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Shi Y, Dong W, Zhang P. Letter to the Editor: Rethinking the preoperative risk assessment classifier for PTC: A Surgeon's view from China. Int J Surg 2024; 110:5310-5311. [PMID: 39143717 PMCID: PMC11325950 DOI: 10.1097/js9.0000000000001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/16/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Yang Shi
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, People's Republic of China
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Gu Y, Yu M, Deng J, Lai Y. The Association of Pretreatment Systemic Immune Inflammatory Response Index (SII) and Neutrophil-to-Lymphocyte Ratio (NLR) with Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma. Int J Gen Med 2024; 17:2887-2897. [PMID: 38974140 PMCID: PMC11225953 DOI: 10.2147/ijgm.s461708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Immunoinflammatory response can participate in the development of cancer. To investigate the relationship between pretreatment systemic immune inflammatory response index (SII), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and lymph node metastasis in patients with papillary thyroid carcinoma (PTC). Methods A retrospective analysis was performed on 547 PTC patients treated in Meizhou People's Hospital from January 2018 to December 2021. Clinicopathological data were collected, including gender, age, Hashimoto's thyroiditis, maximum tumor diameter, extra-membrane infiltration, disease stage, BRAF V600E mutation, pretreatment inflammatory index levels, and lymph node metastasis. The optimal cutoff values of SII, SIRI, NLR, PLR and LMR were calculated by receiver operating characteristic (ROC) curve, and the relationship between inflammatory indexes and other clinicopathological features and lymph node metastasis was analyzed. Results There were 303 (55.4%) PTC patients with lymph node metastasis. The levels of SII, SIRI, NLR, and PLR in patients with lymph node metastasis were significantly higher than those in patients without lymph node metastasis, while the levels of LMR were significantly lower than those in patients without lymph node metastasis (all p<0.05). When lymph node metastasis was taken as the endpoint, the critical value of SII was 625.375, the SIRI cutoff value was 0.705, the NLR cutoff value was 1.915 (all area under the ROC curve >0.6). The results of regression logistic analysis showed that age <55 years old (OR: 1.626, 95% CI: 1.009-2.623, p=0.046), maximum tumor diameter >1cm (OR: 2.681, 95% CI: 1.819-3.952, p<0.001), BRAF V600E mutation (OR: 2.709, 95% CI: 1.542-4.759, p=0.001), SII positive (≥625.375/<625.375, OR: 2.663, 95% CI: 1.560-4.546, p<0.001), and NLR positive (≥1.915/<1.915, OR: 1.808, 95% CI: 1.118-2.923, p=0.016) were independent risk factors for lymph node metastasis of PTC. Conclusion Age <55 years old, maximum tumor diameter >1cm, BRAF V600E mutation, SII positive, and NLR positive were independent risk factors for lymph node metastasis in PTC.
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Affiliation(s)
- Yihua Gu
- Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Ming Yu
- Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Jiaqin Deng
- Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Yeqian Lai
- Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
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Hu L, Ye L, Pei C, Sun C, Zhang C, Jiang F, He N, Lv W. Enhanced stiffness in peri-cancerous tissue: a marker of poor prognosis in papillary thyroid carcinoma with lymph node metastasis. Oncologist 2024:oyae086. [PMID: 38902966 DOI: 10.1093/oncolo/oyae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/11/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The prognostic significance of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) remains controversial. Notably, there is evidence suggesting an association between tissue stiffness and the aggressiveness of the disease. We therefore aimed to explore the effect of tissue stiffness on LNM-related invasiveness in PTC patients. METHOD A total of 2492 PTC patients from 3 hospitals were divided into an LNM group and a non-LNM group based on their pathological results. The effects of interior lesion stiffness (E) and peri-cancerous tissue stiffness (Eshell) on the LNM-related recurrence rate and mortality in each patient with PTC subgroup were analyzed. The activation of cancer-associated fibroblasts (CAFs) and extracellular matrix component type 1 collagen (COL-I) in the lesion were compared and analyzed across different subgroups. The underlying biological basis of differences in each subgroup was identified using RNA sequencing (RNA-seq) data. RESULTS The Eshell value and Eshell/E in the LNM group were significantly higher than those in the non-LNM group of patients with PTC (Eshell: 72.72 ± 5.63 vs 66.05 ± 4.46; Eshell/E: 1.20 ± 1.72 vs 1.09 ± 1.10, P < .001). When Eshell/E > 1.412 and LNM were both present, the recurrence rate and mortality were significantly increased compared to those of group of patients with LNM (91.67% and 7.29%, respectively). The CAF activation and COL-I content in the Eshell/E+ group were significantly higher than those in the Eshell/E- group (all P < .001), and the RNA-seq results revealed significant extracellular matrix (ECM) remodeling in the LNM-Eshell/E+ group. CONCLUSIONS Stiff peri-cancerous tissue induced CAF activation, COL-I deposition, and ECM remodeling, resulting in a poor prognosis for PTC patients with LNM.
