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Fu J, Liu J, Wang Z, Qian L. Predictive Values of Clinical Features and Multimodal Ultrasound for Central Lymph Node Metastases in Papillary Thyroid Carcinoma. Diagnostics (Basel) 2024; 14:1770. [PMID: 39202260 PMCID: PMC11353660 DOI: 10.3390/diagnostics14161770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024] Open
Abstract
Papillary thyroid carcinoma (PTC), the predominant pathological type among thyroid malignancies, is responsible for the sharp increase in thyroid cancer. Although PTC is an indolent tumor with good prognosis, 60-70% of patients still have early cervical lymph node metastasis, typically in the central compartment. Whether there is central lymph node metastasis (CLNM) or not directly affects the formulation of preoperative surgical procedures, given that such metastases have been tied to compromised overall survival and local recurrence. However, detecting CLNM before operation can be challenging due to the limited sensitivity of preoperative approaches. Prophylactic central lymph node dissection (PCLND) in the absence of clinical evidence of CLNM poses additional surgical risks. This study aims to provide a comprehensive review of the risk factors related to CLNM in PTC patients. A key focus is on utilizing multimodal ultrasound (US) for accurate prognosis of preoperative CLNM and to highlight the distinctive role of US-based characteristics for predicting CLNM.
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Affiliation(s)
- Jiarong Fu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.F.); (Z.W.)
| | - Jinfeng Liu
- Department of Interventional Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
| | - Zhixiang Wang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.F.); (Z.W.)
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.F.); (Z.W.)
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Wang G, Yin C, Wang Y, Li Q, Yang D, Wang P, Nie F. Contrast-enhanced ultrasound (CEUS) characteristics of atypical-enhanced papillary thyroid carcinoma (PTC). Clin Hemorheol Microcirc 2024:CH242173. [PMID: 38848170 DOI: 10.3233/ch-242173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To investigate the diagnostic value of CEUS in atypical-enhanced PTC. METHODS The clinical data, qualitative and quantitative parameters of CEUS in 177 Iso/hyper-enhanced thyroid nodules with definite pathological results were retrospectively analyzed in the Lanzhou University Second Hospital from June 2019 to January 2021. And the clinical value of CEUS in the diagnosis of atypical-enhanced PTC was assessed using univariate and multivariate analysis. RESULTS Among the 177 thyroid nodules, 59 were benign and 118 were PTC. There were significant differences in age, enhancement border, ring enhancement, speed of wash in, speed of wash out, enhancement pattern, capsule interruption, time to peak, time to wash out, RT, TPH, and TTP (P < 0.05). Multivariate analysis showed unclear enhancement border and concentric enhancement were independent risk factors for the diagnosis of atypical-enhanced PTC by CEUS. The sensitivity, specificity, PPV, NPV, and accuracy of the model in diagnosing atypical-enhanced PTC were 88.1%, 71.2%, 86.0%, 75.0%, and 82.5%, respectively. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.910. CONCLUSION The diagnosis of atypical-enhanced PTC can be better performed by enhancement characteristics and time intensity curve (TIC) of CEUS, which have a good clinical application value.
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Affiliation(s)
- Guojuan Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, Gansu, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, Gansu, China
| | - Ci Yin
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, Gansu, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, Gansu, China
| | - Yanfang Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, Gansu, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, Gansu, China
| | - Qi Li
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, Gansu, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, Gansu, China
| | - Dan Yang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, Gansu, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, Gansu, China
| | - Peihua Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, Gansu, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, Gansu, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, Gansu, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, Gansu, China
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He L, Chen X, Hu J, Meng Y, Zhang Y, Chen W, Fan Y, Li T, Fang J. Score based on contrast-enhanced ultrasound predict central lymph node metastasis in papillary thyroid cancer. Front Endocrinol (Lausanne) 2024; 15:1336787. [PMID: 38699389 PMCID: PMC11063297 DOI: 10.3389/fendo.2024.1336787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/07/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives To investigate the association between contrast-enhanced ultrasound (CEUS) features of PTC and central lymph node metastasis (CLNM) and to develop a predictive model for the preoperative identification of CLNM. Methods This retrospective study evaluated 750 consecutive patients with PTC from August 2020 to April 2023. Conventional ultrasound and qualitative CEUS features were analyzed for the PTC with or without CLNM using univariate and multivariate logistic regression analysis. A nomogram integrating the predictors was constructed to identify CLNM in PTC. The predictive nomogram was validated using a validation cohort. Results A total of 684 patients were enrolled. The 495 patients in training cohort were divided into two groups according to whether they had CLNM (pCLNM, n= 191) or not (nCLNM, n= 304). There were significant differences in terms of tumor size, shape, echogenic foci, enhancement direction, peak intensity, and score based on CEUS TI-RADS between the two groups. Independent predictive US features included irregular shape, larger tumor size (≥ 1.0cm), and score. Nomogram integrating these predictive features showed good discrimination and calibration in both training and validation cohort with an AUC of 0.72 (95% CI: 0.68, 0.77) and 0.79 (95% CI: 0.72, 0.85), respectively. In the subgroup with larger tumor size, age ≤ 35 years, irregular shape, and score > 6 were independent risk factors for CLNM. Conclusion The score based on preoperative CEUS features of PTC may help to identify CLNM. The nomogram developed in this study provides a convenient and effective tool for clinicians to determine an optimal treatment regimen for patients with PTC.
