, contrast-enhanced ultrasound