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Affiliation(s)
- Lei Hu
- Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of People's Republic of China, Hefei, Anhui 230001, People's Republic of China
| | - Lei Ye
- Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of People's Republic of China, Hefei, Anhui 230001, People's Republic of China
| | - Chong Pei
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Hefei City, The Third Affiliated Hospital of Anhui Medical University, Hefei 230001, People's Republic of China
| | - Chunlei Sun
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of USTC, University of Science and Technology of People's Republic of China, Hefei, 230001, People's Republic of China
| | - Chaoxue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230001, People's Republic of China
| | - Fan Jiang
- Department of Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, People's Republic of China
| | - Nianan He
- Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of People's Republic of China, Hefei, Anhui 230001, People's Republic of China
| | - Weifu Lv
- Department of Radiology, The First Affiliated Hospital of USTC, University of Science and Technology of People's Republic of China, Hefei, 230001, People's Republic of China
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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] [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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Xu J, Zhang X, Yang G, Sun W, Wang W, Mi C. Analysis of differentially expressed proteins in lymph fluids related to lymphatic metastasis in a breast cancer rabbit model guided by contrast‑enhanced ultrasound. Oncol Lett 2024; 27:143. [PMID: 38385114 PMCID: PMC10879953 DOI: 10.3892/ol.2024.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/13/2023] [Indexed: 02/23/2024] Open
Abstract
The aim of the present study was to identify differentially expressed proteins in the lymph fluid of rabbits with breast cancer lymphatic metastasis compared with healthy rabbits and to analyze and verify these proteins using proteomics technologies. In the process of breast cancer metastasis, the composition of the lymph fluid will also change. Rabbits with breast cancer lymph node metastasis and normal rabbits were selected for analysis. Lymph fluid was extracted under the guidance of percutaneous contrast-enhanced ultrasound. Label-free quantitative proteomics was used to detect and compare differences between the rabbit cancer model and healthy rabbits and differential protein expression results were obtained. Bioinformatics analysis was performed using Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analysis software, selecting the most significantly differentially expressed proteins. Finally, parallel reaction monitoring technology was applied for validation. A total of 547 significantly differentially expressed proteins were found in the present study, which included 371 upregulated proteins and 176 downregulated proteins. The aforementioned genes were mainly involved in various cellular and metabolic pathways, including upregulated proteins, such as biliverdin reductase A and isocitrate dehydrogenase 2 and downregulated proteins, such as pyridoxal kinase. The upregulated proteins protein disulfide-isomerase 3, protein kinase cAMP-dependent type I regulatory subunit α and ATP-binding cassette sub-family C member 4 participated in immune regulation, endocrine regulation and anti-tumor drug resistance regulation, respectively. Compared with healthy rabbits, rabbits with breast cancer metastasis differentially expressed of a number of different proteins in their lymph, which participate in the pathophysiological process of tumor occurrence and metastasis. Through further research, these differential proteins can be used as predictive indicators of breast cancer metastasis and new therapeutic targets.
