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Wang L, Zhang L, Wang D, Chen J, Su W, Sun L, Jiang J, Wang J, Zhou Q. Predicting central cervical lymph node metastasis in papillary thyroid carcinoma with Hashimoto's thyroiditis: a practical nomogram based on retrospective study. PeerJ 2024; 12:e17108. [PMID: 38650652 PMCID: PMC11034492 DOI: 10.7717/peerj.17108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
Background In papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT), preoperative ultrasonography frequently reveals the presence of enlarged lymph nodes in the central neck region. These nodes pose a diagnostic challenge due to their potential resemblance to metastatic lymph nodes, thereby impacting the surgical decision-making process for clinicians in terms of determining the appropriate surgical extent. Methods Logistic regression analysis was conducted to identify independent risk factors associated with central lymph node metastasis (CLNM) in PTC patients with HT. Then a prediction model was developed and visualized using a nomogram. The stability of the model was assessed using ten-fold cross-validation. The performance of the model was further evaluated through the use of ROC curve, calibration curve, and decision curve analysis. Results A total of 376 HT PTC patients were included in this study, comprising 162 patients with CLNM and 214 patients without CLNM. The results of the multivariate logistic regression analysis revealed that age, Tg-Ab level, tumor size, punctate echogenic foci, and blood flow grade were identified as independent risk factors associated with the development of CLNM in HT PTC. The area under the curve (AUC) of this model was 0.76 (95% CI [0.71-0.80]). The sensitivity, specificity, accuracy, and positive predictive value of the model were determined to be 88%, 51%, 67%, and 57%, respectively. Conclusions The proposed clinic-ultrasound-based nomogram in this study demonstrated a favorable performance in predicting CLNM in HT PTCs. This predictive tool has the potential to assist clinicians in making well-informed decisions regarding the appropriate extent of surgical intervention for patients.
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Affiliation(s)
- Lirong Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Lin Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Dan Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Jiawen Chen
- Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Wenxiu Su
- Department of Pathology, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Lei Sun
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Jue Jiang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Juan Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Qi Zhou
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
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Li P, Liu Y, Wei T, Wang X, Zhu J, Yang R, Gong Y, Zhao W. Effect and Interactions of BRAF on Lymph Node Metastasis in Papillary Thyroid Carcinoma With Hashimoto Thyroiditis. J Clin Endocrinol Metab 2024; 109:944-954. [PMID: 37967234 DOI: 10.1210/clinem/dgad667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023]
Abstract
CONTEXT The role of B-Raf proto-oncogene (BRAF) in papillary thyroid carcinoma (PTC) with Hashimoto thyroiditis (HT) is unknown. OBJECTIVE We aimed to explore risk factors affecting lymph node (LN) metastasis and interaction effect of BRAF in PTC patients with HT. METHODS We retrospectively collected the data of 994 PTC patients with HT who underwent surgery at the West China Hospital. We analyzed the correlations between preoperative characteristics and LN metastasis in overall, and different BRAFV600E-mutation patients. Logistic regression was applied to analyze the risk factors for LN metastasis. Finally, we performed an interaction effect analysis to identify the interaction effect of BRAF. RESULTS The overall LN metastasis rate was 52.71% (524/994); the overall BRAF mutation rate was 26.9% (268/994). BRAF mutation rates were significantly different in LN metastasis and nonmetastasis patients (31.7% vs 21.5%; P < .001). In all 994 patients, age, body mass index (BMI), hypertension, tumor maximum diameter, BRAF mutation, tumor location, aspect ratio, calcification, and extrathyroidal invasion were risk factors for LN metastasis (P < .05). In BRAF-mutant patients, smoking, hypertension, maximum diameter, calcification, and multifocality were risk factors for LN metastasis (P < .05). In BRAF wild-type patients, age, BMI, maximum diameter, tumor location, aspect ratio, tumor shape, calcification, and extrathyroidal invasion were risk factors (P < .05). Additionally, we found statistically significant interactions between BRAF and BMI, hypertension, maximum diameter, and calcification (P < .05), suggesting the potential interaction effect of BRAF. CONCLUSION BRAF is a risk factor for LN metastasis in PTC with HT. Meanwhile, BRAF can interact with age, BMI, hypertension, and calcification, which together influence LN metastasis.