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Affiliation(s)
| | | | | | | | | | | | | | - Tao Li
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, China
| | - Jingqin Fang
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, China
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Su B, Li L, Liu Y, Liu H, Zhan J, Chai Q, Fang L, Wang L, Chen L. Quantitative parameters of contrast-enhanced ultrasound effectively promote the prediction of cervical lymph node metastasis in papillary thyroid carcinoma. Drug Discov Ther 2024; 18:44-53. [PMID: 38355122 DOI: 10.5582/ddt.2023.01095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Papillary thyroid carcinoma (PTC), the most common endocrine tumor, often spreads to cervical lymph nodes metastasis (CLNM). Preoperative diagnosis of CLNM is important when selecting surgical strategies. Therefore, we aimed to explore the effectiveness of quantitative parameters of contrast-enhanced ultrasound (CEUS) in predicting CLNM in PTC. We retrospectively analyzed 193 patients with PTC undergoing conventional ultrasound (CUS) and CEUS. The CUS features and quantitative parameters of CEUS were evaluated according to PTC size ≤ 10 or > 10 mm, using pathology as the gold standard. For the PTC ≤ 10 mm, microcalcification and multifocality were significantly different between the CLNM (+) and CLNM (-) groups (both P < 0.05). For the PTC > 10 mm, statistical significance was noted between the two groups with respect to the margin, capsule contact, and multifocality (all P < 0.05). For PTC ≤ 10 mm, there was no significant difference between the CLNM (+) and CLNM (-) groups in all quantitative parameters of CEUS (all P > 0.05). However, for PTC > 10 mm, the peak intensity (PI), mean transit time, and slope were significantly associated with CLNM (all P < 0.05). Multivariate analysis showed that PI > 5.8 dB was an independent risk factor for predicting CLNM in patients with PTC > 10 mm (P < 0.05). The area under the curve of PI combined with CUS (0.831) was significantly higher than that of CUS (0.707) or PI (0.703) alone in the receiver operator characteristic curve analysis (P < 0.05). In conclusion, PI has significance in predicting CLNM for PTC > 10 mm; however, it is not helpful for PTC ≤ 10 mm.
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Affiliation(s)
- Biao Su
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Department of Ultrasound, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lisha Li
- Department of Reproductive Immunology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Hui Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Department of Ultrasound, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Qiliang Chai
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Ling Wang
- Department of Reproductive Immunology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
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Lu S, Ren Y, Lu C, Qian X, Liu Y, Zhang J, Shan X, Sun E. Radiomics features from whole thyroid gland tissue for prediction of cervical lymph node metastasis in the patients with papillary thyroid carcinoma. J Cancer Res Clin Oncol 2023; 149:13005-13016. [PMID: 37466794 DOI: 10.1007/s00432-023-05184-1] [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: 06/23/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE We aimed to develop a clinical-radiomics nomogram that could predict the cervical lymph node metastasis (CLNM) of patients with papillary thyroid carcinoma (PTC) using clinical characteristics as well as radiomics features of dual energy computed tomography (DECT). METHOD Patients from our hospital with suspected PTC who underwent DECT for preoperative assessment between January 2021 and February 2022 were retrospectively recruited. Clinical characteristics were obtained from the medical record system. Clinical characteristics and rad-scores were examined by univariate and multivariate logistic regression. All features were incorporated into the LASSO regression model, with penalty parameter tuning performed using tenfold cross-validation, to screen risk factors for CLNM. An easily accessible radiomics nomogram was constructed. Receiver Operating Characteristic (ROC) curve together with Area Under the Curve (AUC) analysis was conducted to evaluate the discrimination performance of the model. Calibration curves were employed to assess the calibration performance of the clinical-radiomics nomogram, followed by goodness-of-fit testing. Decision curve analysis (DCA) was performed to determine the clinical utility of the established models by estimating net benefits at varying threshold probabilities for training and testing groups. RESULTS A total of 461 patients were retrospectively recruited. The rates of CLNM were 49.3% (70 /142) in the training cohort and 53.3% (32/60) in the testing cohort. Out of the 960 extracted radiomics features, 192 were significantly different in positive and negative groups (p < 0.05). On the basis of the training cohort, 12 stable features with nonzero coefficients were selected using LASSO regression. LASSO regression identified 7 risk factors for CLNM, including male gender, maximum tumor size > 10 mm, multifocality, CT-reported central CLN status, US-reported central CLN status, rad-score, and TGAb. A nomogram was developed using these factors to predict the risk of CLNM. The AUC values in each cohort were 0.850 and 0.797, respectively. The calibration curve together with the Hosmer-Lemeshow test for the nomogram indicated good agreement between predicted and pathological CLN statuses in the training and testing cohorts. Results of DCA proved that the nomogram offers a superior net benefit for predicting CLNM compared to the "treat all or none" strategy across the majority of risk thresholds. CONCLUSION A nomogram comprising the clinical characteristics as well as radiomics features of DECT and US was constructed for the prediction of CLNM for patients with PTC, which in determining whether lateral compartment neck dissection is warranted.