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Affiliation(s)
- Jiachao Xu
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, P.R. China
| | - Xin Zhang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, P.R. China
| | - Guangfei Yang
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, P.R. China
| | - Wei Sun
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, P.R. China
| | - Wen Wang
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, P.R. China
| | - Chengrong Mi
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, P.R. China
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Liu J, Yu J, Wei Y, Li W, Lu J, Chen Y, Wang M. Ultrasound radiomics signature for predicting central lymph node metastasis in clinically node-negative papillary thyroid microcarcinoma. Thyroid Res 2024; 17:4. [PMID: 38369523 PMCID: PMC10875890 DOI: 10.1186/s13044-024-00191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/06/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Whether prophylactic central lymph node dissection is necessary for patients with clinically node-negative (cN0) papillary thyroid microcarcinoma (PTMC) remains controversial. Herein, we aimed to establish an ultrasound (US) radiomics (Rad) score for assessing the probability of central lymph node metastasis (CLNM) in such patients. METHODS 480 patients (327 in the training cohort, 153 in the validation cohort) who underwent thyroid surgery for cN0 PTMC at two institutions between January 2018 and December 2020 were included. Radiomics features were extracted from the US images. Least absolute shrinkage and selection operator logistic regression were utilized to generate a Rad score. A nomogram consisting of the Rad score and clinical factors was then constructed for the training cohort. Both cohorts assessed model performance using discrimination, calibration, and clinical usefulness. RESULTS Based on the six most valuable radiomics features, the Rad score was calculated for each patient. A multivariate analysis revealed that a higher Rad score (P < 0.001), younger age (P = 0.006), and presence of capsule invasion (P = 0.030) were independently associated with CLNM. A nomogram integrating these three factors demonstrated good calibration and promising clinical utility in the training and validation cohorts. The nomogram yielded areas under the curve of 0.795 (95% confidence interval [CI], 0.745-0.846) and 0.774 (95% CI, 0.696-0.852) in the training and validation cohorts, respectively. CONCLUSIONS The radiomics nomogram may be a clinically useful tool for the individual prediction of CLNM in patients with cN0 PTMC.
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Affiliation(s)
- Jie Liu
- Department of Head and Neck Thyroid Surgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, No.31 Huanghe West Road, 061000, Cangzhou, Hebei Province, China.
| | - Jingchao Yu
- Department of Head and Neck Thyroid Surgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, No.31 Huanghe West Road, 061000, Cangzhou, Hebei Province, China
| | - Yanan Wei
- Department of TCM Internal Medicine, Cangzhou Hospital of Integrated TCM-WM·Hebei, 061000, Cangzhou, China
| | - Wei Li
- Department of Head and Neck Thyroid Surgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, No.31 Huanghe West Road, 061000, Cangzhou, Hebei Province, China
| | - Jinle Lu
- Department of Head and Neck Thyroid Surgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, No.31 Huanghe West Road, 061000, Cangzhou, Hebei Province, China
| | - Yating Chen
- Department of Head and Neck Thyroid Surgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, No.31 Huanghe West Road, 061000, Cangzhou, Hebei Province, China
| | - Meng Wang
- Department of Head and Neck Thyroid Surgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, No.31 Huanghe West Road, 061000, Cangzhou, Hebei Province, China
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Chen Y, Wang Y, Li C, Zhang X, Fu Y. Meta-analysis of the effect and clinical significance of Delphian lymph node metastasis in papillary thyroid cancer. Front Endocrinol (Lausanne) 2024; 14:1295548. [PMID: 38313842 PMCID: PMC10836594 DOI: 10.3389/fendo.2023.1295548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/18/2023] [Indexed: 02/06/2024] Open
Abstract
Objective To investigate the effect and clinical significance of Delphian lymph nodes (DLN) on the factors influencing papillary thyroid cancer (PTC) to provide individualized guidance for the surgical treatment of thyroid cancer. Methods Relevant studies from PubMed, Web of Science, the Cochrane Library, Embase, and China National Knowledge Infrastructure databases were searched until February 13, 2023. Stringent selection parameters were used to obtain included data and homogeneous articles. Analyses were performed using Revman 5.4 and SPSS software. A P-value of < 0.05 was considered statistically significant. Results Five studies were finally included in this study. The results revealed a higher risk of DLN metastasis (DLNM) in patients with tumor size >1cm, multifocality, and extrathyroidal extension (ETE) of the thyroid. The risk of central lymph node metastasis (CLNM) was 11.25 times higher in DLN-positive patients with PTC than in DLN-negative (OR = 11.25, 95% CI: 8.64-14.64, P < 0.05) patients. The risk of LLNM was 5.57 times higher in DLN-positive patients with PTC than in DLN-negative (OR = 5.57, 95% CI: 4.57-6.78, P < 0.001) patients. The risk of postoperative recurrence in DLN-positive patients with PTC was 3.49 times higher (OR = 3.49, 95% CI: 1.91-6.38, P < 0.001) than in DLN-negative patients with PTC. Conclusion Patients with tumor size >1 cm in diameter, multifocality, and ETE have an increased risk for DLN development. DLN-positive patients with central and lateral cervical lymph node metastasis and postoperative recurrence are at higher risk than DLN-negative patients.
