Prediction of lymph node metastasis in central group of thyroid papillary microcarcinoma by CT signs combined with clinicopathological features_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 PAN Meng , HUANG Yong , WANG Hanhua , XIE Hao , ZOU Junwei , WU Zhaoying

Department of General Surgery, Second Affiliated Hospital of Wangnan Medical College, Wuhu, Anhui 241001, P. R. China;

Corresponding?author：

PAN Meng, Email: doctorpwpm@163.com

Keywords：

papillary thyroid microcarcinoma; central lymph node metastasis; tomography; spiral computer

DOI：

10.7507/1007-9424.202107088

Video：

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Objective To explore the predictive value of CT signs combined with clinicopathological features for single cN0 papillary thyroid microcarcinoma (PTMC) central lymph node metastasis (CLNM). Methods A retrospective analysis of the CT signs and clinicopathological characteristics of 115 cases of single cN0 PTMC confirmed by surgery and pathology was performed, and univariate and multivariate logistic regression analysis were used to analyze the relationship between the contact between tumor and thyroid edge, tumor calcification, tumor location, tumor diameter, age, gender, thyroglobulin level and CLNM. According to the different contact range between tumor and thyroid edge in CT signs, the patients were divided into three groups: <1/4 group, 1/4–<1/2 group and ≥1/2 group. The proportion of CLNM positive patients in different contact areas between tumor body and thyroid edge was analyzed by using χ² test. Results Among 115 cases of single cN0 PTMC, there were 26 cases and 89 cases with CLNM positive and negative, respectively. Univariate analysis showed that contact between tumor body and thyroid edge, tumor diameter, age, and gender were associated with CLNM positive (P<0.05). Further multivariate logistic regression analysis showed that thyroid marginal contact, age <45 years old and male were associated with CLNM positive (P<0.05). The proportion of CLNM positive patients in different contact areas between tumor body and thyroid edge (between the three groups ) was statistically different (P<0.05). The pairwise comparison among the three groups showed that the proportion of CLNM positive patients were statistically different (P<0.0167 after correction). Conclusions Tumor body contact with thyroid edge, age <45 years and male were independent risk factors for CLNM in patients with single cN0 PTMC. The combination of multiple risk factors can further improve the preoperative evaluation level of CLNM in patients with PTMC. Excluding clinical characteristic factors, the wider the contact area between the tumor and the thyroid edge, the higher the risk of CLNM, which provides a reasonable basis for selective central lymph node dissection.

Citation： PAN Meng, HUANG Yong, WANG Hanhua, XIE Hao, ZOU Junwei, WU Zhaoying. Prediction of lymph node metastasis in central group of thyroid papillary microcarcinoma by CT signs combined with clinicopathological features. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(6): 738-742. doi: 10.7507/1007-9424.202107088 Copy