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Affiliation(s)
- Siyuan Lu
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu Province, China
| | - Yongzhen Ren
- Department of Ultrasonography, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu Province, China
| | - Chao Lu
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu Province, China
| | - Xiaoqin Qian
- Department of Ultrasonography, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu Province, China
| | - Yingzhao Liu
- Department of Endocrinology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu Province, China
| | - Jiulou Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiuhong Shan
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu Province, China.
| | - Eryi Sun
- Department of Neurosurgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu Province, China.
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Yang Z, Wang X, Tao T, Zou J, Qiu Z, Wang L, Du H, Chen N, Yin X. Diagnostic value of contrast-enhanced ultrasonography in the preoperative evaluation of lymph node metastasis in papillary thyroid carcinoma: a single-center retrospective study. BMC Surg 2023; 23:325. [PMID: 37875825 PMCID: PMC10599078 DOI: 10.1186/s12893-023-02199-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) has been recently used for the assessment of cervical lymph node metastasis (LNM) to guide surgical operation in patients with papillary thyroid carcinoma (PTC). However, the specificity and sensitivity of CEUS reported from previous studies are not consistent. The objective of this study was to evaluate the diagnostic value of CEUS for the metastasis of cervical lymph nodes in PTC patients based on data from one regional central hospital. METHODS The diagnostic value of CEUS in preoperative LNM of PTC patients was concluded by comparing the results of CEUS on lymph node status with postoperative pathology examination. In addition, this study conducted hierarchical analysis of PTC patients to explore whether tumor size, different lymph node regions, and Hashimoto's thyroiditis influence the assessment of CEUS. RESULTS This research study ultimately enrolled 965 PTC patients, including 266 males and 699 females with a mean age of 42.27 ± 11.34 years. A total of 527 patients were considered clinical-node negative, and 438 were clinical-node positive before surgery. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS in the assessment of LNM in PTC patients were 56.00%, 71.00%, 57.06%, 69.76% and 62.59%, respectively. For central and lateral lymph nodes, the accuracy of CEUS in PTC patients was 49.43% and 54.30%, respectively. In addition, it was shown that the accuracy of CEUS in PTC patients with Hashimoto's thyroiditis (HT) slightly decreased to 58.44%, and the accuracy of CEUS in PTC patients with non-HT in turn increased to 64.17%. The accuracy of CEUS in non-papillary thyroid microcarcinoma (PTMC) and PTMC patients was 65.68% and 61.24%, respectively. The accuracy of CEUS in predicting central LNM was significantly different between PTC patients with or without HT (P < 0.001) in this study but not for lateral lymph nodes (P = 0.114). CONCLUSION The accuracy of CEUS in the assessment of LNM in PTC is not consistently satisfactory, especially for central lymph nodes, small tumor diameters, or patients with HT. More diagnostic technologies for abnormal lymph nodes should be considered in PTC patients.
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Affiliation(s)
- Zhixin Yang
- Department of Breast and Thyroid, Guiyang Maternal and Child Health Care Hospital & Guiyang Children's Hospital, Guiyang, China
| | - Xiaofeng Wang
- Department of Breast and Thyroid Surgery, Dongying People's Hospital, Dongying City, Shandong, China
| | - Tao Tao
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiali Zou
- Department of Breast and Thyroid, Guiyang Maternal and Child Health Care Hospital & Guiyang Children's Hospital, Guiyang, China
| | - Zhu Qiu
- Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Long Wang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huimin Du
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ni Chen
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xuedong Yin
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Chen Q, Liu Y, Liu J, Su Y, Qian L, Hu X. Development and validation of a dynamic nomogram based on conventional ultrasound and contrast-enhanced ultrasound for stratifying the risk of central lymph node metastasis in papillary thyroid carcinoma preoperatively. Front Endocrinol (Lausanne) 2023; 14:1186381. [PMID: 37409231 PMCID: PMC10319155 DOI: 10.3389/fendo.2023.1186381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The aim of this study was to develop and validate a dynamic nomogram by combining conventional ultrasound (US) and contrast-enhanced US (CEUS) to preoperatively evaluate the probability of central lymph node metastases (CLNMs) for patients with papillary thyroid carcinoma (PTC). Methods A total of 216 patients with PTC confirmed pathologically were included in this retrospective and prospective study, and they were divided into the training and validation cohorts, respectively. Each cohort was divided into the CLNM (+) and CLNM (-) groups. The least absolute shrinkage and selection operator (LASSO) regression method was applied to select the most useful predictive features for CLNM in the training cohort, and these features were incorporated into a multivariate logistic regression analysis to develop the nomogram. The nomogram's discrimination, calibration, and clinical usefulness were assessed in the training and validation cohorts. Results In the training and validation cohorts, the dynamic nomogram (https://clnmpredictionmodel.shinyapps.io/PTCCLNM/) had an area under the receiver operator characteristic curve (AUC) of 0.844 (95% CI, 0.755-0.905) and 0.827 (95% CI, 0.747-0.906), respectively. The Hosmer-Lemeshow test and calibration curve showed that the nomogram had good calibration (p = 0.385, p = 0.285). Decision curve analysis (DCA) showed that the nomogram has more predictive value of CLNM than US or CEUS features alone in a wide range of high-risk threshold. A Nomo-score of 0.428 as the cutoff value had a good performance to stratify high-risk and low-risk groups. Conclusion A dynamic nomogram combining US and CEUS features can be applied to risk stratification of CLNM in patients with PTC in clinical practice.
