Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, People's Republic of China.
Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, 226006, People's Republic of China.
BMC Cancer. 2022 Apr 27;22(1):461. doi: 10.1186/s12885-022-09550-z.
The advantages of prophylactic central lymph node dissection (CLND) for clinically node-negative patients remained a great deal of controversies. Our research was aimed to analyze the relationship between cervical central lymph node metastasis (CLNM) and BRAF mutation, ultrasonic and clinicopathologic characterizes in papillary thyroid carcinoma (PTC).
In current study, a total of 112 consecutive PTC patients who experienced thyroidectomy plus cervical central neck dissection were included in our research. All PTC were pre-operatively analyzed by ultrasonic features, including tumor size, multifocality or not, tumor location, internal components, echogenicity, microcalcification, margins, orientation, taller than wide shape, and internal vascularity. The presence of clinicopathologic factors, including age, sex, T stage, Hashimoto's thyroiditis, and BRAF mutation was then investigated. Univariate and multivariate analysis were conducted to check into the relationship between predictive factors and cervical CLNM in PTC patients, and then a predictive model was also established.
Pathologically, 58.0% (65/112) of the PTC patients harbored cervical CLNM. Univariate and multivariate analysis were conducted to identify age < 55 years, tumor size > 10 mm, microcalcification, non-concomitant Hashimoto's thyroiditis and BRAF mutation were predictive factors for cervical CLNM in PTC. The risk score for cervical CLNM in PTC patients was calculated: risk score = 1.284 × (if age < 55 years) + 1.241 × (if tumor size > 10 mm) + 1.143 × (if microcalcification) - 2.097 × (if concomitant Hashimoto's thyroiditis) + 1.628 × (if BRAF mutation).
Age < 55 years old, PTC > 10 mm, microcalcification, non-concomitant Hashimoto's thyroiditis and BRAF mutation are predictive factors for cervical CLNM. BRAF mutation by pre-operative US-FNA technology synergized with clinicopathologic and ultrasonic features is expected to guide the appropriate surgical management for PTC patients.
预防性中央淋巴结清扫术（CLND）对临床淋巴结阴性患者的优势仍存在很大争议。我们的研究旨在分析甲状腺乳头状癌（PTC）中中央颈部淋巴结转移（CLNM）与 BRAF 突变、超声及临床病理特征之间的关系。
本研究共纳入 112 例连续接受甲状腺切除术加颈中央颈清扫术的 PTC 患者。所有 PTC 患者术前均通过超声特征进行分析，包括肿瘤大小、多灶性、肿瘤位置、内部成分、回声、微钙化、边界、方位、高宽比和内部血管。然后检查年龄、性别、T 分期、桥本甲状腺炎和 BRAF 突变等临床病理因素的存在情况。对 PTC 患者的预测因素与颈中央淋巴结转移的关系进行单因素和多因素分析，并建立预测模型。
病理上，58.0%（65/112）的 PTC 患者存在颈中央淋巴结转移。单因素和多因素分析显示，年龄<55 岁、肿瘤大小>10mm、微钙化、无桥本甲状腺炎并存和 BRAF 突变是 PTC 颈中央淋巴结转移的预测因素。计算 PTC 患者颈中央淋巴结转移的风险评分：风险评分=1.284×（年龄<55 岁）+1.241×（肿瘤大小>10mm）+1.143×（微钙化）-2.097×（桥本甲状腺炎并存）+1.628×（BRAF 突变）。
年龄<55 岁、PTC>10mm、微钙化、无桥本甲状腺炎并存和 BRAF 突变是颈中央淋巴结转移的预测因素。术前 US-FNA 技术检测 BRAF 突变与临床病理及超声特征相结合，有望指导 PTC 患者的适当手术治疗。