1.	Hughes DT, Haymart MR, Miller BS, et al. The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years. Thyroid, 2011, 21(3): 231-236.
2.	趙淑艷, 馬云海, 尹哲, 等. cN0 T1/T2期甲狀腺乳頭狀癌行頸中央區淋巴清掃的合理性及其范圍的探討. 中華耳鼻咽喉頭頸外科雜志, 2018, 53(2): 105-109.
3.	劉文華, 施洋, 李敏, 等. 基于臨床、血清學及CT特征列線圖預測甲狀腺乳頭狀癌中央區淋巴結轉移的價值. 中國臨床醫學影像雜志, 2020, 31(6): 394-397, 402.
4.	閔蕊, 韓丹, 趙雯, 等. 甲狀腺乳頭狀癌原發灶CT值聯合形態學預測中央組淋巴結轉移的價值. 中國醫學影像學雜志, 2020, 28(3): 184-188.
5.	尹冰心, 李寧, 韓志江. CT平掃瘤體與甲狀腺邊緣接觸程度對乳頭狀癌中央組淋巴結轉移的預測. 中國臨床醫學影像雜志, 2017, 28(3): 173-175,179.
6.	黃春, 鄧暢, 蘇新良. cN0甲狀腺微小乳頭狀癌淋巴結轉移的危險因素分析. 中國普外基礎與臨床雜志, 2021, 28(7): 888-891.
7.	Yaz?c? D, ?olako?lu B, Sa?lam B, et al. Effect of prophylactic central neck dissection on the surgical outcomes in papillary thyroid cancer: experience in a single center. Eur Arch Otorhinolaryngol, 2020, 277(5): 1491-1497.
8.	楊瑞, 張守鵬, 黃韜, 等. cN0期甲狀腺微小乳頭狀癌淋巴結轉移模型的構建和驗證以及手術方式探討. 臨床耳鼻咽喉頭頸外科雜志, 2021, 35(2): 137-140.
9.	Sippel RS, Robbins SE, Poehls JL, et al. A randomized controlled clinical trial: no clear benefit to prophylactic central neck dissection in patients with clinically node negative papillary thyroid cancer. Ann Surg, 2020, 272(3): 496-503.
10.	劉文, 程若川, 蘇艷軍, 等. 2015版美國甲狀腺協會指南cN0甲狀腺乳頭狀癌手術方案合理性分析. 中國實用外科雜志, 2017, 37(5): 568-571, 576.
11.	解孝章, 鄭炳行, 鄧建偉. 300例cN0甲狀腺微小乳頭狀癌的隨訪研究. 中國普外基礎與臨床雜志, 2020, 27(5): 569-573.
12.	馬銘玉, 崔樂, 鄒丹, 等. cN0甲狀腺微小乳頭狀癌中央區淋巴結轉移危險因素分析及列線圖建立. 中華內分泌外科雜志, 2021, 15(2): 154-157.
13.	胡磊, 余盛敬, 王才善, 等. 多因素Logistic分析單灶甲狀腺微小乳頭狀癌中央區淋巴結轉移的危險因素. 川北醫學院學報, 2020, 35(3): 453-457.
14.	莊歡, 廉猛, 房居高, 等. cN0甲狀腺微小乳頭狀癌中央區淋巴結轉移相關因素分析. 中國耳鼻咽喉頭頸外科, 2020, 27(6): 311-315.
15.	陳立權, 龐士勇, 丁士海, 等. 甲狀腺微小乳頭狀癌頸淋巴結轉移危險因素分析及外科處理策略. 安徽醫藥, 2020, 24(5): 985-988.
16.	李小毅. 2015年美國甲狀腺學會《成人甲狀腺結節與分化型甲狀腺癌診治指南》解讀: 外科部分. 中國癌癥雜志, 2016, 26(1): 13-18.
17.	王海濱, 舒艷艷, 韓志江, 等. 不同大小甲狀腺乳頭狀癌的CT征象比較. 中華內分泌外科雜志, 2018, 12(2): 132-135,139.
18.	Wei Q, Wu D, Luo H, et al. Features of lymph node metastasis of papillary thyroid carcinoma in ultrasonography and CT and the significance of their combination in the diagnosis and prognosis of lymph node metastasis. J BUON, 2018, 23(4): 1041-1048.
19.	Xiang T, Yan W, Zhou L. Retrospective analysis of prognostic factors in patients of papillary thyroid microcarcinoma. Oncotarget, 2018, 9(85): 35553-35558.
20.	Huang XP, Ye TT, Zhang L, et al. Sonographic features of papillary thyroid microcarcinoma predicting high-volume central neck lymph node metastasis. Surg Oncol, 2018, 27(2): 172-176.
21.	李寧, 舒艷艷, 韓志江. CT征象聯合臨床特征對cN0期單發甲狀腺乳頭狀癌中央組淋巴結轉移的預測價值. 中國臨床醫學影像雜志, 2016, 27(9): 616-619.
22.	申金付, 李娟, 王卓群, 等. 甲狀腺乳頭狀癌中央區淋巴結轉移的影響因素分析. 安徽醫學, 2020, 41(12): 1398-1401.
23.	高明, 葛明華, 嵇慶海, 等. 甲狀腺微小乳頭狀癌診斷與治療中國專家共識(2016版). 中國腫瘤臨床, 2016, 43(10): 405-411.