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Zhang M, Zhang Y, Wei H, Yang L, Liu R, Zhang B, Lyu S. Ultrasound radiomics nomogram for predicting large-number cervical lymph node metastasis in papillary thyroid carcinoma. Front Oncol 2023; 13:1159114. [PMID: 37361586 PMCID: PMC10285658 DOI: 10.3389/fonc.2023.1159114] [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: 02/05/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose To evaluate the value of preoperative ultrasound (US) radiomics nomogram of primary papillary thyroid carcinoma (PTC) for predicting large-number cervical lymph node metastasis (CLNM). Materials and methods A retrospective study was conducted to collect the clinical and ultrasonic data of primary PTC. 645 patients were randomly divided into training and testing datasets according to the proportion of 7:3. Minimum redundancy-maximum relevance (mRMR) and least absolution shrinkage and selection operator (LASSO) were used to select features and establish radiomics signature. Multivariate logistic regression was used to establish a US radiomics nomogram containing radiomics signature and selected clinical characteristics. The efficiency of the nomogram was evaluated by the receiver operating characteristic (ROC) curve and calibration curve, and the clinical application value was assessed by decision curve analysis (DCA). Testing dataset was used to validate the model. Results TG level, tumor size, aspect ratio, and radiomics signature were significantly correlated with large-number CLNM (all P< 0.05). The ROC curve and calibration curve of the US radiomics nomogram showed good predictive efficiency. In the training dataset, the AUC, accuracy, sensitivity, and specificity were 0.935, 0.897, 0.956, and 0.837, respectively, and in the testing dataset, the AUC, accuracy, sensitivity, and specificity were 0.782, 0.910, 0.533 and 0.943 respectively. DCA showed that the nomogram had some clinical benefits in predicting large-number CLNM. Conclusion We have developed an easy-to-use and non-invasive US radiomics nomogram for predicting large-number CLNM with PTC, which combines radiomics signature and clinical risk factors. The nomogram has good predictive efficiency and potential clinical application value.
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Xue J, Li S, Qu N, Wang G, Chen H, Wu Z, Cao X. Value of clinical features combined with multimodal ultrasound in predicting lymph node metastasis in cervical central area of papillary thyroid carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:908-918. [PMID: 37058552 DOI: 10.1002/jcu.23465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the clinical features, multimodal ultrasound features and multimodal ultrasound imaging features in predicting lymph node metastasis in the central cervical region of papillary thyroid carcinoma. METHODS A total of 129 patients with papillary thyroid carcinoma (PTC) confirmed by pathology were selected from our hospital from September 2020 to December 2022. According to the pathological results of cervical central lymph nodes, these patients were divided into metastatic group and non-metastatic group. Patients were randomly sampled and divided into training group (n = 90) and verification group (n = 39) according to the ratio of 7:3. The independent risk factors for central lymph node metastasis (CLNM) were determined by least absolute shrinkage and selection operator and multivariate logistic regression. Based on independent risk factors to build a prediction model, select the best diagnostic effectiveness of the prediction model sketch line chart, and finally, the line chart calibration and clinical benefits were evaluated. RESULTS A total of 8, 11 and 17 features were selected from conventional ultrasound images, shear wave elastography (SWE) images and contrast-enhanced ultrasound (CEUS) images to construct the Radscore of conventional ultrasound, SWE and CEUS, respectively. After univariate and multivariate logistic regression analysis, male, multifocal, encapsulation, iso-high enhancement and multimodal ultrasound imaging score were independent risk factors for cervical CLNM in PTC patients (p < 0.05). Based on independent risk factors, a clinical combined with multimodal ultrasound feature model was constructed, and multimodal ultrasound Radscore were added to the clinical combined with multimodal ultrasound feature model to form a joint prediction model. In the training group, the diagnostic efficacy of combined model (AUC = 0.934) was better than that of clinical combined with multimodal ultrasound feature model (AUC = 0.841) and multimodal ultrasound radiomics model (AUC = 0.829). In training group and validation group, calibration curves show that the joint model has good predictive ability for cervical CLNM of PTC patients; The decision curve shows that most of the net benefits of the nematic chart are higher than those of clinical + multimodal ultrasound feature model and multimodal ultrasound radiomics model within a reasonable risk threshold range. CONCLUSION Male, multifocal, capsular invasion and iso-high enhancement are independent risk factors of CLNM in PTC patients, and the clinical plus multimodal ultrasound model based on these four factors has good diagnostic efficiency. The joint prediction model after adding multimodal ultrasound Radscore to clinical and multimodal ultrasound features has the best diagnostic efficiency, high sensitivity and specificity, which is expected to provide objective basis for accurately formulating individualized treatment plans and evaluating prognosis.
