Ultrasound and Contrast-Enhanced Ultrasound Characteristics Associated With cN1 and Microscopic pN1 in Papillary Thyroid Carcinoma

Abstract

ObjectivesLymph node metastases (LNMs) could be stratified into clinical N1 (cN1) and microscopic pN1 (pathological N1), which bear different biological behavior and prognosis. Our study aimed to investigate the associations between LNMs and primary tumor’s US (ultrasound) and CEUS (contrast-enhanced ultrasound) characteristics based on the stratification of LNMs into cN1 and microscopic pN1 in papillary thyroid carcinoma (PTC).MethodsFrom August 2019 to May 2020, 444 consecutive PTC patients who underwent preoperative neck US and CEUS evaluation were included. According to regional lymph node status, the patients were classified into cN1 group versus cN0 (clinical N0) group and microscopic pN1 group versus pN0 (pathological N0) group. For multiple PTCs, the largest one was selected for the evaluation of US, CEUS and clinical features. Univariate and multivariate analyses were performed to determine independent predictors of cN1 and microscopic pN1.Results85 cN1 versus 359 cN0 patients and 117 microscopic pN1 versus 242 pN0 patients were analyzed. Multivariate logistic regression analysis showed that <55-years-old (OR: 2.56 (1.08–6.04), male [OR: 2.18 (1.22–3.91)], large size [OR: 2.59 (1.71–3.92)], calcification [OR: 3.88 (1.58–9.51)], and hyper-enhancement [OR: 2.78 (1.22–6.30)] were independent risk factors of cN1, while <55-years-old [OR: 1.91 (1.04–3.51)], large size [OR: 1.56 (1.003–2.42)], multifocality [OR: 1.67 (1.04–2.66)] were independent risk factors of microscopic pN1.ConclusionsFor patients with PTC, young age, male, large size, calcification, and hyper-enhancement were independent predictors of cN1, while young age, large size and multifocality were independent predictors of microscopic pN1.

Predicting central cervical lymph node metastasis in papillary thyroid carcinoma with Hashimoto’s thyroiditis: a practical nomogram based on retrospective study

“…These factors include age, TG-Ab levels, tumor size, calcifications, and blood flow grade. Indeed, most studies have identified age, sex, tumor size, multifocality, calcifications, and extrathyroidal extension as independent predictive factors for PTC CLNM ( Guang et al, 2021 ; Li et al, 2022 ; Li et al, 2021 ; Liu et al, 2019 ; Zhang et al, 2022 ). These findings indicate that there is heterogeneity in the clinical and ultrasound features between HT PTCs and PTCs without HT.…”

Development and validation of clinical predictive models for differentiated thyroid carcinoma and cervical lymph node metastasis: A retrospective cohort study

“…This is consistent with the preserved ultrasonographic features in most studies. [23][24][25] Additionally, other ultrasound features such as tumor size, multiplicity, and blood ow signal were included in the model.…”

Score based on contrast-enhanced ultrasound predict central lymph node metastasis in papillary thyroid cancer

“…However, the association between these PTC CEUS features and lymph node metastasis remains controversial. Both hyperenhancement, isoenhancement, and hypoenhancement at peak intensity have been reported to predict lymph node metastasis in PTC (6)(7)(8)(9). Therefore, further studies are still needed to explore reliable CEUS features for predicting lymph node metastasis.…”