The sonographic features of preoperative ultrasonography of metastatic tumors of thyroid cancer confirmed by surgical pathology.
Características ecográficas de la ultrasonografía preoperatoria de tumores metastásicos de cáncer de tiroides confirmados por patología quirúrgica.
Abstract
This study aimed to analyze the sonographic features of metastatic tumors in patients with thyroid cancer that underwent preoperative ultrasonography. One hundred and three thyroid cancer patients whose metastases were confirmed by surgical pathology in The First People’s Hospital of Wenling from January 2020 to December 2021 were enrolled. All patients received preoperative ultrasound examinations, and the sonographic features were analyzed. Ultrasound examination showed 83.50% of cervical lymph node metastasis (CLNM), 24.27% of soft tissue invasion (STI), 3.88% of distant organ metastasis (DOM), 8.74% of CLNM + STI, 0.97% of CLNM + DOM, and 0.97% of CLNM + STI+DOM. Unilateral CLNM accounted for 72.09%, while bilateral CLNM accounted for 27.91%. The mean long diameter of metastatic lymph nodes was (1.83±0.63) cm, and the mean short diameter was (1.03±0.42) cm. Metastases to zone II, III, IV, V, VI, and VII accounted for 8.14%, 48.84%, 23.26%, 4.65%, 11.63%, and 3.49%, respectively. The L/T ratio of lymph nodes in 65 cases was lower than 2; 45 of 70 solid metastases exhibited solid hyperechoic, 15 multifocal hyperechoic, seven unifocal hyperechoic, and three diffusely distributed solid hyperechoic images. There were 25 patients with STI that experienced invasion of the thyroid capsule, ten patients experienced the invasion of the cervical fatty muscles, two patients had invasion of the trachea, and one patient had invasion of the thyroid cartilage. Of the four patients with DOM, one had parotid metastasis, one had submandibular metastasis, one had axillary metastasis, and one had uterine metastasis. The most common metastatic sites of thyroid cancer are cervical lymph nodes. However, there were also metastases in the soft tissues and distant organs. The ultrasonography exhibited typical sonographic features. An adequate familiarity with these sonographic features can aid in detecting suspicious metastases in time, which is crucial to the clinical diagnosis, treatment, and prognostic assessment.
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Vasileiadis I, Boutzios G, Karalaki M, Misiakos E, Karatzas T. Papillary thyroid carcinoma of the isthmus: Total thyroidectomy or isthmusectomy? Am J Surg 2018; 216(1):135-139. doi: 10.1016/j.amj-surg.2017.09.008.
Yu J, Deng Y, Liu T, Zhou J, Jia X, Xiao T, Zhou S, Li J, Guo Y, Wang Y, Zhou J, Chang C. Lymph node metastasis prediction of papillary thyroid carcinoma based on transfer learning radiomics. Nat Commun 2020; 11(1):4807. doi: 10.1038/s41467-020-18497-3.
Zhao H, Huang T, Li H. Risk factors for skip metastasis and lateral lymph node metastasis of papillary thyroid cancer. Surgery 2019; 166(1):55-60. doi: 10.1016/j.surg.2019.01.025.
Takano T. Natural history of thyroid cancer [Review]. Endocr J 2017; 64(3):237-244. doi: 10.1507/endocrj.EJ17-0026.
Paulson VA, Rudzinski ER, Hawkins DS. Thyroid Cancer in the Pediatric Population. Genes (Basel) 2019; 10(9). doi: 10.3390/genes10090723.
Ruiz E, Niu T, Zerfaoui M, Kunnimalaiyaan M, Friedlander PL, Abdel-Mageed AB, Kandil E. A novel gene panel for prediction of lymph-node metastasis and recurrence in patients with thyroid cancer. Surgery 2020; 167(1):73-79. doi: 10.10 16/j.surg.2019.06.058.
Lee JH, Ha EJ, Kim JH. Application of deep learning to the diagnosis of cervical lymph node metastasis from thyroid cancer with CT. Eur Radiol 2019; 29(10):5452- 5457. doi: 10.1007/s00330-019-06098-8.
Liu T, Zhou S, Yu J, Guo Y, Wang Y, Zhou J, Chang C. Prediction of lymph node metastasis in patients with papillary thyroid carcinoma: a radiomics method based on preoperative ultrasound images. Technol Cancer Res Treat 2019; 18:1078099361. doi: 10.1177/1533033819831713.
Ke Z, Liu Y, Zhang Y, Li J, Kuang M, Peng S, Liang J, Yu S, Su L, Chen L, Sun C, Li B, Cao J, Lv W, Xiao H. Diagnostic value and lymph node metastasis prediction of a custommade panel (thyroline) in thyroid cancer. Oncol Rep 2018; 40(2):659-668. doi: 10.3892/or.2018.6493.