1. Hughes DT, Haymart MR, Miller BS, et al. The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years. Thyroid, 2011, 21(3): 231-236.
2. 趙淑艷, 馬云海, 尹哲, 等. cN0 T1/T2期甲狀腺乳頭狀癌行頸中央區淋巴清掃的合理性及其范圍的探討. 中華耳鼻咽喉頭頸外科雜志, 2018, 53(2): 105-109.
3. 劉文華, 施洋, 李敏, 等. 基于臨床、血清學及CT特征列線圖預測甲狀腺乳頭狀癌中央區淋巴結轉移的價值. 中國臨床醫學影像雜志, 2020, 31(6): 394-397, 402.
4. 閔蕊, 韓丹, 趙雯, 等. 甲狀腺乳頭狀癌原發灶CT值聯合形態學預測中央組淋巴結轉移的價值. 中國醫學影像學雜志, 2020, 28(3): 184-188.
5. 尹冰心, 李寧, 韓志江. CT平掃瘤體與甲狀腺邊緣接觸程度對乳頭狀癌中央組淋巴結轉移的預測. 中國臨床醫學影像雜志, 2017, 28(3): 173-175,179.
6. 黃春, 鄧暢, 蘇新良. cN0甲狀腺微小乳頭狀癌淋巴結轉移的危險因素分析. 中國普外基礎與臨床雜志, 2021, 28(7): 888-891.
7. Yaz?c? D, ?olako?lu B, Sa?lam B, et al. Effect of prophylactic central neck dissection on the surgical outcomes in papillary thyroid cancer: experience in a single center. Eur Arch Otorhinolaryngol, 2020, 277(5): 1491-1497.
8. 楊瑞, 張守鵬, 黃韜, 等. cN0期甲狀腺微小乳頭狀癌淋巴結轉移模型的構建和驗證以及手術方式探討. 臨床耳鼻咽喉頭頸外科雜志, 2021, 35(2): 137-140.
9. Sippel RS, Robbins SE, Poehls JL, et al. A randomized controlled clinical trial: no clear benefit to prophylactic central neck dissection in patients with clinically node negative papillary thyroid cancer. Ann Surg, 2020, 272(3): 496-503.
10. 劉文, 程若川, 蘇艷軍, 等. 2015版美國甲狀腺協會指南cN0甲狀腺乳頭狀癌手術方案合理性分析. 中國實用外科雜志, 2017, 37(5): 568-571, 576.
11. 解孝章, 鄭炳行, 鄧建偉. 300例cN0甲狀腺微小乳頭狀癌的隨訪研究. 中國普外基礎與臨床雜志, 2020, 27(5): 569-573.
12. 馬銘玉, 崔樂, 鄒丹, 等. cN0甲狀腺微小乳頭狀癌中央區淋巴結轉移危險因素分析及列線圖建立. 中華內分泌外科雜志, 2021, 15(2): 154-157.
13. 胡磊, 余盛敬, 王才善, 等. 多因素Logistic分析單灶甲狀腺微小乳頭狀癌中央區淋巴結轉移的危險因素. 川北醫學院學報, 2020, 35(3): 453-457.
14. 莊歡, 廉猛, 房居高, 等. cN0甲狀腺微小乳頭狀癌中央區淋巴結轉移相關因素分析. 中國耳鼻咽喉頭頸外科, 2020, 27(6): 311-315.
15. 陳立權, 龐士勇, 丁士海, 等. 甲狀腺微小乳頭狀癌頸淋巴結轉移危險因素分析及外科處理策略. 安徽醫藥, 2020, 24(5): 985-988.
16. 李小毅. 2015年美國甲狀腺學會《成人甲狀腺結節與分化型甲狀腺癌診治指南》解讀: 外科部分. 中國癌癥雜志, 2016, 26(1): 13-18.
17. 王海濱, 舒艷艷, 韓志江, 等. 不同大小甲狀腺乳頭狀癌的CT征象比較. 中華內分泌外科雜志, 2018, 12(2): 132-135,139.
18. Wei Q, Wu D, Luo H, et al. Features of lymph node metastasis of papillary thyroid carcinoma in ultrasonography and CT and the significance of their combination in the diagnosis and prognosis of lymph node metastasis. J BUON, 2018, 23(4): 1041-1048.
19. Xiang T, Yan W, Zhou L. Retrospective analysis of prognostic factors in patients of papillary thyroid microcarcinoma. Oncotarget, 2018, 9(85): 35553-35558.
20. Huang XP, Ye TT, Zhang L, et al. Sonographic features of papillary thyroid microcarcinoma predicting high-volume central neck lymph node metastasis. Surg Oncol, 2018, 27(2): 172-176.
21. 李寧, 舒艷艷, 韓志江. CT征象聯合臨床特征對cN0期單發甲狀腺乳頭狀癌中央組淋巴結轉移的預測價值. 中國臨床醫學影像雜志, 2016, 27(9): 616-619.
22. 申金付, 李娟, 王卓群, 等. 甲狀腺乳頭狀癌中央區淋巴結轉移的影響因素分析. 安徽醫學, 2020, 41(12): 1398-1401.
23. 高明, 葛明華, 嵇慶海, 等. 甲狀腺微小乳頭狀癌診斷與治療中國專家共識(2016版). 中國腫瘤臨床, 2016, 43(10): 405-411.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prediction of lymph node metastasis in central group of thyroid papillary microcarcinoma by CT signs combined with clinicopathological features

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