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Affiliation(s)
- Pengyu Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
- Center for Frontier Medicine in Molecular Networks, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
| | - Yang Liu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
| | - Tao Wei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
- Center for Frontier Medicine in Molecular Networks, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
| | - Xiaofei Wang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
| | - Jingqiang Zhu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
- Center for Frontier Medicine in Molecular Networks, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
| | - Rui Yang
- Center for Frontier Medicine in Molecular Networks, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
| | - Yanping Gong
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
| | - Wanjun Zhao
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Wuhou District, Chengdu 610044, China
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Sun H, Zhao X, Wang X, Ma J, Liu M. Correlation analysis of risk factors for cervical lymphatic metastasis in papillary thyroid carcinoma. Diagn Pathol 2024; 19:13. [PMID: 38218832 PMCID: PMC10788004 DOI: 10.1186/s13000-024-01440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE This study aims to identify and analyze the risk factors associated with Cervical Lymph Node Metastasis (CNM) in Papillary Thyroid Carcinoma (PTC) patients. METHODS We conducted a retrospective study involving the clinicopathological data of 2384 PTC patients admitted to our hospital between January 2016 and December 2020. All relevant data were statistically processed and analyzed. RESULTS The related risk factors for Central Lymph Node Metastasis (CLNM) were gender (male), age (≤ 30 years old), tumor lesion size (> 0.855 cm), and multifocal tumor foci. The ROC curve revealed that the critical value for predicting CLNM based on tumor lesion size was 0.855 (sensitivity = 57.9%, specificity = 69%, AUC = 0.269, and P < 0.05). Lateral Lymph Node Metastasis (LLNM) was positively correlated with tumor diameter. Specifically, the LLNM rate increased with the tumor diameter. LLNM occurrence was significantly higher in zones II, III, and IV than in zones I and V. Although the BRAF gene mutation detection assay has certain clinical benefits in diagnosing PTC and LLNM, no statistically significant difference was found in its relationship with central and lateral neck lymph node metastases (P = 0.741). CONCLUSION Our findings revealed that CLNM is associated with gender (male), age (≤ 30 years old), tumor lesion size (> 0.855 cm), and multiple tumor lesions in PTC patients. Central Lymph Node Dissection (CLND) is recommended for patients with these risk factors. On the other hand, preoperative ultrasound examination, fine-needle pathological examination, and genetic testing should be used to determine whether Lateral Cervical Lymph Node Dissection (LLND) is needed.
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Affiliation(s)
- Haoying Sun
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdaobei Street, Hohhot, Inner Mongolia, 010050, China
| | - Xueyu Zhao
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdaobei Street, Hohhot, Inner Mongolia, 010050, China
| | - Xin Wang
- Inner Mongolia Cancer Hospital, Hohhot, China
| | - Jinzhu Ma
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdaobei Street, Hohhot, Inner Mongolia, 010050, China
| | - Ming Liu
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdaobei Street, Hohhot, Inner Mongolia, 010050, China.
