| Objectives:To compare the diagnostic value of high-frequency ultrasound,contrast-enhanced CT,ultrasound-guided fine-needle aspiration and the combination of different methods for the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma;to explore the optimal cut-off value of thyroglobulin in fine-needle aspirate fluid for the diagnosis of lateral cervical lymph node metastasis of PTC;to explore the risk factors associated with cervical lymph node metastasis of PTC and to assess the prediction efficiency of independent risk factors for lymph node metastasis.Methods:1.We collected 173 patients with PTC who underwent ultrasound examination of the thyroid and cervical lymph nodes in the ultrasound department of our hospital from January2020 to July 2022 and underwent contrast-enhanced CT examination at the same time and confirmed by surgical pathology.The diagnostic value of high-frequency ultrasound,contrast-enhanced CT and the combination of both on lateral cervical lymph node metastasis of PTC was compared,using surgical pathological results as the golden standard.2.We collected 230 patients with PTC who underwent FNA-Tg in the ultrasound department of our hospital from January 2020 to July 2022 and confirmed by surgical pathology.Based on the surgical pathological results,the ROC curve of FNA-Tg for the diagnosis of lateral cervical lymph node metastasis of PTC was drawn to explore the optimal cut-off value of FNA-Tg.A total of 123 patients underwent FNAC examination at the same time,and the diagnostic value of FNAC,FNA-Tg and the combination of both on lateral cervical lymph node metastasis of PTC was compared,using surgical pathological results as the golden standard.3.We collected 279 patients with PTC who underwent ultrasound examination of the thyroid and cervical lymph nodes in the ultrasound department of our hospital from July2019 to September 2022 and confirmed by surgical pathology,their clinical and ultrasonographic data were analyzed,and the patients were divided into two groups according to the presence or absence of cervical lymph node metastasis based on surgical pathological results.The relevant characteristics of the two groups were analyzed to explore the risk factors associated with cervical lymph node metastasis in PTC,and the predictive performance of independent risk factors on cervical lymph node metastasis of PTC was compared by ROC curves.Results:1.The sensitivity of high-frequency ultrasound,contrast-enhanced CT and the combination of both were 80.1%,78.3% and 93.7%,respectively;the specificity were 70.9%,68.4% and 64.6%,respectively;and the accuracy were 77.7%,75.7% and 86.0%,respectively,for the diagnosis of lateral cervical lymph node metastasis of PTC.By ROC curve analysis,the AUC of high-frequency ultrasound for the diagnosis of lateral cervical lymph node metastasis of PTC was 0.755 [95% CI:(0.689-0.821)];the AUC of contrastenhanced CT was 0.733 [95% CI:(0.666-0.801)];and the AUC of the combined group was0.791 [95% CI:(0.724-0.858)].Both single tests had good diagnostic value for lateral cervical lymph node metastasis of PTC,and the combination of both had higher diagnostic value for lateral cervical lymph node metastasis of PTC(P < 0.05).2.The concentration of FNA-Tg was significantly higher in the metastasis group than in the non-metastasis group(P < 0.05).the optimal cut-off value of FNA-Tg for the diagnosis of lateral cervical lymph node metastasis of PTC was 58.94 ng/L.3.The sensitivity of FNAC,FNA-Tg and the combination of both were 85.6%,93.7% and99.1%,respectively;the specificity were 95.2%,97.6% and 92.9%,respectively;and the accuracy were 88.2%,94.8% and 97.4%,respectively,for the diagnosis of lateral cervical lymph node metastasis of PTC.By ROC curve analysis,The AUC of FNAC for the diagnosis of lateral cervical lymph node metastasis of PTC was 0.904 [95% CI:(0.846-0.946)];the AUC of FNA-Tg was 0.957 [95% CI:(0.911-0.983)];the AUC of the combined group was0.960 [95% CI:(0.915-0.985)],and the efficacy of the combination of both was better than FNAC for the diagnosis of lateral cervical lymph node metastasis of PTC(P < 0.05).4.The risk factors associated with cervical lymph node metastasis of PTC included the patient’s age,gender,and characteristics such as the maximum diameter,border,shape,microcalcifications,and distance from the thyroid capsule of cancer nodes.Multivariate analysis showed that male,maximum diameter of cancer nodes ≥ 10 mm,microcalcifications,and distance from the thyroid capsule ≤ 2 mm were independent risk factors for cervical lymph node metastasis of PTC.5.The single independent risk factors had similar predictive efficacy for cervical lymph node metastasis in PTC,and the combination of the four had the highest predictive efficacy,the AUC was 0.785 [95% CI:(0.721-0.849)],(P < 0.05).6.The consistency index of the nomogram constructed by the four independent risk factors for predicted cervical lymph node metastasis of PTC was 0.755,and the nomogram correction curve showed that the prediction curve(Apparent)fitted well with the standard curve(Ideal),which more intuitively reflected the prediction efficiency of independent risk factors for cervical lymph node metastasis of PTC.Conclusions:1.Different methods have advantages for the diagnosis of lateral cervical lymph node metastasis of PTC.The diagnostic value of high-frequency ultrasound and contrast-enhanced CT was similar,and the diagnostic value of high-frequency ultrasound combined with contrast-enhanced CT was higher than high-frequency ultrasound or contrast-enhanced CT alone;the diagnostic accuracy of FNA-Tg was better than FNAC,and the diagnostic efficacy of FNAC combined with FNA-Tg was higher than FNAC alone.2.FNA-Tg is widely used in clinical practice as a good method to diagnose cervical lymph node metastasis of PTC.The optimal cut-off value of FNA-Tg for the diagnosis of cervical lymph node metastasis of PTC in this study was 58.94 ng/L.Determining the optimal cutoff value of FNA-Tg can help to accurately diagnose cervical lymph node metastasis of PTC.3.The clinical characteristics of patients and the sonographic features of PTC nodes were closely associated with cervical lymph node metastasis.Male,maximum diameter of cancer nodes ≥ 10 mm,microcalcifications,and distance from the thyroid capsule ≤ 2 mm were independent risk factors for cervical lymph node metastasis of PTC,and the combination of the four could improve the ultrasonographer’s ability to assess the risk of cervical lymph node metastasis of PTC. |
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