The preoperative diagnostic value of conventional ultrasound combined with clinical features for central lymph node metastasis in papillary thyroid microcarcinoma

doi:10.3877/cma.j.issn.1674-3946.2025.04.013.

Abstract

Abstract:

Objective

To investigate whether conventional ultrasound can be used in combination with clinical characteristics to diagnose central lymph node metastases in papillary thyroid microcarcinoma(PTMC).

Methods

We conducted a retrospective study on 1113 consecutive PTMC patients admitted to the First Affiliated Hospital of Army Medical University between January 2018 and December 2020. Analyses were conducted to examine the correlation between ultrasonic imaging features combined with clinical characteristics and the presence of central lymph node metastases.

Results

Male gender, younger age, greater maximum diameter, multiple nodules, calcifications, and abnormal structure of the central lymph node hilum were significantly correlated with an increased risk of central lymph node metastasis (P<0.05). According to the regression model, area under the ROC curve was 0.7151 (95% CI: 0.685-0.745), with a sensitivity and specificity of 62.9% and 41.6%, respectively. Further analysis of factors such as multiple nodules,calcifications within nodules, and abnormal structure of the central lymph node hilum revealed that PTMC with 1, 2, and 3 risk factors had a 1.81-fold, 3.07-fold, and 4.76-fold higher risk of central lymph node metastases compared to the patients without risk factors.

Conclusion

Combining conventional ultrasonic imaging features with clinical characteristics provides a simple and efficient method of assessing the risk of central lymph node metastasis in PTMC, which is valuable when determining the surgical extent before surgery. Aims To investigate whether conventional ultrasound can be used in combination with clinical characteristics to diagnose central lymph node metastases in papillary thyroid microcarcinoma (PTMC).

Key words: Papillary thyroid Microcarcinoma, Central Lymph Node Metastasis, Ultrasonic Imaging Features, Preoperative Diagnosis

Min Yang, Jiangxiu Liao, Guozhi Zhang, Ye Zhang, Linjun Fan. The preoperative diagnostic value of conventional ultrasound combined with clinical features for central lymph node metastasis in papillary thyroid microcarcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 396-400.

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Figures/Tables 4

	总人群(n=1113)	中央区淋巴结未转移 (n=615)	中央区淋巴结转移(n=498)	统计量	P值
性别［例(%)］				χ ²=37. 76	＜0. 001
男	269 (24. 2)	105 (17. 1)	164 (32. 9)
女	844 (75. 8)	510 (82. 9)	334 (67. 1)
年龄（岁， $\overset{ˉ}{x}$ ± s ）	42. 3±10. 7	43.7±10.4	40. 6±10. 8	t=4. 78	＜0. 001
最大径（ mm， $\overset{ˉ}{x}$ ± s ）	8. 0±2. 0	7. 3±2. 0	8. 3±1. 9	t=-8. 14	＜0. 001
纵横比>1［例(%)］				χ ²=5. 07	0. 02
是	247 (22. 2)	152 (24. 7)	95 (19. 1)
否	866 (77. 8)	463 (75. 3)	403 (80. 9)
结节数量［例(%)］				χ ²=0. 97	0. 32
单灶	411 (36. 9)	235 (38. 2)	176 (35. 3)
多灶	702 (63. 1)	380 (61. 8)	322 (64. 7)
结节边缘［例(%)］				χ ²=0. 54	0. 46
不光整	1067(95. 9)	592 (96. 3)	475 (95. 4)
光整	46 (4. 1)	23 (3. 7)	23 (4. 6)
与被膜的关系［例(%)］				χ ²=0. 64	0. 42
不清	12 (1. 1)	8 (1. 3)	4 (0. 8)
清晰	1101(98. 9)	607 (98. 7)	494 (99. 2)
结节内钙化灶［例(%)］				χ ²=36. 77	＜0. 001
无	384 (34. 5)	260 (42. 3)	124 (24. 9)
有	729 (65. 5)	355 (57. 7)	374 (75. 1)
结节回声性质［例(%)］				χ ²=0. 12	0. 73
囊实性	119 (10. 7)	64 (10. 4)	55 (11. 0)
实性	994 (89. 3)	551 (89. 6)	443 (89. 0)
异常淋巴门结构［例(%)］				χ ²=32. 42	＜0. 001
无	557 (50. 0)	355 (57. 7)	202 (40. 6)
有	556 (50. 0)	260 (42. 3)	296 (59. 4)

