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.	赵淑艳, 马云海, 尹哲, 等. cN0 T1/T2期甲状腺乳头状癌行颈中央区淋巴清扫的合理性及其范围的探讨. 中华耳鼻咽喉头颈外科杂志, 2018, 53(2): 105-109.
3.	刘文华, 施洋, 李敏, 等. 基于临床、血清学及CT特征列线图预测甲状腺乳头状癌中央区淋巴结转移的价值. 中国临床医学影像杂志, 2020, 31(6): 394-397, 402.
4.	闵蕊, 韩丹, 赵雯, 等. 甲状腺乳头状癌原发灶CT值联合形态学预测中央组淋巴结转移的价值. 中国医学影像学杂志, 2020, 28(3): 184-188.
5.	尹冰心, 李宁, 韩志江. CT平扫瘤体与甲状腺边缘接触程度对乳头状癌中央组淋巴结转移的预测. 中国临床医学影像杂志, 2017, 28(3): 173-175,179.
6.	黄春, 邓畅, 苏新良. cN0甲状腺微小乳头状癌淋巴结转移的危险因素分析. 中国普外基础与临床杂志, 2021, 28(7): 888-891.
7.	Yazıcı D, Çolakoğlu B, Sağlam 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.	杨瑞, 张守鹏, 黄韬, 等. cN0期甲状腺微小乳头状癌淋巴结转移模型的构建和验证以及手术方式探讨. 临床耳鼻咽喉头颈外科杂志, 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.	刘文, 程若川, 苏艳军, 等. 2015版美国甲状腺协会指南cN0甲状腺乳头状癌手术方案合理性分析. 中国实用外科杂志, 2017, 37(5): 568-571, 576.
11.	解孝章, 郑炳行, 邓建伟. 300例cN0甲状腺微小乳头状癌的随访研究. 中国普外基础与临床杂志, 2020, 27(5): 569-573.
12.	马铭玉, 崔乐, 邹丹, 等. cN0甲状腺微小乳头状癌中央区淋巴结转移危险因素分析及列线图建立. 中华内分泌外科杂志, 2021, 15(2): 154-157.
13.	胡磊, 余盛敬, 王才善, 等. 多因素Logistic分析单灶甲状腺微小乳头状癌中央区淋巴结转移的危险因素. 川北医学院学报, 2020, 35(3): 453-457.
14.	庄欢, 廉猛, 房居高, 等. cN0甲状腺微小乳头状癌中央区淋巴结转移相关因素分析. 中国耳鼻咽喉头颈外科, 2020, 27(6): 311-315.
15.	陈立权, 庞士勇, 丁士海, 等. 甲状腺微小乳头状癌颈淋巴结转移危险因素分析及外科处理策略. 安徽医药, 2020, 24(5): 985-988.
16.	李小毅. 2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读: 外科部分. 中国癌症杂志, 2016, 26(1): 13-18.
17.	王海滨, 舒艳艳, 韩志江, 等. 不同大小甲状腺乳头状癌的CT征象比较. 中华内分泌外科杂志, 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.	李宁, 舒艳艳, 韩志江. CT征象联合临床特征对cN0期单发甲状腺乳头状癌中央组淋巴结转移的预测价值. 中国临床医学影像杂志, 2016, 27(9): 616-619.
22.	申金付, 李娟, 王卓群, 等. 甲状腺乳头状癌中央区淋巴结转移的影响因素分析. 安徽医学, 2020, 41(12): 1398-1401.
23.	高明, 葛明华, 嵇庆海, 等. 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版). 中国肿瘤临床, 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. 赵淑艳, 马云海, 尹哲, 等. cN0 T1/T2期甲状腺乳头状癌行颈中央区淋巴清扫的合理性及其范围的探讨. 中华耳鼻咽喉头颈外科杂志, 2018, 53(2): 105-109.
3. 刘文华, 施洋, 李敏, 等. 基于临床、血清学及CT特征列线图预测甲状腺乳头状癌中央区淋巴结转移的价值. 中国临床医学影像杂志, 2020, 31(6): 394-397, 402.
4. 闵蕊, 韩丹, 赵雯, 等. 甲状腺乳头状癌原发灶CT值联合形态学预测中央组淋巴结转移的价值. 中国医学影像学杂志, 2020, 28(3): 184-188.
5. 尹冰心, 李宁, 韩志江. CT平扫瘤体与甲状腺边缘接触程度对乳头状癌中央组淋巴结转移的预测. 中国临床医学影像杂志, 2017, 28(3): 173-175,179.
6. 黄春, 邓畅, 苏新良. cN0甲状腺微小乳头状癌淋巴结转移的危险因素分析. 中国普外基础与临床杂志, 2021, 28(7): 888-891.
7. Yazıcı D, Çolakoğlu B, Sağlam 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. 杨瑞, 张守鹏, 黄韬, 等. cN0期甲状腺微小乳头状癌淋巴结转移模型的构建和验证以及手术方式探讨. 临床耳鼻咽喉头颈外科杂志, 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. 刘文, 程若川, 苏艳军, 等. 2015版美国甲状腺协会指南cN0甲状腺乳头状癌手术方案合理性分析. 中国实用外科杂志, 2017, 37(5): 568-571, 576.
11. 解孝章, 郑炳行, 邓建伟. 300例cN0甲状腺微小乳头状癌的随访研究. 中国普外基础与临床杂志, 2020, 27(5): 569-573.
12. 马铭玉, 崔乐, 邹丹, 等. cN0甲状腺微小乳头状癌中央区淋巴结转移危险因素分析及列线图建立. 中华内分泌外科杂志, 2021, 15(2): 154-157.
13. 胡磊, 余盛敬, 王才善, 等. 多因素Logistic分析单灶甲状腺微小乳头状癌中央区淋巴结转移的危险因素. 川北医学院学报, 2020, 35(3): 453-457.
14. 庄欢, 廉猛, 房居高, 等. cN0甲状腺微小乳头状癌中央区淋巴结转移相关因素分析. 中国耳鼻咽喉头颈外科, 2020, 27(6): 311-315.
15. 陈立权, 庞士勇, 丁士海, 等. 甲状腺微小乳头状癌颈淋巴结转移危险因素分析及外科处理策略. 安徽医药, 2020, 24(5): 985-988.
16. 李小毅. 2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读: 外科部分. 中国癌症杂志, 2016, 26(1): 13-18.
17. 王海滨, 舒艳艳, 韩志江, 等. 不同大小甲状腺乳头状癌的CT征象比较. 中华内分泌外科杂志, 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. 李宁, 舒艳艳, 韩志江. CT征象联合临床特征对cN0期单发甲状腺乳头状癌中央组淋巴结转移的预测价值. 中国临床医学影像杂志, 2016, 27(9): 616-619.
22. 申金付, 李娟, 王卓群, 等. 甲状腺乳头状癌中央区淋巴结转移的影响因素分析. 安徽医学, 2020, 41(12): 1398-1401.
23. 高明, 葛明华, 嵇庆海, 等. 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版). 中国肿瘤临床, 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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