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Affiliation(s)
| | | | | | | | - Yantao Fu
- Division of thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin University, Changchun, China
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Ma T, Wang L, Zhang X, Shi Y. A clinical and molecular pathology prediction model for central lymph node metastasis in cN0 papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2023; 14:1075598. [PMID: 36817603 PMCID: PMC9932534 DOI: 10.3389/fendo.2023.1075598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The frequency of thyroid cancer has rapidly increased in recent years globally. Thus, more papillary thyroid microcarcinoma (PTMC) patients are being diagnosed, including clinical lymph node-negative (cN0) patients. Our study attempted to develop a prediction model for assessing the probability of central lymph node metastasis (CLNM) in cN0 PTMC patients. METHODS A total of 595 patients from the Affiliated Hospital of Qingdao University (training cohort: 456 patients) and the Affiliated Hospital of Jining Medical University (verification cohort: 139 patients) who underwent thyroid surgery between January 2020 and May 2022 were enrolled in this study. Their clinical and molecular pathology data were analyzed with multivariate logistic regression to identify independent factors, and then we established a prediction model to assess the risk of CLNM in cN0 PTMC patients. RESULTS Multivariate logistic regression analysis revealed that sex, Hashimoto's thyroiditis (HT), tumor size, extrathyroidal extension, TERT promoter mutations and NRAS mutation were independent factors of CLNM. The prediction model demonstrated good discrimination ability (C-index: 0.757 and 0.753 in the derivation and validation cohorts, respectively). The calibration curve of the model was near the optimum diagonal line, and decision curve analysis (DCA) showed a noticeably better benefit. CONCLUSION CLNM in cN0 PTMC patients is associated with male sex, tumor size, extrathyroidal extension, HT, TERT promoter mutations and NRAS mutation. The prediction model exhibits good discrimination, calibration and clinical usefulness. This model will help to assess CLNM risk and make clinical decisions in cN0 PTMC patients.
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Affiliation(s)
- Teng Ma
- Department of Thyroid Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Lulu Wang
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xueyan Zhang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Yafei Shi
- Department of Thyroid Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
- *Correspondence: Yafei Shi,
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Chen L, Dong B, Jiang L, Zhang J, Chen L, Li T, Shao Y, Sun X. Microbubble contrast agent SonoVue: An efficient medium for the preoperative lymphatic mapping of thyroid carcinoma. Front Bioeng Biotechnol 2022; 10:1077145. [PMID: 36568294 PMCID: PMC9773067 DOI: 10.3389/fbioe.2022.1077145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Objective: To assess the value of microbubble contrast agent SonoVue in the thorough preoperative lymphatic mapping of patients with thyroid carcinoma, including the lymphatic drainage region, the detection of sentinel lymph node (SLN), and the diagnosis of lymph node metastasis (LNM). Materials and methods: 55 patients with 62 thyroid malignancies proved by surgical pathology (59 papillary thyroid carcinomas and three medullary thyroid carcinomas) who underwent preoperative lymphatic contrast-enhanced ultrasound (LCEUS) with microbubble contrast agent SonoVue were enrolled. All LNM were confirmed by pathology. The location of thyroid lesions, ultrasonic features of lymph nodes, lymphatic drainage region, and detection of SLN were assessed. The diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value and accuracy) of different parameters for the LNM diagnosis was calculated. Results: SonoVue effectively demonstrated the lymphatic drainage region for all enrolled thyroid carcinomas. The most common lymphatic drainage region for thyroid carcinomas was region VI (93.55%), followed by region III (62.90%), region IV (48.39%) and region II (4.84%). When divided by the lesion location, the most common lymphatic drainage regions for the nodule in isthmus, superior lobe and inferior lobe of the thyroid were region VI, region III, and region VI respectively. SLN was detected in 96.77% (60/62) of cases. The two cases without SLN demonstration had pathologically proven LNM. The most common sonographic sign of LNM was perfusion defect (54.17%). The diagnostic accuracy of SonoVue in central and lateral compartment LNM was 86.67% and 91.67%, respectively. Conclusion: Microbubble contrast agent SonoVue is a valuable imaging contrast medium for thorough preoperative lymphatic mapping in patients with thyroid carcinoma, including the lymphatic drainage region, the detection of SLN, and the diagnosis of LNM. LCEUS with SonoVue alone has limitations of false negatives when there is lymphatic vessel obstruction and may need to be combined with other ultrasound modalities.