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Du J, Yang Q, Sun Y, Shi P, Xu H, Chen X, Dong T, Shi W, Wang Y, Song Z, Shang X, Tian X. Risk factors for central lymph node metastasis in patients with papillary thyroid carcinoma: a retrospective study. Front Endocrinol (Lausanne) 2023; 14:1288527. [PMID: 38047112 PMCID: PMC10690810 DOI: 10.3389/fendo.2023.1288527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Thyroid cancer is the most prevalent endocrine malignancy, with its global incidence increasing annually in recent years. Papillary carcinoma is the most common subtype, frequently accompanied by cervical lymph node metastasis early on. Central lymph node metastasis (CLNM) is particularly the common metastasis form in this subtype, and the presence of lymph node metastasis correlates strongly with tumor recurrence. However, effective preoperative assessment methods for CLNM in patients with papillary thyroid carcinoma (PTC) remain lacking. Methods Data from 400 patients diagnosed with PTC between January 1, 2018, and January 1, 2022, at the Shandong Provincial Hospital were retrospectively analyzed. This data included clinicopathological information of the patients, such as thyroid function, BRAF V600E mutation, whether complicated with Hashimoto's thyroiditis, and the presence of capsular invasion. Univariate and multivariate logistic regression analyses were performed to assess the risk factors associated with cervical CLNM in patients with PTC. Subsequently, a clinical prediction model was constructed, and prognostic risk factors were identified based on univariate and multivariate Cox regression analyses. Results Univariate and multivariate analyses identified that age >45 years (P=0.014), body mass index ≥25 (P=0.008), tumor size ≥1 cm (P=0.001), capsular invasion (P=0.001), and the presence of BRAF V600E mutation (P<0.001) were significantly associated with an increased risk of CLNM. Integrating these factors into the nomogram revealed an area-under-the-curve of 0.791 (95% confidence interval 0.735-0.846) and 0.765 (95% confidence interval: 0.677-0.852) for the training and validation sets, respectively, indicating strong discriminative abilities. Subgroup analysis further confirmed that patients with papillary thyroid microcarcinoma and BRAF V600E mutations who underwent therapeutic central compartment neck dissection had significantly better 3-year disease-free survival than those who had prophylactic central compartment neck dissection (P<0.001). Conclusion The study revealed that age >45 years, body mass index ≥25, tumor size ≥1 cm, BRAF V600E mutation, and capsular invasion are the related risk factors for CLNM in patients with PTC. For patients with clinically nodal-negative (cN0) papillary thyroid microcarcinoma, accurately identifying the BRAF V600E mutation is essential for guiding the central lymph node dissection approach and subsequent treatments.
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Affiliation(s)
- Jiachen Du
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Qing Yang
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Yixuan Sun
- Department of Hematology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Peng Shi
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Hao Xu
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Xiao Chen
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Tianyi Dong
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Wenjing Shi
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Yatong Wang
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Zhenzhi Song
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Xingchen Shang
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Xingsong Tian
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong, China
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
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Marongiu A, Nuvoli S, De Vito A, Vargiu S, Spanu A, Madeddu G. Hashimoto's Thyroiditis and Papillary Thyroid Carcinoma: A Follow-Up Study in Patients with Absence of Aggressive Risk Factors at the Surgery of the Primary Tumor. Diagnostics (Basel) 2023; 13:3068. [PMID: 37835813 PMCID: PMC10572807 DOI: 10.3390/diagnostics13193068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Hashimoto's thyroiditis (HT) is often associated with papillary thyroid carcinoma (PC); it is still a matter of controversy whether the behavior of carcinoma is more aggressive or not. During the follow-up, we retrospectively enrolled 97 patients with PC/HT after thyroidectomy without risk factors at the surgery of the primary tumor, such as multifocality/multicentricity, extrathyroid tumor extension, vascular invasion, neck and distant metastases, and aggressive histological variants. HT diagnosis was confirmed by histology and serum thyroid antibodies. Tumor size was ≤10 mm in 64 cases (microcarcinomas); 206 matched PC patients after thyroidectomy without HT and risk factors were enrolled as controls, totaling 122 microcarcinomas. During follow-up, metastases occurred in 15/97 (15.5%) PC/HT cases, eight microcarcinomas, and in 16/206 (7.8%) without HT, eight microcarcinomas (p = 0.04). Considering both PC/HT and PC patients without HT who developed metastases, univariate analysis showed an increased risk of metastases in patients with HT coexistence, OR: 2.17 (95% CI 1.03-4.60) p = 0.043. Disease-free survival (DFS) was significantly (p = 0.0253) shorter in PC/HT than in the controls. The present study seems to demonstrate that HT is not a cancer protective factor in PC patients given the less favorable outcomes and significantly shorter DFS. HT may also represent an independent recurrence predictor without other risk factors.
