A Study On The Clinical Invasiveness Of Papillary Thyroid Carcinoma Combined With Hashimoto's Disease

Objective:To explore the impact of the clinicopathological characteristics of patients on the invasiveness of thyroid papillary carcinoma,especially the impact of Hashimoto’s diseaseMethods:A retrospective analysis of the medical records of patients with papillary thyroid cancer who were admitted to the Center for Thyroid Diseases of the First Affiliated Hospital of Kunming Medical University from April 2012 to December 2018.A total of 3,816 patients who had been selected for the initial surgery and whose surgical method was full/near total thyroidectomy and postoperative pathological diagnosis of thyroid papillary carcinoma;who had no history of other malignant tumors,normal serum TSH,and complete clinical data were eligible for inclusion in this study.The current statistics include gender,age,presence or absence of extraglandular invasion,tumor type,size,presence or absence of vascular invasion,presence or absence of Hashimoto’s disease,and test results of thyroid function(TSH),which are divided into two groups according to the presence or absence of extraglandular invasion.Statistical methods used chi-square/rank sum test,Logistic regression and linear regression analysis.Results:Among the 3,816 patients included in this study,the male to female ratio was approximately 1:3.7.The average age of the subjects included this time was(43.1±11.0)years old,and the median diameter of the largest tumor was 0.9(0.5-1.5)cm.There were 588 cases(15.4%).with extraglandular infiltration and 3228 cases(84.6%)without extraglandular invasion.Univariate analysis showed that tumor size,vascular invasion,and Hashimoto were related to extraglandular infiltration(p＜0.05).Multivariate logistic regression analysis showed that tumor size[β=0.696,p＜0.001,OR(95%CI)=2.006(1.827-2.204)],vascular invasion[β=0.772,p＜0.001,OR(95%CI)=2.165(1.546-3.031)],Hashimoto[β=-0.303,p=0.006,OR(95%CI)=0.739(0.596-0.915)]has an independent effect on extraglandular infiltration,the more the tumor diameter Larger tumors are more prone to extraglandular infiltration,and patients with Hashimoto’s disease are less prone to extraglandular infiltration.The results of linear regression analysis of tumor size showed that gender(β=0.082,p＜0.001),age(β=-0.134,p＜0.001),extraglandular infiltration(β=0.268,p＜0.001),vascular invasion(β=0.076,p＜0.001)is an independent influencing factor for tumor size,and the tumor size is larger in males,younger(age≤45 years),patients with extraglandular infiltration and vascular invasion.Conclusions:It was proved that tumor size and vascular invasion is an invasive risk factor of thyroid papillary carcinoma,and hashimoto’s disease is its protective factor again.Sex,age,extra-glandular invasion and vascular invasion were independent risk factors for tumor size of thyroid papillary carcinoma.The clinical significance and mechanism of the difference in the effect of hashimoto’s disease on the extra-gland infiltration of thyroid papillary carcinoma remains to be further studied.Objective:To evaluate the sensitivity to the macroscopic evaluation of metastatic lymph nodes.To discuss the influencing factors of sensitivity of metastatic lymph node evaluation.To explore how to improve the accuracy of intraoperative evaluation of metastatic lymph nodes.Methods:The standard for identifying metastatic lymph nodes during operation is that the lymph nodes are obviously enlarged(usually greater than 5mm),which are round,hard,and the color of the lymph nodes is darkened or even blackened without the injection of nano-carbon.Obvious extranodal infiltration.Postoperative pathological diagnosis is completed by more than two diagnostic physicians in the pathology department according to internationally established standards.Then analyze the patient’s gender(male,female),age(≤45 years,＞45 years),tumor size(≤1cm,＞1cm),number of lesions(single,multiple),combined with Hashimoto’s disease(yes,no)The impact on intraoperative identification of metastatic lymph nodes.Statistical description The normal distribution measurement data adopts mean± standard deviation(x±s),the skewed distribution adopts median(interquartile range),and count data adoption rate(%).Univariate analysis used chi-square test and Fisher’s exact probability method and multivariate analysis was performed using Logistic regression,both with p＜0.05 indicating that the difference was statistically significant.Results:A total of 82 patients were included in this study,including 17 males and 65 females.The average age was 46.3±9.6 years.There were 31 cases with unilateral thyroidectomy and ipsilateral central lymph node dissection,and 51 cases with total thyroidectomy and bilateral central lymph node dissection.The median size of primary thyroid papillary carcinoma was 0.75(0.5-1.0)cm.27 cases in hashimoto;There were 33 patients with central lymph node metastasis,and the number of lymph node metastases ranged from 1 to 7,with a median of 2(1-3).In this study,the results of unilateral central lymph node identification were compared.There were 133 central lymph nodes in total.The sensitivity and specificity of intraoperative identification were 23%,91%,positive predictive value was 0.53,and negative predictive value was 0.73.The sensitivity and specificity of intraoperative identification of metastatic lymph nodes in male patients were 36%and 94%respectively.The sensitivity and specificity of intraoperative identification of metastatic lymph nodes in female patients were 17%and 91%respectively.When the age of the patient was≤45 years old,the sensitivity and specificity of intraoperative identification of metastatic lymph nodes were 12%and 91%respectively.When the patient was 45 years old,the sensitivity and specificity of intraoperative identification of metastatic lymph nodes were 43%and 92%.When the tumor size was≤1cm,the sensitivity and specificity of intraoperative identification of metastatic lymph nodes were 23%and 91%respectively.When the tumor size was 1 cm,the sensitivity and specificity of intraoperative identification of metastatic lymph nodes were 22%and 94%.In patients with only one lesion,the sensitivity and specificity of intraoperative identification of metastatic lymph nodes were 14%and 92%.When patients had multiple lesions,the sensitivity and specificity of intraoperative identification of metastatic lymph nodes were 32%and 91%.When patients are combined with hashimoto’s disease,the general characteristics and number of lymph nodes can be significantly changed.Therefore,the sensitivity and specificity of intraoperative identification of metastatic lymph nodes are 8%and 90%.The sensitivity and specificity of intraoperative identification of metastatic lymph nodes were 29%and 92%in patients without hashimoto’s disease.Single-factor analysis showed that age alone had an effect on the sensitivity of the identification of metastatic lymph nodes(p<0.05),but multivariate analysis showed that age was not an independent factor affecting the identification(p=0.186).Conclusions:It was found in this paper that hashimoto’s disease can significantly affect the general characteristics and number of lymph nodes,and the sensitivity of intraoperative identification of metastatic lymph nodes was relatively low.Therefore,the different characteristics in the combination of hashimoto’s disease should be considered in the intraoperative identification of metastatic lymph nodes,suggesting that we may be able to explore in the future by combining other means such as imaging examination.