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Affiliation(s)
- Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Bingwan Dong
- Department of ORL-HNS, Peking University First Hospital, Beijing, China
| | - Liu Jiang
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Jixin Zhang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China,*Correspondence: Tiancheng Li, ; Luzeng Chen,
| | - Tiancheng Li
- Department of ORL-HNS, Peking University First Hospital, Beijing, China,*Correspondence: Tiancheng Li, ; Luzeng Chen,
| | - Yuhong Shao
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Xiuming Sun
- Department of Ultrasound, Peking University First Hospital, Beijing, China
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Sun Y, Wang W, Mi C, Zhang Q, Zhang K. Differential Diagnosis Value of Shear-Wave Elastography for Superficial Enlarged Lymph Nodes. Front Oncol 2022; 12:908085. [PMID: 35847906 PMCID: PMC9280688 DOI: 10.3389/fonc.2022.908085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To evaluate the diagnostic efficiency and diagnostic threshold of conventional US and shear-wave elastography (SWE) in superficial enlarged lymph nodes (LNs). Methods A total of 204 patients with superficial enlarged LNs were enrolled in this retrospective study aged 46.0 ± 15.2 years from March 2020 to March 2021. LNs with a long axis larger than 0.7 cm were considered as superficial enlarged. Before the histological biopsy, LNs that were considered suspicious according to both conventional US and SWE were included, while LNs with no or unclear pathological results, or with no satisfactory SWE images, were excluded. The conventional and 2-D SWE examinations were performed with Aplio i800 and Acuson sequoia equipped with i18LX5 linear-array transducer (5-18 MHz) and 10L4 linear-array transducer (4-10 MHz), respectively. Both E Median and Vs Median parameters were investigated by two senior ultrasound physicians. The pathological results were performed as the gold standard. Results Variables including transverse axis size, lymphatic hilum, L/T ratio, echogenicity, and color Doppler pattern were considered significant. The mean E Median value in benign, metastatic LNs, and lymphoma were 28.26 ± 8.87 kPa, 77.46 ± 22.85 kPa, and 50.37 ± 5.41 kPa (p <0.001), while Vs Median values were 3.02 ± 0.50 m/s, 4.87 ± 0.90 m/s, and 4.09 ± 0.22 m/s, respectively (p < 0.001). The diagnostic performance indicated the high sensitivity, specificity, PPV, NPV, and overall accuracy of conventional US combined with SWE. The optimal cutoff values of E Median and Vs Median for predicting malignant LNs were 42.90 kPa and 3.73 m/s, respectively. As AUC value, sensitivity, specificity, accuracy, PPV, and NPV revealed, the indexes of E Median were 0.976, 0.927, 0.975, 0.946, 0.983, and 0.897, respectively, while Vs Median were 0.970, 0.927, 0.963, 0.941, 0.975, and 0.895, respectively (p <0.001). The ROC curves of both E Median (AUC=0.976) Vs Median (AUC=0.970) suggested the remarkable diagnostic efficiency in distinguishing benignity between suspected malignant LNs. Conclusions Above results indicated that conventional US together with 2-D SWE could elevate the diagnostic performance. Meanwhile, the parameters of 2-D SWE including E Median and Vs Median could effectively assess malignant LNs, which provide valuable differentiating information in superficial enlarged LNs.