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Affiliation(s)
- Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Sonia Vargiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (S.N.); (S.V.); (A.S.); (G.M.)
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Wang R, Tang Z, Wu Z, Xiao Y, Li J, Zhu J, Zhang X, Ming J. Construction and validation of nomograms to reduce completion thyroidectomy by predicting lymph node metastasis in low-risk papillary thyroid carcinoma. Eur J Surg Oncol 2023; 49:1395-1404. [PMID: 37061404 DOI: 10.1016/j.ejso.2023.03.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/17/2023]
Abstract
CONTEXT More than 5 central lymph nodes metastases (CLNM) or lateral lymph node metastasis (LLNM) indicates a higher risk of recurrence in low-risk papillary thyroid carcinoma (PTC) and may lead to completion thyroidectomy (CTx) in patients initially undergoing lobectomy. OBJECTIVE To screen potentially high-risk patients from low-risk patients by using preoperative and intraoperative clinicopathological features to predict lymph node status. METHODS A retrospective analysis of 8301 PTC patients in Wuhan Union Hospital database (2009-2021) was performed according to the 2015 American Thyroid Association (ATA) and 2021 National Comprehensive Cancer Network (NCCN) guidelines, respectively. Logistic regression and best subsets regression were used to identify risk factors. Nomograms were established and externally validated using the Differentiated Thyroid Cancer in China cohort. RESULTS More than 5 CLNM or LLNM was detected in 1648 (19.9%) patients. Two predictive models containing age, gender, maximum tumor size, free thyroxine (FT4) and palpable node (all p < 0.05) were established. The nomogram based on NCCN criteria showed better discriminative power and consistency with a specificity of 0.706 and a sensitivity of 0.725, and external validation indicated that 76% of potentially high-risk patients could achieve preoperative conversion of surgical strategy. CONCLUSIONS Models based on large cohorts with good predictive performance were constructed and validated. Preoperative low-risk (T1-2N0M0) patients with age younger than 40 years, male gender, large tumor size, low FT4 and palpable nodes may be at high risk of LLNM or more than 5 CLNM, and they should receive more aggressive initial therapy to reduce CTx.
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Affiliation(s)
- Rong Wang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zimei Tang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhenghao Wu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yunxiao Xiao
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiexiao Li
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Junling Zhu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ximeng Zhang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jie Ming
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Jie Y, Ruan J, Luo M, Liu R. Ultrasonographic, clinical, and pathological features of papillary thyroid carcinoma in children and adolescents with or without Hashimoto's thyroiditis. Front Oncol 2023; 13:1198468. [PMID: 37593099 PMCID: PMC10428624 DOI: 10.3389/fonc.2023.1198468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/07/2023] [Indexed: 08/19/2023] Open
Abstract
Objective To compare the ultrasonographic, clinical, and pathological features of children and adolescents with papillary thyroid carcinoma (PTC) with and without Hashimoto's thyroiditis (HT). Materials and methods A total of 52 children and adolescent patients surgically diagnosed with PTC between 2017 and 2022 were included; 14 children and adolescent patients with PTC were diagnosed with HT via pathological examination. The preoperative ultrasonographic, postoperative histological, and molecular and clinical characteristics were retrospectively analyzed. Results The prevalence rate of PTC in patients with HT was 27%. Papillary thyroid microcarcinomas were found in 11 of 38 patients without HT, but none in patients with HT (p = 0.023). Extrathyroidal extension, capsular invasion, and lymph node metastases were more frequent in patients with PTC and HT than in patients with PTC alone (p < 0.05 for both). The ultrasonographic features of nodule composition, echogenicity, shape, margin, Thyroid Imaging Reporting and Data System categories, and total points were similar. The patterns of echogenic foci were more prominent in the nodules of patients with HT than in those of patients without HT (p = 0.016). Conclusion The frequency of papillary thyroid microcarcinomas in patients with PTC and HT was less, whereas that of extrathyroidal extension, capsular invasion, and lymph node metastasis was significantly higher in patients with PTC and HT than in those with PTC alone. The patterns of echogenic foci on ultrasonography may represent a risk for PTC.