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Affiliation(s)
- Jie Xue
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Siyao Li
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Nina Qu
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Guoyun Wang
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Huangzhuonan Chen
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, China
| | - Zhihui Wu
- School of Medical Imaging, Binzhou Medical University, Binzhou, Shandong, China
| | - Xiaoli Cao
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Zhang W, Ni T, Tang W, Yang G. The Role of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Tuberous Vas Deferens Tuberculosis and Metastatic Inguinal Lymph Nodes. Diagnostics (Basel) 2023; 13:diagnostics13101762. [PMID: 37238246 DOI: 10.3390/diagnostics13101762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/30/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE To retrospective analysis and summary the features of tuberous vas deferens tuberculosis (VD TB) and inguinal metastatic lymph nodes (MLN) in routine ultrasound (US) and contrast-enhanced US (CEUS) as well as to assess the utility of CEUS in differentiating between the two diseases. METHODS The US and CEUS findings of patients with pathologically confirmed tuberous VD TB (n = 17) and inguinal MLN (n = 28), including the number of lesions, presence of bilateral disease, differences in internal echogenicity, a conglomeration of lesions, and blood flow within the lesions, were retrospectively analyzed. RESULTS Routine US showed no significant difference in the number of lesions, nodule size, internal echogenicity, sinus tract, or skin rupture; however, significant differences were observed between the two conditions in the conglomeration of lesions (χ2 = 6.455; p = 0.023) and the degree, intensity, and echogenicity pattern on CEUS (χ2 = 18.865, 17.455, and 15.074, respectively; p = 0.000 for all). CONCLUSIONS CEUS can show the blood supply of the lesion, and judge the physical condition of the lesion better than US. Homogeneous, centripetal, and diffuse enhancement should prompt a diagnosis of inguinal MLN, whereas lesions with heterogeneous and diffuse enhancement on CEUS should be considered as VD TB. CEUS has great diagnostic value in differentiating between tuberous VD TB and inguinal MLN.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Hangzhou Red Cross Hospital), Hangzhou 310003, China
| | - Tu Ni
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Hangzhou Red Cross Hospital), Hangzhou 310003, China
| | - Wei Tang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Hangzhou Red Cross Hospital), Hangzhou 310003, China
| | - Gaoyi Yang
- Department of Ultrasonography, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Hangzhou Red Cross Hospital), Hangzhou 310003, China
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Lin YY, Zhu Y, Wang YX, Wang B. Horner Syndrome subsequent to ultrasound-guided cervical lymph node fine-needle aspiration - A case report and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:203-209. [PMID: 36165415 DOI: 10.1002/jcu.23349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Horner Syndrome (HS) is characterized by symptoms of ipsilateral miosis, ptosis, enophthalmos, and facial anhidrosis, which is caused by the damaged oculosympathetic pathway. HS is rarely reported as postoperative complications of fine-needle aspiration (FNA). We report a case of HS triggered by Ultrasound-guided FNA during thyroid cancer management and conducted the literature review. A 31-year-old male with differentiated thyroid cancer underwent total thyroidectomy and regional lymph node dissection as well as radioactive iodine ablation, presented with persistently elevated tumor marker of thyroglobulin and suspicious left level IV and V cervical lymph nodes by neck ultrasound. Ultrasound-guided left cervical lymph nodes FNA for cellular diagnosis was performed, and typical manifestations of HS appeared immediately after the procedure. Subsequent ultrasound evaluation of the same area demonstrated a subtle strip of the hypo-echogenic area in the superior pole of the suspected level IV structure, suggesting sympathetic ganglia with the visible originating nerve fiber on the superior pole. All of the patient's symptoms of HS were resolved 2 months after the incidence. Cervical sympathetic ganglia can be similar in size, shape, and ultrasound characteristics to a malignant lymph node. Thorough ultrasound examination by directly comparing the potential ganglia with a typical malignant lymph node, and paying attention to any potential root fibers on the target is key to avoiding ganglia injury before the neck invasive procedures.
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Affiliation(s)
- Yu Yang Lin
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Ying Zhu
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Yi Xuan Wang
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Bei Wang
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
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Hu W, Zhuang Y, Tang L, Chen H, Wang H, Wei R, Wang L, Ding Y, Xie X, Ge Y, Wu PY, Song B. Preoperative Cervical Lymph Node Metastasis Prediction in Papillary Thyroid Carcinoma: A Noninvasive Clinical Multimodal Radiomics (CMR) Nomogram Analysis. JOURNAL OF ONCOLOGY 2023; 2023:3270137. [PMID: 36936372 PMCID: PMC10019962 DOI: 10.1155/2023/3270137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/10/2022] [Accepted: 02/11/2023] [Indexed: 03/12/2023]
Abstract
This study aimed to evaluate the feasibility of applying a clinical multimodal radiomics nomogram based on ultrasonography (US) and multiparametric magnetic resonance imaging (MRI) for the prediction of cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) preoperatively. We performed retrospective evaluations of 133 patients with pathologically confirmed PTC, who were assigned to the training cohort and validation cohort (7 : 3), and extracted radiomics features from the preoperative US, T2-weighted (T2WI),diffusion-weighted (DWI), and contrast-enhanced T1-weighted (CE-T1WI) images. Optimal subsets were selected using minimum redundancy, maximum relevance, and recursive feature elimination in the support vector machine (SVM). For LNM prediction, the radiomics model was constructed by SVM, and Multi-Omics Graph cOnvolutional NETworks (MOGONET) was used for the effective classification of multiradiomics data. Multivariable logistic regression incorporating multiradiomics signatures and clinical risk factors was used to generate a nomogram, whose performance and clinical utility were assessed. Results showed that the nine most predictive features were separately selected from US, T2WI, DWI, and CE-T1WI images, and 18 features were selected in the combined model. The combined radiomics model showed better performance than models based on US, T2WI, DWI, and CE-T1WI. In a comparison of the combined radiomics and MOGONET model, receiver operating curve analysis showed that the area under the curve (AUC) value (95% CI) was 0.84 (0.76-0.93) and 0.84 (0.71-0.96) for the MOGONET model in the training and validation cohorts, respectively. The corresponding values (95% CI) for the combined radiomics model were 0.82 (0.74-0.90) and 0.77 (0.61-0.94), respectively. The MOGONET model had better performance and better prediction specificity compared with the combined radiomics model. The nomogram including the MOGONET signature showed a better predictive value (AUC: 0.81 vs. 0.88) in the training and validation (AUC: 0.74vs. 0.87) cohorts, as compared with the clinical model. Calibration curves showed good agreement in both cohorts. The applicability of the clinical multimodal radiomics (CMR) nomogram in clinical settings was validated by decision curve analysis. In patients with PTC, the CMR nomogram could improve the prediction of cervical LNM preoperatively and may be helpful in clinical decision-making.
