| Objective: 1.The aims of this study were to explore the difference in ultrasonic features between papillary thyroid carcinoma(PTC)and benign nodules in the context of Hashimoto’s thyroiditis(HT)and investigate the differentially diagnostic value of benign and malignant thyroid nodules based on clinical data such as serum thyroid autoantibodies,in order to improve the diagnostic efficiency of malignant nodules with HT;2.Based on the preoperative serum thyroid autoantibodies,the clinicopathological characteristics and ultrasonic features of the research population were analyzed to explore the risk factors of central lymph node metastasis(CLNM)in patients with HT and PTC,in order to help clinicians choose the best treatment options.Methods: 1.According to the inclusion and exclusion criteria,in Subei People’s Hospital from August 2013 to January 2020,a retrospective analysis was conducted on509 patients who were diagnosed with thyroid nodules(TN)by ultrasound before surgery and pathologically confirmed with HT after thyroidectomy.Among the 509 patients,192 were benign thyroid nodules with HT(benign nodules group),and 317 were PTC patients with HT(PTC group).Patient’s basic information(including age,gender),ultrasonic features of thyroid nodules(number of nodules,internal echogenicity,nodule boundary,nodule shape,internal blood flow distribution,presence of microcalcification,aspect ratio,nodular cystic change,capsule invasion,and diffuse swelling of glands)as well as serum thyroid stimulating hormone(TSH)and thyroid antibodies expressions were collected for comparison.Furthermore,patients were divided into four groups(TPOAb single-positive,Tg Ab single-positive,double-positive,and double-negative)according to their preoperative autoantibody status.2.A retrospective analysis of PTC patients who were pathologically diagnosed with HT from August 2013 to January 2020 to Subei People’s Hospital.A total of 268 PTC patients with HT were enrolled,108 of these patients had CLNM(metastatic group)and 160 without CLNM(non-metastatic group).The patient’s clinicopathological data and ultrasonic features of thyroid nodules were collected for comparison.Clinicopathological data include the patient’s age,gender,TSH values,preoperative thyroid antibodies values,immunohistochemical staining of Galectin-3,Cytokeratin-19 and HBME-1 expression.At the same time,the diameter of the tumor,the number of tumor foci,extrathyroidal extension and whether the central lymphatic metastasis occurred were recorded.The collection of nodule ultrasonic features is the same as the first part.Results: 1.After postoperative pathological examination,there were 192 patients in the benign nodules group,including 4 males and 188 females.The age ranged from16 to 74 years,with an average age of(49.30±11.09)years.There were 317 patients in the malignant nodule group,of which 31 were males and 286 were females.The age ranged from 19 to 75 years,with an average age of(43.48±12.09)years.In the PTC group,the proportion of patients above the normal range of TSH was significantly higher than that of the benign nodule group,while the proportion of patients below the normal range of TSH was significantly lower than that of the benign nodule group.The results of general clinical data analysis between the two groups showed that there were statistically significant differences in age(P<0.001),gender(P=0.001),and TSH value(P<0.001),while there were no statistically significant differences in the expression level of preoperative thyroid autoantibodies(P=0.517).In addition,the results of ultrasound image feature analysis between the two groups showed that there are statistical differences in the echo type(P<0.001),boundary(P<0.001),shape(P=<0.001),aspect ratio(P<0.001),blood flow distribution of the thyroid nodule(P<0.001),with or without capsular invasion(P=0.014),with or without micro-calcification(P<0.001),with or without cystic change(P < 0.001),but there was no significant difference in the number of nodules(P=0.093)and the presence or absence of diffuse glandular swelling(P=0.093).Notably,malignant nodules are mostly hypoechoic,unclear borders,irregular shapes,aspect ratios> 1,no blood flow or central blood flow,capsular invasion,micro-calcification and rare cystic changes.2.The results of univariate analysis showed that there were significant difference in age(P < 0.001),gender(P=0.006),tumor diameter(P < 0.001),number of cancer foci(P < 0.001),preoperative thyroid antibodies status(P=0.002)and microcalcification(P<0.001)between the metastatic group and the non-metastatic group.Multivariate logistic regression analysis showed that younger age of onset,male,tumor diameter ≥1cm,multiple cancers,preoperative thyroid antibodies status and microcalcification were all independent risk factors for CLNM in PTC patients with HT(P<0.05).Conclusions: 1.In patients with HT,PTC is more common in female patients with a younger age of onset,but the probability of cancer in male patients with thyroid nodules is significantly higher than that in female patients.The serum TSH expression level of PTC patients is significantly higher than that of benign nodules,indicating that high level of TSH further promot the occurrence of nodules canceration.Ultrasound images showed hypoechoic,unclear nodule edges,irregular shapes,central blood flow,with microcalcification,aspect ratio>1,and capsular invasion,which may indicate malignant nodules,while cystic lesions may indicate benign nodules with HT.2.Young men,tumor diameter ≥1cm,multiple cancer foci,serum thyroid antibody level and microcalcification are all independent risk factors for CLNM in patients with HT and PTC.Notably,the risk of CLNM in the Tg Ab single-positive group was significantly higher than that of the other three groups. |
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