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Affiliation(s)
- Yue Jie
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- GuangDong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingliang Ruan
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- GuangDong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Man Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- GuangDong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rongbin Liu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- GuangDong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Wang Y, Zheng J, Hu X, Chang Q, Qiao Y, Yao X, Zhou X. A retrospective study of papillary thyroid carcinoma: Hashimoto's thyroiditis as a protective biomarker for lymph node metastasis. Eur J Surg Oncol 2023; 49:560-567. [PMID: 36404253 DOI: 10.1016/j.ejso.2022.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE There is approximately 10%-50% of papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT). In this research, we sought to better understand the role of HT in PTC progression as well as lymph node metastasis. METHODS It is a retrospective and cross-sectional study, and 4131 PTC patients who underwent thyroidectomy were finally enrolled. Chi-square test, univariate and multivariate logistic regression analyses were employed to evaluate both the risk factors and the critical roles of HT during PTC metastasis. RESULT In this cohort, 1555 patients (37.6%) were diagnosed with HT. According to multivariate analysis, male sex, high levels of TG and TPOAb, tumor extrathyroidal extension, maximum diameter >1 cm, and multifocality were independent risk factors for both central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). In addition, age <55 years and smoking were risk factors for CLNM, while CLNM was one of the risk factors for LLNM. Furthermore, HT was suggested a valuable protective factor for both CLNM and LLNM. In patients with HT, the total number of central lymph nodes was higher, while the positive rate was lower. Compared with those without HT, age and sex did not predict CLNM and LLNM in patients with HT. CONCLUSION HT is considered a protective factor for both CLNM and LLNM in PTC. For patients with HT, surgeons should pay more attention to the preservation of parathyroid gland and the protection of recurrent laryngeal nerve due to less lymph node metastasis. Otherwise, radical operation is highly recommended.
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Affiliation(s)
- Yu Wang
- Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Jianwei Zheng
- Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Xiaomeng Hu
- Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Qing Chang
- Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Yu Qiao
- Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Xiaofeng Yao
- Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Xuan Zhou
- Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
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Zhao T, Xu S, Zhang X, Xu C. Comparison of Various Ultrasound-Based Malignant Risk Stratification Systems on an Occasion for Assessing Thyroid Nodules in Hashimoto's Thyroiditis. Int J Gen Med 2023; 16:599-608. [PMID: 36845342 PMCID: PMC9946008 DOI: 10.2147/ijgm.s398601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
Purpose To compare the diagnostic performance and unnecessary ultrasound-guided fine-needle aspiration (US-FNA) biopsy rate of the 2015 American Thyroid Association (ATA), 2016 Korean Society of Thyroid Radiology (KSThR), and 2017 American College of Radiology (ACR) guidelines for patients with and without Hashimoto's thyroiditis (HT). Patients and Methods This retrospective study included 716 nodules from 696 consecutive patients, which were classified using the categories defined by the three guidelines: ATA, KSThR, and ACR. The malignancy risk in each category was calculated and the diagnostic performance and unnecessary fine-needle aspiration (FNA) rates of the three guidelines were compared. Results In total, 426 malignant and 290 benign nodules were identified. Patients with malignant nodules had lower total thyroxine levels and higher thyroid-stimulating hormone, thyroid peroxidase antibody, and thyroglobulin antibody levels than those without malignant nodules (all P<0.01). The margin difference was significant in non-HT patients (P<0.01), but comparable in HT patients (P=0.55). The calculated malignancy risks of high and intermediate suspicion nodules in the ATA and KSThR guidelines and moderately suspicious nodules in the ACR guidelines were significantly lower in non-HT patients compared with HT patients (P<0.05). The ACR guidelines showed the lowest sensitivity, highest specificity, and lowest unnecessary FNA rates in patients with and without HT. Compared to non-HT patients, HT patients had significantly lower unnecessary FNA rates (P<0.01). Conclusion HT was associated with a higher malignancy rate of thyroid nodules with intermediate suspicion according to the ATA, KSThR, and ACR guidelines. The three guidelines, especially ACR, were likely to be more effective and could allow a greater reduction in the percentage of benign nodules biopsied in patients with HT.