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Affiliation(s)
- Yanjuan Sun
- Department of Ultrasound, General Hospital of Ningxia Medical University, No. 804 South Shengli Street, Yinchuan, China
| | - Wen Wang
- Department of Ultrasound, Cardiovascular and Cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Chengrong Mi
- Department of Ultrasound, General Hospital of Ningxia Medical University, No. 804 South Shengli Street, Yinchuan, China
| | - Qian Zhang
- Department of Ultrasound, Cardiovascular and Cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University, Yinchuan, China
- *Correspondence: Qian Zhang, ; Kun Zhang,
| | - Kun Zhang
- Central Laboratory and Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Qian Zhang, ; Kun Zhang,
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Analysis of the Application Value of Ultrasound Imaging Diagnosis in the Clinical Staging of Thyroid Cancer. JOURNAL OF ONCOLOGY 2022; 2022:8030262. [PMID: 35720223 PMCID: PMC9200573 DOI: 10.1155/2022/8030262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/08/2022] [Indexed: 12/03/2022]
Abstract
Thyroid cancer affects 1.3 percent of the population, with rates of occurrence rising in recent years (approximately 2 percent per year). Thyroid cancer is a common endocrine cancer with an annual increase in occurrence. Although the general prognosis for differentiated subtypes is favorable, the rate of mortality linked with thyroid cancer has been steadily progressing. The presence of suspicious thyroid nodules necessitates more diagnostic testing, including laboratory evaluation, additional imaging, and biopsy. For clinical staging and appropriate patient therapy design, accurate diagnosis is necessary. In this paper, we examined the application value of ultrasound imaging diagnosis in the clinical staging of thyroid tumor in this research. The benefit of early diagnosis is determined in this article using ultrasonography reports from Chinese patients. Images of benign and malignant thyroid nodules were collected and annotated in this work, and deep learning-based image recognition and diagnostic system was built utilizing the adaptive wavelet transform-based AdaBoost algorithm (AWT-AA). The system's efficacy in diagnosing thyroid nodules was assessed, and the use of ultrasound imaging in clinical practice was studied. The variables that had a significant impact on malignant nodules were studied using logistic multiple regression analysis. The sensitivity and specificity of ultrasonography thyroid imaging reporting and data system (TI-RADS) categorization outcomes for benign and malignant tumors were also calculated.
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Zhang H, Dong Y, Jia X, Zhang J, Li Z, Chuan Z, Xu Y, Hu B, Huang Y, Chang C, Xu J, Dong F, Xia X, Wu C, Hu W, Wu G, Li Q, Chen Q, Deng W, Jiang Q, Mou Y, Yan H, Xu X, Yan H, Zhou P, Shao Y, Cui L, He P, Qian L, Liu J, Shi L, Zhao Y, Xu Y, Song Y, Zhan W, Zhou J. Comprehensive Risk System Based on Shear Wave Elastography and BI-RADS Categories in Assessing Axillary Lymph Node Metastasis of Invasive Breast Cancer—A Multicenter Study. Front Oncol 2022; 12:830910. [PMID: 35359391 PMCID: PMC8960926 DOI: 10.3389/fonc.2022.830910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/14/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose To develop a risk stratification system that can predict axillary lymph node (LN) metastasis in invasive breast cancer based on the combination of shear wave elastography (SWE) and conventional ultrasound. Materials and Methods A total of 619 participants pathologically diagnosed with invasive breast cancer underwent breast ultrasound examinations were recruited from a multicenter of 17 hospitals in China from August 2016 to August 2017. Conventional ultrasound and SWE features were compared between positive and negative LN metastasis groups. The regression equation, the weighting, and the counting methods were used to predict axillary LN metastasis. The sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUC) were calculated. Results A significant difference was found in the Breast Imaging Reporting and Data System (BI-RADS) category, the “stiff rim” sign, minimum elastic modulus of the internal tumor and peritumor region of 3 mm between positive and negative LN groups (p < 0.05 for all). There was no significant difference in the diagnostic performance of the regression equation, the weighting, and the counting methods (p > 0.05 for all). Using the counting method, a 0–4 grade risk stratification system based on the four characteristics was established, which yielded an AUC of 0.656 (95% CI, 0.617–0.693, p < 0.001), a sensitivity of 54.60% (95% CI, 46.9%–62.1%), and a specificity of 68.99% (95% CI, 64.5%–73.3%) in predicting axillary LN metastasis. Conclusion A 0–4 grade risk stratification system was developed based on SWE characteristics and BI-RADS categories, and this system has the potential to predict axillary LN metastases in invasive breast cancer.