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Affiliation(s)
- Wenjuan Hu
- 1Department of Radiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Yuzhong Zhuang
- 1Department of Radiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Lang Tang
- 2Department of Ultrasonography, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Hongyan Chen
- 2Department of Ultrasonography, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Hao Wang
- 1Department of Radiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Ran Wei
- 1Department of Radiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Lanyun Wang
- 1Department of Radiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Yi Ding
- 1Department of Radiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Xiaoli Xie
- 3Department of Pathology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | | | | | - Bin Song
- 1Department of Radiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
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Liu Z, Li C. Correlation of lymph node metastasis with contrast-enhanced ultrasound features, microvessel density and microvessel area in patients with papillary thyroid carcinoma. Clin Hemorheol Microcirc 2022; 82:361-370. [PMID: 36213988 DOI: 10.3233/ch-221545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aims to investigate the relationship of cervical lymph node metastasis (LNM) with contrast-enhanced ultrasound (CEUS) features, microvessel density (MVD) and microvessel area (MVA) in patients with papillary thyroid carcinoma (PTC), and to evaluate the diagnostic value of CEUS for PTC. METHODS A total of 108 patients diagnosed with PTC at the First Affiliated Hospital of Jinzhou Medical University from January 2016 to December 2018 were selected and underwent preoperative CEUS of the thyroid, surgical resection and postoperative histopathological examination of their resected lesion. They were divided into a lymphatic metastasis-positive group (LNM+, n = 61) and a lymphatic metastasis-negative group (LNM-, n = 47) based on their lymph node status. The CEUS quantitative parameters, MVD and MVA, were compared between the two groups, and risk factors for LNM were analyzed by univariate and multivariate logistic regression. RESULTS Compared with patients with in the LNM-group, the tumor diameter and the proportion of capsule contact of patients in the LNM+group were significantly greater and the patients in this group were younger. The rise time (RT), peak intensity (PI), area under the curve (AUC), MVD, and MVA were also significantly higher in the LNM+group than in the LMN-group, while there was no significant difference in time to peak (TP), mean transit time (mTT), velocity of intensity increase (IIV), and velocity of intensity decrease (IDV) between the two groups. Univariate and multivariate correlation analysis indicated that tumor size, RT, PI, AUC, MVD, and MVA were risk factors for LNM, and ROC curves further suggested that RT had the best overall predictive performance. CONCLUSION Tumor size, RT, PI, AUC, MVD and MVA are risk factors for LNM in PTC. In other words, CEUS is an important non-invasive and preoperative tool for evaluating PTC, with MVD and MVA identified as vital postoperative diagnostic indicators.
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Affiliation(s)
- Zhining Liu
- Department of Ultrasound, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Chen Li
- Molecular Testing Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou City, Liaoning Province, China
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Zhou X, Zhang M, Jin L, Tang X, Hu Q, Cheng G, Xiao Y. Quantitative analysis of contrast-enhanced ultrasound combined with ultrasound in the unifocal papillary thyroid micro-carcinoma. Med Eng Phys 2022; 110:103840. [PMID: 35811229 DOI: 10.1016/j.medengphy.2022.103840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate diagnostic value of ultrasound (US) combined with contrast-enhanced ultrasound (CEUS) in the invasiveness of unifocal papillary thyroid micro-carcinoma (UPTMC) without capsule-invasion. METHODS This retrospective study included data from patients with UPTMC who received US and CEUS examinations in the Ultrasound Department of the Central Hospital of Changsha, China between June 2019 and September 2021. Univariate and multivariate logistic regression analysis were used to evaluate the risk of US and CEUS parameters for UPTMC. Diagnostic performance was estimated by ROC analysis. RESULTS A total of 136 cases were enrolled, including invasive UPTMC (n = 47) and non-invasive UPTMC (n = 89), which were divided into test set (n = 109) and validation set (n = 27). The occurrence of microcalcification and the ratios (R) of each time-intensity curve (TIC) of CEUS parameter were significantly higher in patients with invasive UTPMC than non-invasive UPTMC (all P < 0.05). Additionally, nodular diameter was significantly longer in the invasive group (P < 0.05). Multivariate analysis showed that microcalcification (OR = 2.917, 95% CI: 1.002-8.491, P = 0.050), R-TTP > 1 (OR = 3.376, 95%CI: 1.267-8.994, P = 0.015), R-DS > 1 (OR = 6.558, 95% CI: 2.358-18.243, P < 0.010) were independently associated with invasive UPTMC. The sensitivities of US, CEUS and their combined application were 82.1%, 46.2% and 79.5%, respectively, and their specificities were 37.1%, 88.6% and 61.4%, respectively. The combination of the two methods had the best diagnostic efficiency (AUC=0.775)compared to US (AUC = 0.596) and CEUS (AUC = 0.750). CONCLUSION The combination of US and CEUS might have good diagnostic value for UPTMC with capsule non-invasion.
