Predictive value of multimodal ultrasonography in cervical lymph node metastasis of thyroid micropapillary carcinoma

doi:10.3877/cma.j.issn.1672-6448.2021.09.004

Abstract

Abstract:

Objective

To investigate the predictive value of multimodal ultrasound consisting of conventional ultrasound, contrast-enhanced ultrasound, and superb microvascular imaging (SMI) in cervical lymph node metastasis (CLNM) of papillary thyroid microcarcinoma (PTMC).

Methods

A retrospective analysis was performed on 99 patients with pathologically confirmed PTMC at Beijing Tiantan Hospital, Capital Medical University from October 2018 to April 2021. Conventional ultrasound, contrast-enhanced ultrasound, and SMI were all performed preoperatively. According to pathologic results, the patients were divided into either a non-metastatic cervical lymph node group (n=60) or a metastatic cervical lymph node group (n=39). Features of multimodal ultrasound and clinical data of PTMC were observed and recorded. Independent-sample t test, Chi-square test, and Fisher exact test were used to compare the differences in all features between the two groups, and the statistically significant factors were included in multivariate Logistic regression analysis to identify the independent risk factors for PTMC with CLNM.

Results

Univariate analysis showed that compared with the patients with CLNM, the patients without CLNM were older [(47.50±11.48) years vs (39.67±9.95) years], had smaller PTMC [(0.66±0.02) cm vs (0.77±0.02) cm], were less likely to have the maximum diameter of single carcinoma or the sum of the maximum diameter of multiple carcinoma＞1.0 cm (13/60 vs 17/39), had less microcalcifications (none, ≤5 but not none, and＞5∶23, 23, and 14 vs 10, 10, and 19, respectively), were less likely to have PTMC with equal or high density enhancement (9/60 vs 13/39), and were less likely to have interruption of capsule continuity in early stage of contrast-enhanced ultrasound (14/60 vs 17/39) (t=3.491, P=0.001; t=3.376, P=0.001; χ²=5.379, P=0.020; χ²=6.854, P=0.032; χ²=4.596, P=0.032; and χ²=4.509, P=0.034, respectively). Multivariate analysis showed that younger age (odds ratio [OR]=0.933, P =0.004), larger PTMC (OR=30.567,P=0.046), and interruption of capsule continuity in early stage of contrast-enhanced ultrasound (OR=0.296, P=0.032) independently increased the risk of CLNM in PTMC.

Conclusion

Younger age, larger PTMC, and interruption of capsule continuity in early stage of contrast-enhanced ultrasound are independent risk factors for predicting CLNM of PTMC. The features of preoperative multimodal ultrasound have appreciated predictive value for CLNM in patients with PTMC.

Key words: Ultrasonography,multimodal, Papillary thyroid microcarcinoma, Cervical lymph node metastasis

Yukang Zhang, Wen He, Fang Wan, Yang Guang. Predictive value of multimodal ultrasonography in cervical lymph node metastasis of thyroid micropapillary carcinoma[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(09): 834-840.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.09.004

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Figures/Tables 3

组别	例数	男性/女性（例）	年龄（岁， $x ¯$ ±s）	最大径（cm， $x ¯$ ±s）	单发癌灶最大径或多发癌灶最大径之和（例）		病灶数量（例）		病灶分布（例）
组别	例数	男性/女性（例）	年龄（岁， $x ¯$ ±s）	最大径（cm， $x ¯$ ±s）	≤1.0 cm	＞1.0 cm	单灶	多灶	单灶	单叶多灶	双叶多灶
颈部淋巴结未转移组	60	12/48	47.50±11.48	0.66±0.02	47	13	37	23	37	12	11
颈部淋巴结转移组	39	10/29	39.67±9.95	0.77±0.02	22	17	20	19	20	8	11
统计值		χ²=0.043	t=3.491	t=3.376	χ²=5.379		χ²=0.065		χ²=1.482
P值		0.337	0.001	0.001	0.020		0.799		0.477
组别	例数	位置（例）				边缘（例）			形态（例）				实性成分回声（例）				钙化类型（例）
组别	例数	上部	中部	下部		光滑	分叶或不规则		椭圆形	类圆形	不规则		等回声	低回声	极低回声		无钙化	微小钙化	混合钙化
颈部淋巴结未转移组	60	11	25	24		4	56		2	11	47		3	27	30		23	35	2
颈部淋巴结转移组	39	7	20	12		1	38		4	5	30		2	11	26		9	26	4
统计值		χ²=1.037				-			-				-				-
P值		0.596				0.659			0.327				0.281				0.161
组别	例数	微钙化数量（例）				纵横比（例）			桥本甲状腺炎（例）			CDFI Rago分级（例）				SMI Rago分级（例）
组别	例数	无	有且≤5个	＞5个		≤1	＞1		有	无		Ⅰ级	Ⅱ级	Ⅲ级		Ⅰ级	Ⅱ级	Ⅲ级
颈部淋巴结未转移组	60	23	23	14		15	45		16	44		12	40	8		2	37	21
颈部淋巴结转移组	39	10	10	19		11	28		14	25		6	26	7		1	23	15
统计值		χ²=6.854				χ²=0.125			χ²=0.954			χ²=0.609				-
P值		0.032				0.723			0.329			0.737				0.925
组别	例数	造影后病灶边缘（例）			造影剂灌注方向（例）			病灶增强水平（例）			造影强度分布（例）			增强早期被膜连续性（例）			增强早期与腺体比较（例）			增强晚期与腺体比较（例）
组别	例数	清	不清		向心	弥漫		低增强	等或高增强		均匀	不均匀		连续	中断		同步增强	晚于腺体增强		同步消退	早于腺体消退
颈部淋巴结未转移组	60	5	55		40	20		51	9		7	53		46	14		14	46		18	42
颈部淋巴结转移组	39	1	38		28	11		26	13		7	32		22	17		12	27		14	25
统计值		χ²=0.554			χ²=0.289			χ²=4.596			χ²=0.768			χ²=4.509			χ²=0.675			χ²=0.376
P值		0.457			0.591			0.032			0.381			0.034			0.411			0.540