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Affiliation(s)
- Tianxue Zhao
- Department of Endocrinology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Shaokun Xu
- Department of Geriatrics, Zhejiang Provincial People’s Hospital, Hangzhou, People’s Republic of China
| | - Xianfeng Zhang
- Department of Endocrinology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Chenke Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China,Correspondence: Chenke Xu, Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, No. 261 Huansha Road, Hangzhou, 310006, People’s Republic of China, Tel +86-571-56005600, Email
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Zhang Y, Lu KN, Ding JW, Peng Y, Pan G, Teng LS, Luo DC. Identification of Long Noncoding RNAs Associated With the Clinicopathological Features of Papillary Thyroid Carcinoma Complicated With Hashimoto’s Thyroiditis. Front Oncol 2022; 12:766016. [PMID: 35359359 PMCID: PMC8963332 DOI: 10.3389/fonc.2022.766016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/11/2022] [Indexed: 12/20/2022] Open
Abstract
Long noncoding RNAs (lncRNAs) play a significant role in cancer biology. This study aimed to determine the roles of lncRNAs in establishing the differences in clinical features between patients with papillary thyroid carcinoma (PTC) without Hashimoto’s thyroiditis (HT) and patients with PTC and HT. In the present study, we detected the differentially expressed lncRNAs between tumor tissues of patients with PTC with or without HT through lncRNA microarrays. The data were verified and analyzed through qRT-PCR, cell viability, cell cycle and bioinformatics analyses. We found that 1031 lncRNAs and 1338 mRNAs were abnormally expressed in 5 tissue samples of PTC complicated with HT [PTC/HT (+)] compared with 5 samples of PTC without HT [PTC/HT (-)]. Gene Ontology and pathway analyses of the mRNAs suggested that several biological processes and pathways, particularly immune system processes, were induced in the PTC/HT (+) tissues. Twenty lncRNAs were verified in 31 PTC/HT (+) and 64 PTC/HT (-) specimens by qRT-PCR, and the results were consistent with the microarray data. Specifically, ENST00000452578, a downregulated lncRNA in PTC/HT(+), was negatively correlated with the tumor size. Cell viability assays revealed that ENST00000452578 could inhibit cell proliferation. Our results indicate that lncRNAs and mRNAs play an important role in establishing the different clinical characteristics between patients with PTC/HT(+) and patients with PTC/HT(-), and might provide new insights from the perspective of RNA for obtaining a further understanding of the clinical features related to PTC with HT.