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Affiliation(s)
- Xiaohui Zhou
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Min Zhang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Linyuan Jin
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Xianpeng Tang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Qiang Hu
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Guanghui Cheng
- Department of Breast and Thyroid Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161, Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Yaocheng Xiao
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China.
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Pan X, Li Q. Risk factor score for the prediction of central compartment lymph node metastasis in papillary thyroid carcinoma and its clinical significance. Front Surg 2022; 9:914696. [DOI: 10.3389/fsurg.2022.914696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022] Open
Abstract
ObjectiveTo establish the criteria for a risk factor score (RFS) for predicting the probability of central compartment lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) and to explore the clinical significance of the RFS.MethodsThe data of 412 patients with PTC who underwent surgical resection between May 2013 and July 2016 were retrospectively analysed and divided into two groups: a central LNM group and a non-central LNM group. In each group, the frequency of six risk factors was documented: sex, age, tumour size, extracapsular spread (ECS), tumour multifocality, and tumour location. The maximum likelihood method of discriminant analysis was adopted to calculate patient scores for the six risk indicators. In addition, the data of 104 patients with PTC admitted between July 2016 and December 2016 were prospectively analysed using this method and these six risk factors. A higher score represented one certain possibility that was the more appropriate for one patient.ResultsIn the retrospective group, the result was as follows: 129 patients with positive (+) lymph nodes in the central compartment and 168 patients with negative (−) lymph nodes in the central compartment, which was in line with the actual results. In the prospective group, there were 28 patients with positive lymph nodes in the central compartment and 48 patients with negative lymph nodes in the central compartment. The coincidence rates using the RFS were 71.9% for the retrospective group and 73.1% for the prospective group.ConclusionBy simple and quantitative analyses of the presence of central LNM, the RFS is of great significance when choosing surgical approaches and postoperative individual-based treatment plans, as well as when determining the prognosis of central compartment LNM in patients with PTC.
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Spiesecke P, Neumann K, Wakonig K, Lerchbaumer MH. Contrast-enhanced ultrasound (CEUS) in characterization of inconclusive cervical lymph nodes: a meta-analysis and systematic review. Sci Rep 2022; 12:7804. [PMID: 35551228 PMCID: PMC9098903 DOI: 10.1038/s41598-022-11542-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/25/2022] [Indexed: 01/02/2023] Open
Abstract
Lymph node metastases are common in malignant neoplasms of head and neck. Since cervical lymph nodes (cLN) are localized superficially, ultrasound (US) represents the primary imaging modality. The aim of the study is to report the value of US and contrast-enhanced ultrasound (CEUS) and their diagnostic confidence in the characterization of inconclusive cLN. A systematic review was performed using the literature data base PubMed. Results were filtered (published in a peer-reviewed journal, full-text available, published within the last ten years, species human, English or German full-text) and inclusion criteria were clearly defined (cohort with lymphadenopathy or malignancy in head and neck ≥ 50 patients, histological confirmation of malignant imaging findings, performance of CEUS as outcome variable). The results were quantified in a meta-analysis using a random-effects model. Overall, five studies were included in qualitative and quantitative analysis. The combination of non-enhanced US and CEUS enlarges the diagnostic confidence in the characterization of lymph nodes of unclear dignity. The pooled values for sensitivity and specificity in the characterization of a malignant cervical lymph node using US are 76% (95%-CI 66-83%, I2 = 63%, p < 0.01) and 80% (95%-CI 45-95%, I2 = 92%, p < 0.01), compared to 92% (95%-CI 89-95%, I2 = 0%, p = 0.65) and 91% (95%-CI 87-94%, I2 = 0%, p = 0.40) for the combination of US and CEUS, respectively. Consistent results of the included studies show improved diagnostic performance by additional CEUS. Nevertheless, more prospective studies are needed to implement CEUS in the diagnostic pathway of cLN.
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Affiliation(s)
- Paul Spiesecke
- Department of Radiology, Interdisciplinary Ultrasound Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité -Universitätsmedizin Berlin Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Katharina Wakonig
- Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus H Lerchbaumer
- Department of Radiology, Interdisciplinary Ultrasound Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité -Universitätsmedizin Berlin Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Tong Y, Zhang J, Wei Y, Yu J, Zhan W, Xia H, Zhou S, Wang Y, Chang C. Ultrasound-based radiomics analysis for preoperative prediction of central and lateral cervical lymph node metastasis in papillary thyroid carcinoma: a multi-institutional study. BMC Med Imaging 2022; 22:82. [PMID: 35501717 PMCID: PMC9059387 DOI: 10.1186/s12880-022-00809-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022] Open
Abstract
Background An accurate preoperative assessment of cervical lymph node metastasis (LNM) is important for choosing an optimal therapeutic strategy for papillary thyroid carcinoma (PTC) patients. This study aimed to develop and validate two ultrasound (US) nomograms for the individual prediction of central and lateral compartment LNM in patients with PTC. Methods A total of 720 PTC patients from 3 institutions were enrolled in this study. They were categorized into a primary cohort, an internal validation, and two external validation cohorts. Radiomics features were extracted from conventional US images. LASSO regression was used to select optimized features to construct the radiomics signature. Two nomograms integrating independent clinical variables and radiomics signature were established with multivariate logistic regression. The performance of the nomograms was assessed with regard to discrimination, calibration, and clinical usefulness. Results The radiomics scores were significantly higher in patients with central/lateral LNM. A radiomics nomogram indicated good discrimination for central compartment LNM, with an area under the curve (AUC) of 0.875 in the training set, the corresponding value in the validation sets were 0.856, 0.870 and 0.870, respectively. Another nomogram for predicting lateral LNM also demonstrated good performance with an AUC of 0.938 and 0.905 in the training and internal validation cohorts, respectively. The AUC for the two external validation cohorts were 0.881 and 0.903, respectively. The clinical utility of the nomograms was confirmed by the decision curve analysis. Conclusion The nomograms proposed here have favorable performance for preoperatively predicting cervical LNM, hold promise for optimizing the personalized treatment, and might greatly facilitate the decision-making in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00809-2.
