| Objective: This study aimed to explore the predictive value of high-frequency ultrasound features combined with patients’ preoperative serum thyroglobulin(Tg)levels in papillary thyroid carcinoma(PTC)patients with cervical lymph node metastasis,and to provide reference for clinical individualized diagnosis and treatment.Methods: Sixty-six patients with PTC who underwent surgical treatment in our hospital from January 2021 to January 2023 were included in the study.High frequency ultrasound and serum Tg levels were tested before surgical treatment.According to postoperative pathological results,all patients who underwent preventive central lymph node dissection were divided into two groups: some patients without cervical lymph node metastasis called N0 group,other patients had cervical lymph node metastasis called N1 group.Record the general clinical data(gender,age,etc.)of the patient,and the maximum nodal diameter,number of lesions,aspect ratio,internal echogenicity,microcalcifications,borders,blood flow signal,tegument and morphology of the PTC ultrasound features were observed.The ultrasound characteristics,preoperative serum Tg levels and general clinical data of the N0 and N1 groups were compared,and one-way and multi-way logistic regression analyses were performed to evaluate the factors associated with cervical lymph node metastasis in PTC patients.Results: 1.A total of sixty-six patients with pathologically confirmed PTC,19(28.8%)were male and 47(71.2%)were female,and the chi-square test analyzed a statistical difference in gender between the two groups(P=0.026).The preoperative serum Tg level of patients with PTC ranged from 2.26 to 501.5 ng/ml.The preoperative serum Tg level of N0 patients was10.65(5.43 to 14.7)ng/ml.The preoperative serum Tg level of N1 patients was 29.2(13.4 to75.6)ng/ml.Mann-Whitney U test showed that there was a statistically significant difference in the preoperative serum Tg level between the two groups(P<0.01).2.The ultrasound characteristics of the nodules in the two groups of PTC patients were analyzed by chi-square test,and the differences were statistically significant in terms of maximum nodule diameter(P=0.03),microcalcification(P=0.002),capsule(P<0.001),and morphology(P=0.027).3.Binary logistic regression analysis of variables with significant univariate analysis yielded:preoperative serum Tg(OR=1.083,95% CI: 1.018 to 1.152),nodal invasion of the tegument in ultrasound features(OR=10.159,95% CI: 2.009 to 51.381),microcalcifications(OR=16.938,95% CI: 1.201 to 238.918)were independent risk factors for the development of cervical lymph node metastasis in patients with PTC(P < 0.05).4.The ROC curve was plotted based on preoperative serum Tg levels and cervical lymph node metastasis.The ROC curve showed that the AUC of preoperative serum Tg levels for evaluating cervical lymph node metastasis was 0.808,the optimal threshold value was18.07ng/ml,the predictive sensitivity was 0.677,and the specificity was 0.886.The ROC curve was drawn based on the prediction probability of binary logistic regression analysis results and lymph node metastasis.The results showed that the AUC of high-frequency ultrasound combined with preoperative serum Tg levels for predicting cervical lymph node metastasis was 0.919,the optimal threshold value was 0.657,the predictive sensitivity was0.710,and the specificity was 0.943.Conclusion: Preoperative serum Tg >18.07 ng/ml,nodules with maximum diameter ≥10 mm in ultrasound features,microcalcifications,nodules invading the perineurium,irregular morphology,and males are risk factors for cervical lymph node metastasis in patients with PTC.Preoperative serum Tg >18.07 ng/ml,nodule invasion of the perineurium and microcalcifications in high-frequency ultrasound features were independent risk factors for cervical lymph node metastasis in PTC patients.High-frequency ultrasound combined with preoperative serum Tg has good predictive value for cervical lymph node metastasis in PTC patients. |
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