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Affiliation(s)
- Huiting Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohong Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhiyao Li
- Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhirui Chuan
- Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjun Xu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Bin Hu
- Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai, China
| | - Yunxia Huang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, and The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, and The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xiaona Xia
- Department of Ultrasound Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chengrong Wu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wenjia Hu
- Department of Ultrasound, People’s Hospital of Henan Province, Zhengzhou, China
| | - Gang Wu
- Department of Ultrasound, People’s Hospital of Henan Province, Zhengzhou, China
| | - Qiaoying Li
- Department of Ultrasound Diseases, Tangdu Hospital, Four Military Medical University, Xi’an, China
| | - Qin Chen
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wanyue Deng
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiongchao Jiang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonglin Mou
- Department of Ultrasound, General Hospital of Northern Theater Command, Shenyang, China
| | - Huannan Yan
- Department of Ultrasound, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaojing Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongju Yan
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yang Shao
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jinping Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liying Shi
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Yanan Zhao
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yongyuan Xu
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yanyan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
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Zhang X, Ni T, Zhang W. Ultrasonography-Guided Thermal Ablation for Cervical Lymph Node Metastasis of Recurrent Papillary Thyroid Carcinoma: Is it Superior to Surgical Resection? Front Endocrinol (Lausanne) 2022; 13:907195. [PMID: 35832431 PMCID: PMC9272822 DOI: 10.3389/fendo.2022.907195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
AIM The study aimed to systematically evaluate the safety and efficacy of ultrasonography-guided percutaneous thermal ablation in the treatment of cervical lymph node metastasis (LNM) of recurrent papillary thyroid carcinoma (PTC). METHODS PubMed, PubMed Central (PMC), Embase, and Cochrane were examined. The inclusion and exclusion criteria were determined and the relevant data were extracted from the library and other databases for LNM thermal ablation of recurrent PTC. The data were analyzed using Stata15.1, Revman5.3 software, and the standard errors of 95% confidence intervals were estimated using fixed or random effects models. Volume reduction rate (VRR), Serum thyroglobulin (Tg) level before and after thermal ablation, the total complications and major complications incidence were analyzed. RESULTS A total of 18 literature articles were included, namely, 10 radiofrequency ablation (RFA), 4 laser ablation (LA), and 4 microwave ablation (MWA). A total of 321 patients had 498 LNM. LNM volume changes before and at the last follow-up of thermal ablation (SMD = 1.04, I2 = 8%, 95% CI 0.86-1.21, P <0.0001). The postoperative lymph node VRR was 88.4% (95% CI 77.8-97.3%, I2 = 34%, P = 0.14). Tg measurements before and after thermal ablation (SMD = 1.15, 95% CI 0.69-1.60, I2 = 84%, P <0.0001). The incidence of total complications was 5.0% (95% CI 3.0-7.0%, I2 = 0.0%, P = 0.915), and the incidence of major complications was 4.0% (95% CI 2.0-6.0%, I2 = 0.0%, P = 0.888). A total of 131 LNM were located in the central region, and the major complication rate was 12.0% (95% CI 6.0-18.0%, I2 = 0.0%, P = 0.653). CONCLUSION Ultrasonography-guided thermal ablation is safe and effective in the treatment of LNM of recurrent PTC. The ablation strategy of central LNM needs to be further explored and improved. It can be used as an alternative to surgery for patients with high surgical risk or who refuse resurgery. SYSTEMATIC REVIEW REGISTRATION 10.37766/inplasy2022.6.0004, identifier INPLASY202260004.
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Li W, Qiu S, Ren L, Li Q, Xue S, Li J, Zhang Y, Luo Y. Ultrasound and Contrast-Enhanced Ultrasound Characteristics Associated With cN1 and Microscopic pN1 in Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:810630. [PMID: 35140687 PMCID: PMC8818865 DOI: 10.3389/fendo.2021.810630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/29/2021] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVES Lymph 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). METHODS From 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. RESULTS 85 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. CONCLUSIONS For 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.
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Affiliation(s)
- Wen Li
- Department of Ultrasound, Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shusheng Qiu
- Department of Surgery, ZiBo Central Hospital, Zibo, China
| | - Ling Ren
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qiuyang Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shaowei Xue
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Li
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Yan Zhang,
| | - Yukun Luo
- Department of Ultrasound, Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Yan Zhang,
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