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Affiliation(s)
- Yu Zhang
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai-Ning Lu
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin-Wang Ding
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China
| | - You Peng
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Pan
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Song Teng
- Cancer Center, The First Affiliated Hospital, Zhejiang University school of Medicine, Hangzhou, China
- *Correspondence: Li-Song Teng, ; Ding-Cun Luo,
| | - Ding-Cun Luo
- Department of Oncological Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Li-Song Teng, ; Ding-Cun Luo,
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11
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Li S, Li S, Lin M, Li Z, He J, Qiu J, Zhang J. Interleukin-17 and vascular endothelial growth factor: new biomarkers for the diagnosis of papillary thyroid carcinoma in patients with Hashimoto's thyroiditis. J Int Med Res 2022; 50:3000605211067121. [PMID: 35023376 PMCID: PMC8793523 DOI: 10.1177/03000605211067121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective The incidences of papillary thyroid carcinoma (PTC) and Hashimoto’s thyroiditis (HT) have shown increasing trends. Numerous studies have shown a close relationship between the two diseases, but the exact mechanism linking PTC with HT is still unclear. Interleukin-17 (IL-17) plays an important role in the development of malignant tumors. However, information on the association between IL-17 and thyroid disease is lacking. Methods Tissue samples were collected from patients with thyroid diseases admitted to the thyroid surgery department of our hospital between May 2015 and December 2017. The characteristics of the thyroid were observed by ultrasonography, hematoxylin-eosin staining, enzyme-linked immunosorbent assays, and immunohistochemistry. Results We found that HT with carcinoma (HTC) showed unique characteristics in two-dimensional ultrasound images. Moreover, IL-17 and vascular endothelial growth factor (VEGF) levels showed gradually increasing trends during the process of HT malignant transformation, with a significant positive correlation between the two cytokines. Serum IL-17 and VEGF levels could distinguish between HTC and HT with benign adenoma. Conclusion Our data suggest that serum IL-17 and VEGF levels may represent novel biomarkers for the diagnosis of HT malignant nodules.
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Affiliation(s)
- Shuiping Li
- Department of Ultrasonography, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Shilin Li
- Department of Ultrasonography, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Min Lin
- Department of Ultrasonography, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Zuolin Li
- Department of Ultrasonography, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Jinghua He
- Department of Ultrasonography, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Jincheng Qiu
- Department of Ultrasonography, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Jiantang Zhang
- Department of Ultrasonography, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
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12
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Wu L, Zhou Y, Guan Y, Xiao R, Cai J, Chen W, Zheng M, Sun K, Chen C, Huang G, Zhang X, Zhai L, Qian Z, Shen SR. Washout DNA copy number analysis by low-coverage whole genome sequencing for assessment of thyroid FNAs. Front Endocrinol (Lausanne) 2022; 13:888072. [PMID: 36313748 PMCID: PMC9614279 DOI: 10.3389/fendo.2022.888072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Papillary thyroid microcarcinoma (PTMC) is defined as a papillary carcinoma measuring ≤ 10 mm. The current management of PTMC has become more conservative; however, there are high-risk tumor features that can be revealed only postoperatively. For thyroid cancer, BRAF mutations and somatic copy number variation (CNV) are the most common genetic events. Molecular testing may contribute to clinical decision-making by molecular risk stratification, for example predicting lymph node (LN) metastasis. Here, we build a risk stratification model based on molecular profiling of thyroid fine needle aspiration (FNA) washout DNA (wDNA) for the differential diagnosis of thyroid nodules. METHODS Fifty-eight patients were recruited, FNA wDNA samples were analyzed using CNV profiling through low-coverage whole genome sequencing (LC-WGS) and BRAF mutation was analyzed using quantitative PCR. FNA pathology was reported as a Bethesda System for Reporting Thyroid Cytopathology (BSRTC) score. Ultrasound examination produced a Thyroid Imaging Reporting and Data System (TIRADS) score. RESULTS In total, 37 (63.8%) patients with a TIRADS score of 4A, 13 (22.4%) patients with a TIRADS score of 4B, and 8 (13.8%) patients with a TIRADS score of 4C were recruited after ultrasound examination. All patients underwent FNA with wDNA profiling. CNVs were identified in 17 (29.3%) patients. CNVs were frequent in patients with a BSRTC score of V or VI, including eight (47.1%) patients with a score of VI and five (29.4%) with a score of V, but not in patients with a score of III, II, or I (0%). BRAF mutation was not significantly correlated with BSRTC score. LN metastasis was found more frequently in CNV-positive (CNV+) than in CNV-negative (CNV-) patients (85.7% vs. 34.6%, odds ratio = 11.33, p = 0.002). In total, three molecular subtypes of thyroid nodules were identified in this study: 1) CNV+, 2) CNV- and BRAF positive (BRAF+), and 3) CNV- and BRAF negative (BRAF-). For the CNV+ subtype, 10 (83.3%) lesions with LN metastasis were found, including four (100%) small lesions (i.e. ≤ 5 mm). For the CNV- and BRAF+ nodules, LN metastases were detected in only seven (60.0%) larger tumors (i.e. > 5 mm). For CNV- and BRAF- tumors, LN metastasis was also frequently found in larger tumors only. CONCLUSIONS It is feasible to identify high-risk LN metastasis thyroid cancer from FNA washout samples preoperatively using wDNA CNV profiling using LC-WGS.
