Ultrasonic Characteristics Improve Prediction Of Central Lymph Node Metastasis In CN0 Single-Focal Papillary Thyroid Cancer

BackgroundIn recent years,with the development of the economy,people have increased their attention to health,and the prevalence of thyroid nodules has increased,leading to an increase in the incidence of thyroid malignancies.According to the degree of differentiation of tumor tissue,thyroid malignancies can be roughly divided into two types:differentiated thyroid carcinoma(DTC)and anaplastic thyroid carcinoma(ATC).The most common type in clinical practice is papillary thyroid carcinoma(PTC),and lymph node metastasis is the main mode of spreadof PTC.As the sentinel lymph node in the neck,the central neck lymph node has important research value.By improving thyroid ultrasound,it is possible to preliminarily determine whether there is malignant tumor neck lymph node metastasis,thus formulating treatment plans.For cN0 unifocal PTC,accurate prediction of central lymph node metastasis(CLNM)in the neck is of great importance for clinical decision-making,but the sensitivity of preoperative detection of central lymph node metastasis is currently low.Therefore,this study aimed to clarify the ultrasound characteristics of central lymph node metastasis in unifocal PTC with a single lesion.MethodsFrom January 2018 to May 2021,a total of 1657 patients with papillary thyroid carcinoma were enrolled in this study,including 514 males and 1143 females.According to the preoperative thyroid ultrasound examination results,patients were required to meet the following inclusion criteria:1.suspected thyroid nodules on ultrasound examination,confirmed by biopsy as PTC;2.thyroid nodules were unifocal,that is,there was only one nodule in the thyroid with a diameter of less than 4cm;3.no history of neck radiation exposure;4.no invasion outside the thyroid gland;5.no evidence of central lymph node or distant metastasis on imaging.All eligible patients underwent total thyroidectomy and prophylactic central lymph node dissection(CLND).The thyroid and lymph node specimens were sent for pathological examination after surgery,Main findingsThe study found that 58.4%of male patients and 36.9%of female patients had central lymph node metastasis in the neck.In the univariate analysis,thyroid nodule size,nodule location adj acent to the anterior capsule,nodule distance to the thyroid lower pole,and color Doppler flow imaging(CDFI)were considered risk factors for both male and female groups(p<0.05).In the multivariate analysis,nodule size,nodule location adjacent to the anterior capsule,nodule distance to the thyroid lower pole,and CDFI were independent risk factors for male patients.For female patients,independent risk factors included nodule diameter,nodule location adj acent to the anterior capsule,nodule distance to the thyroid lower pole,and CDFI.ConclusionIn this study,ultrasonic characteristics,including size,adj acency to the anterior capsule,nodule distance to the thyroid lower pole,and color Doppler flow imaging(CDFI),were identified as potential risk factors for preoperative clinical decision-making for cN0 solitary papillary thyroid carcinoma patients.