	总人群(n=1113)	中央区淋巴结未转移 (n=615)	中央区淋巴结转移(n=498)	统计量	P值
性别［例(%)］				χ ²=37. 76	＜0. 001
男	269 (24. 2)	105 (17. 1)	164 (32. 9)
女	844 (75. 8)	510 (82. 9)	334 (67. 1)
年龄（岁， $\overset{ˉ}{x}$ ± s ）	42. 3±10. 7	43.7±10.4	40. 6±10. 8	t=4. 78	＜0. 001
最大径（ mm， $\overset{ˉ}{x}$ ± s ）	8. 0±2. 0	7. 3±2. 0	8. 3±1. 9	t=-8. 14	＜0. 001
纵横比>1［例(%)］				χ ²=5. 07	0. 02
是	247 (22. 2)	152 (24. 7)	95 (19. 1)
否	866 (77. 8)	463 (75. 3)	403 (80. 9)
结节数量［例(%)］				χ ²=0. 97	0. 32
单灶	411 (36. 9)	235 (38. 2)	176 (35. 3)
多灶	702 (63. 1)	380 (61. 8)	322 (64. 7)
结节边缘［例(%)］				χ ²=0. 54	0. 46
不光整	1067(95. 9)	592 (96. 3)	475 (95. 4)
光整	46 (4. 1)	23 (3. 7)	23 (4. 6)
与被膜的关系［例(%)］				χ ²=0. 64	0. 42
不清	12 (1. 1)	8 (1. 3)	4 (0. 8)
清晰	1101(98. 9)	607 (98. 7)	494 (99. 2)
结节内钙化灶［例(%)］				χ ²=36. 77	＜0. 001
无	384 (34. 5)	260 (42. 3)	124 (24. 9)
有	729 (65. 5)	355 (57. 7)	374 (75. 1)
结节回声性质［例(%)］				χ ²=0. 12	0. 73
囊实性	119 (10. 7)	64 (10. 4)	55 (11. 0)
实性	994 (89. 3)	551 (89. 6)	443 (89. 0)
异常淋巴门结构［例(%)］				χ ²=32. 42	＜0. 001
无	557 (50. 0)	355 (57. 7)	202 (40. 6)
有	556 (50. 0)	260 (42. 3)	296 (59. 4)

	回归系数	标准误	Wald值	OR(95%CI)值	P值
性别［例(%)］
女				Ref.
男	0. 46	0. 08	34. 26	2. 49(1. 84，3. 38)	＜0. 001
年龄（岁， $\overset{ˉ}{x}$ ± s ）	-0. 03	0. 01	20. 37	0. 97(0. 96，0. 98)	＜0. 001
最大径（mm， $\overset{ˉ}{x}$ ± s ）	0. 19	0. 03	29. 35	1. 21(1. 13，1. 29)	＜0. 001
纵横比>1［例(%)］
是				Ref.
否	0. 00	0. 08	0. 00	1. 00(0. 72，1. 38)	0. 98
结节数量［例(%)］
单灶				Ref.
多灶	0. 15	0. 07	4. 65	1. 36(1. 03，1. 81)	0. 03
结节边缘［例(%)］
不光整				Ref.
光整	-0. 19	0. 16	1. 34	0. 68(0. 36，1. 30)	0. 25
与被膜的关系［例(%)］
不清				Ref.
清晰	-0. 12	0. 32	0. 14	0. 79(0. 22，2. 79)	0. 79
结节内钙化灶［例(%)］
无				Ref.
有	0. 29	0. 07	16. 41	1. 78(1. 35，2. 35)	＜0. 001
结节回声性质［例(%)］
囊实性				Ref.
实性	0. 03	0. 11	0. 07	1. 06(0. 69，1. 62)	0. 79
异常淋巴门结构［例(%)］
无				Ref.
有	0. 31	0. 07	22. 34	1. 87(1. 44，2. 42)	＜0. 001

	回归系数	标准误	Wald值	OR(95%CI)值	P值
性别［例(%)］
女				Ref.
男	0. 46	0. 08	34. 26	2. 49(1. 84，3. 38)	＜0. 001
年龄（岁， $\overset{ˉ}{x}$ ± s ）	-0. 03	0. 01	20. 37	0. 97(0. 96，0. 98)	＜0. 001
最大径（mm， $\overset{ˉ}{x}$ ± s ）	0. 19	0. 03	29. 35	1. 21(1. 13，1. 29)	＜0. 001
纵横比>1［例(%)］
是				Ref.
否	0. 00	0. 08	0. 00	1. 00(0. 72，1. 38)	0. 98
结节数量［例(%)］
单灶				Ref.
多灶	0. 15	0. 07	4. 65	1. 36(1. 03，1. 81)	0. 03
结节边缘［例(%)］
不光整				Ref.
光整	-0. 19	0. 16	1. 34	0. 68(0. 36，1. 30)	0. 25
与被膜的关系［例(%)］
不清				Ref.
清晰	-0. 12	0. 32	0. 14	0. 79(0. 22，2. 79)	0. 79
结节内钙化灶［例(%)］
无				Ref.
有	0. 29	0. 07	16. 41	1. 78(1. 35，2. 35)	＜0. 001
结节回声性质［例(%)］
囊实性				Ref.
实性	0. 03	0. 11	0. 07	1. 06(0. 69，1. 62)	0. 79
异常淋巴门结构［例(%)］
无				Ref.
有	0. 31	0. 07	22. 34	1. 87(1. 44，2. 42)	＜0. 001

危险因素个数	回归系数	标准误	Wald值	OR(95%CI)值	P值
0	Ref.	Ref.	Ref.	Ref.	Ref.
1	-0. 22	0. 12	3. 31	1. 81(1. 01，3. 25)	0. 045
2	0. 30	0. 11	7. 45	3. 07(1. 74，5. 42)	0. 006
3	0. 74	0. 13	31. 18	4. 76(2. 60，8. 73)	＜0. 001

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