Kim SY, Lee E, Nam SJ, Kim EK, Moon HJ, Yoon JH, Han KH, Kwak JY. Ultrasound tex- ture analysis: Association with lymph node metastasis of papillary thyroid m i c r o - carcinoma. Plos One 2017; 12(4):e176103. doi: 10.1371/journal.pone.0176103.
Lin P, Yao Z, Sun Y, Li W, Liu Y, Liang K, Liu Y, Qin J, Hou X, Chen L. Deciphering novel biomarkers of lymph node metastasis of thyroid papillary microcarcinoma using proteomic analysis of ultrasound- guided fine-needle aspiration biopsy samples. J Proteomics 2019; 204:103414. doi: 10.1016/j.jprot.2019.103414.
Roman BR, Morris LG, Davies L. The thyroid cancer epidemic, 2017 perspective. Curr Opin Endocrinol Diabetes Obes 2017; 24(5):332-336. doi: 10.1097/MED.0000000000000359.
Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT. American Head and Neck Society; American Academy of Otolaryngology--Head and Neck Surgery. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002; 128(7):751-758. doi: 10.1001/archotol.128.7.751.
Li F, Pan D, He Y, Wu Y, Peng J, Li J, Wang Y, Yang H, Chen J. Using ultrasound features and radiomics analysis to predict lymph node metastasis in patients with thyroid cancer. Bmc Surg 2020; 20(1):315. doi: 10.1186/s12893-020-00974-7.
Jiang W, Wei HY, Zhang HY, Zhuo QL. Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma. World J Clin Cases 2019; 7(1):49- 57. doi: 10.12998/wjcc.v7.i1.49.
Chen L, Chen L, Liu J, Wang B, Zhang H. Value of qualitative and quantitative contrast-enhanced ultrasound analysis in preoperative diagnosis of cervical lymph node metastasis from papillary thyroid carcinoma. J Ultrasound Med 2020; 39(1):73-81. doi: 10.1002/jum.15074.
Yu ST, Ge JN, Sun BH, Wei ZG, Lei ST. Lymph node metastasis in suprasternal space in pathological node-positive papillary thyroid carcinoma. Eur J Surg Oncol 2019; 45(11):2086-2089. doi: 10.1016/j. ejso.2019.07.034.
Liu C, Xiao C, Chen J, Li X, Feng Z, Gao Q, Liu Z. Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: a study of 966 patients. Bmc Cancer 2019; 19(1):622. doi: 10.1186/s12885-019-5835-6.
Qi ZJ, Liu LF, Cheng L, Han X, Wang T, Li F, Lu C, Zhang AB. [Risk factors analyses for lateral neck lymph node metastasis in papillary thyroid carcinoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33(7):603-606. doi: 10.13201/j.issn.1001-1781.2019.07.007.
Xing Z, Qiu Y, Yang Q, Yu Y, Liu J, Fei Y, Su A, Zhu J. Thyroid cancer neck lymph nodes metastasis: Meta-analysis of US and CT diagnosis. Eur J Radiol 2020; 129:109103. doi: 10.1016/j.ejrad.2020.109103.
Sakorafas GH, Koureas A, Mpampali I, Balalis D, Nasikas D, Ganztzoulas S. Patterns of Lymph Node Metastasis in Differentiated Thyroid Cancer; Clinical Implications with Particular Emphasis on the Emerging Role of Compartment-Oriented lymph node dissection. Oncol Res Treat 2019; 42(3):143-147. doi: 10.1159/000488905.
Genpeng L, Jianyong L, Jiaying Y, Ke J, Zhihui L, Rixiang G, Lihan Z, Jingqiang Z. Independent predictors and lymph node metastasis characteristics of multifocal papillary thyroid cancer. Medicine (Baltimore) 2018; 97(5):e9619. doi: 10.1097/ MD.0000000000009619.
Jiang HJ, Hsiao PJ. Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review. Kaohsiung J Med Sci 2020; 36(4):236-243. doi: 10.1002/kjm2.12173.
Zhai T, Muhanhali D, Jia X, Wu Z, Cai Z, Ling Y. Identification of gene co-ex- pression modules and hub genes associated with lymph node metastasis of papillary thyroid cancer. Endocrine 2019; 66(3):573-584. doi: 10.1007/s12020-019-02021-9.
Wang B, Wen XZ, Zhang W, Qiu M. Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma: a single-institution study, systemic review and meta-analysis. J Otolaryngol Head Neck Surg 2019; 48(1):42. doi: 10.1186/ s40463-019-0362-7.
Feng JW, Qin AC, Ye J, Pan H, Jiang Y, Qu Z. Predictive factors for lateral lymph node metastasis and skip metastasis in papillary thyroid carcinoma. Endocr Pathol 2020; 31(1):67-76. doi: 10.1007/s1 2022-019-09599-w.
Guo JN, Song LH, Yu PY, Yu SY, Deng SH, Mao XH, Xiu C, Sun J. Ultrasound elastic parameters predict central lymph node metastasis of papillary thyroid carcinoma. J Surg Res 2020; 253:69-78. doi: 10.1016/j. jss.2020.03.042.