组别	例数	男性/女性（例）	年龄（岁， $x ¯$ ±s）	最大径（cm， $x ¯$ ±s）	单发癌灶最大径或多发癌灶最大径之和（例）		病灶数量（例）		病灶分布（例）
组别	例数	男性/女性（例）	年龄（岁， $x ¯$ ±s）	最大径（cm， $x ¯$ ±s）	≤1.0 cm	＞1.0 cm	单灶	多灶	单灶	单叶多灶	双叶多灶
颈部淋巴结未转移组	60	12/48	47.50±11.48	0.66±0.02	47	13	37	23	37	12	11
颈部淋巴结转移组	39	10/29	39.67±9.95	0.77±0.02	22	17	20	19	20	8	11
统计值		χ²=0.043	t=3.491	t=3.376	χ²=5.379		χ²=0.065		χ²=1.482
P值		0.337	0.001	0.001	0.020		0.799		0.477
组别	例数	位置（例）				边缘（例）			形态（例）				实性成分回声（例）				钙化类型（例）
组别	例数	上部	中部	下部		光滑	分叶或不规则		椭圆形	类圆形	不规则		等回声	低回声	极低回声		无钙化	微小钙化	混合钙化
颈部淋巴结未转移组	60	11	25	24		4	56		2	11	47		3	27	30		23	35	2
颈部淋巴结转移组	39	7	20	12		1	38		4	5	30		2	11	26		9	26	4
统计值		χ²=1.037				-			-				-				-
P值		0.596				0.659			0.327				0.281				0.161
组别	例数	微钙化数量（例）				纵横比（例）			桥本甲状腺炎（例）			CDFI Rago分级（例）				SMI Rago分级（例）
组别	例数	无	有且≤5个	＞5个		≤1	＞1		有	无		Ⅰ级	Ⅱ级	Ⅲ级		Ⅰ级	Ⅱ级	Ⅲ级
颈部淋巴结未转移组	60	23	23	14		15	45		16	44		12	40	8		2	37	21
颈部淋巴结转移组	39	10	10	19		11	28		14	25		6	26	7		1	23	15
统计值		χ²=6.854				χ²=0.125			χ²=0.954			χ²=0.609				-
P值		0.032				0.723			0.329			0.737				0.925
组别	例数	造影后病灶边缘（例）			造影剂灌注方向（例）			病灶增强水平（例）			造影强度分布（例）			增强早期被膜连续性（例）			增强早期与腺体比较（例）			增强晚期与腺体比较（例）
组别	例数	清	不清		向心	弥漫		低增强	等或高增强		均匀	不均匀		连续	中断		同步增强	晚于腺体增强		同步消退	早于腺体消退
颈部淋巴结未转移组	60	5	55		40	20		51	9		7	53		46	14		14	46		18	42
颈部淋巴结转移组	39	1	38		28	11		26	13		7	32		22	17		12	27		14	25
统计值		χ²=0.554			χ²=0.289			χ²=4.596			χ²=0.768			χ²=4.509			χ²=0.675			χ²=0.376
P值		0.457			0.591			0.032			0.381			0.034			0.411			0.540

因素	β值	SE值	Wals χ²值	P值	OR值	95%CI
年龄	-0.070	0.024	8.295	0.004	0.933	0.890~0.978
癌灶最大径（cm）	3.420	1.711	3.995	0.046	30.567	1.069~874.2
单发癌灶最大径或多发癌灶最大径之和是否＞1.0 cm	-1.131	0.603	3.517	0.061	0.323	0.099~1.052
微钙化数量			2.334	0.311
微钙化数量（1）	-0.960	0.628	2.334	0.127	0.383	0.112~1.312
微钙化数量（2）	-0.440	0.621	0.502	0.479	0.644	0.191~2.175
增强水平	-0.965	0.582	2.755	0.097	0.381	0.122~1.191
增强早期被膜连续性	-1.218	0.568	4.600	0.032	0.296	0.097~0.900
常量	2.974	2.004	2.201	0.138	19.561

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