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Affiliation(s)
- Linfeng Wu
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Yuying Zhou
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Yaoyao Guan
- Department of Plastic Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rongyao Xiao
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Jiaohao Cai
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Weike Chen
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Mengmeng Zheng
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Kaiting Sun
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Chao Chen
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Guanli Huang
- Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaogang Zhang
- Hangzhou Catcher Bio Inc., Hangzhou, China
- Hongyuan Biotech Inc., Suzhou, China
| | - Lijuan Zhai
- Hangzhou Catcher Bio Inc., Hangzhou, China
- Hongyuan Biotech Inc., Suzhou, China
| | - Ziliang Qian
- Hongyuan Biotech Inc., Suzhou, China
- Prophet Genomics Inc., San Jose, CA, United States
| | - Shu-rong Shen
- Oncology and Hematology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
- *Correspondence: Shu-rong Shen,
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Wang J, Sheng X, Dai Y, Zhang J, Song L, Guo Y. The Application Value of the Central Lymph Node Metastasis Risk Assessment Model in Papillary Thyroid Microcarcinoma of Stage cN0: A Study of 828 Patients. Front Endocrinol (Lausanne) 2022; 13:843573. [PMID: 35360071 PMCID: PMC8960455 DOI: 10.3389/fendo.2022.843573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study is to build a risk assessment system for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC) of stage cN0 and to explore its application value in clinical practice. METHODS A total of 500 patients with PTMC who underwent thyroid operation from 2013 to 2015 in Ningbo First Hospital were selected as the model group. Independent risk factors related to CLNM in PTMC were analyzed and determined, and a risk assessment system for CLNM was preliminarily established. Furthermore, the clinicopathological data from 328 PTMC patients with the same conditions as the model group from 2016 to 2017 were further collected as the validation group to verify the diagnostic value of the risk assessment system. RESULTS The risk assessment system was based on the score rating (score ≤ 5 was classified as low risk, 6-8 was classified as medium risk, and ≥9 was classified as high-risk). The area under the receiver operating characteristic curve (ROC) was 0.687 (95% CI: 0.635-0.783). According to the risk assessment system, 328 PTMC patients in the validation group were scored. Among the low-risk group, the moderate-risk group, and the high-group, 96.8%, 58.1%, and 43.2% were the CLNM (-) patients, and 3.1%, 41.9%, and 65.8% were CLNM (+) patients, respectively. The area under ROC was 0.837 (95% CI: 0.778-0.869). CONCLUSIONS The risk assessment system in this study is of diagnostic value and can provide a theoretical foundation for intraoperative decision-making of prophylactic central neck dissection (pCND).
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Affiliation(s)
- Jinqiu Wang
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
| | - Xianneng Sheng
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
| | - Yongping Dai
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
| | - Jiabo Zhang
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
| | - Lihua Song
- School of Medicine, Ningbo University, Ningbo, China
| | - Yu Guo
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
- *Correspondence: Yu Guo,
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