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Affiliation(s)
- Yuyang Tong
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai, 200032, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Yi Wei
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai, 200032, China
| | - Jinhua Yu
- Department of Electronic Engineering, Fudan University and Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, 200433, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Hansheng Xia
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Shichong Zhou
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai, 200032, China.
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University and Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, 200433, China
| | - Cai Chang
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai, 200032, China
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Zhong X, Lu Y, Yin X, Wang Q, Wang F, He Z. Prophylactic central lymph node dissection performed selectively with cN0 papillary thyroid carcinoma according to a risk-scoring model. Gland Surg 2022; 11:378-388. [PMID: 35284301 PMCID: PMC8899424 DOI: 10.21037/gs-21-906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/11/2022] [Indexed: 07/28/2023]
Abstract
BACKGROUND This study aimed to explore the risk factors of central lymph node metastasis (CLNM) in patients with clinical central lymph node-negative papillary thyroid carcinoma (PTC), and emphasize the guidance of the risk scoring model for prophylactic central lymph node dissection (pCLND) in patients with clinical lymph node-negative (cN0) PTC. METHODS A total of 582 patients with cN0 PTC who underwent unilateral/bilateral thyroidectomy and prophylactic central lymph node dissection (pCLND) in the Affiliated Hospital of Nantong University from January 2020 to February 2021 were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the risk factors of cN0 PTC. According to the independent risk factors of patients with cN0 PTC, a risk-scoring model was established. Then, the rationality of this risk scoring model was verified by additional clinical data of 112 patients with cN0 PTC in the Affiliated Hospital of Nantong University from March 2021 to April 2021. RESULTS Among 582 cases of cN0 PTC, 53.6% of the patients with cN0 had CLNM. The independent risk factors for CLNM in patients with cN0 PTC included male gender, <45 years of age, tumor with a maximum diameter of ≥1.0 cm, tumor location: middle/lower poles of the thyroid gland, multifocality, and extrathyroidal extension (ETE), and some ultrasound features, such as intra-nodular vascularity, microcalcification, irregular shape, and infiltrative margin. According to independent risk factors, a 24-point risk scoring model was established to predict CLNM in patients with cN0 PTC. CONCLUSIONS Currently, prophylactic central neck lymph node dissection is a controversial operation, which should be selectively performed only for high-risk patients with cN0 PTC. For cN0 PTC patients with scores ≥14 and high-risk patients, even if no CLNM is found before surgery, routine prophylactic CLND is recommended. In addition, for cN0 PTC patients with a score of fewer than 14 points, it is recommended to perform fine-needle aspiration (FNA) before surgery, carefully assess the condition of the central lymph nodes, and then select the best surgical plan based on the results of the assessment.
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Affiliation(s)
- Xiang Zhong
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Yunpeng Lu
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Xu Yin
- Department of Hepatobiliary and Pancreatic Surgery, Changzhou No.2 People’s Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Quhui Wang
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Feiran Wang
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhixian He
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China
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Fang F, Gong Y, Liao L, Ye F, Zuo Z, Li X, Zhang Q, Tang K, Xu Y, Zhang R, Chen S, Niu C. Value of Contrast-Enhanced Ultrasound for Evaluation of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2022; 13:812475. [PMID: 35185795 PMCID: PMC8850786 DOI: 10.3389/fendo.2022.812475] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/10/2022] [Indexed: 12/07/2022] Open
Abstract
The aim of the study was to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC). Two hundred and one cervical LNs (157 metastatic from PTC and 44 benign) were evaluated using conventional ultrasonography (US) and CEUS before biopsy or surgery. Histopathology was used as the gold standard. We evaluated the size, long axis/short axis ratio (L/S), fatty hilum, hyper-echogenicity, calcification, cystic change, peripheral vascularity and CEUS parameters for each lymph nodule. The CEUS parameters included enhancement type, homogeneity, perfusion type, ring enhancement, peak intensity (PI) index and area under the curve (AUC) index. Univariate analysis demonstrated that compared with benign LNs, malignant LNs more frequently had L/S < 2, absence of a fatty hilum, presence of hyper-echogenicity, presence of calcification, peripheral vascularity, hyper-enhancement, heterogeneous enhancement, centripetal perfusion, ring enhancement, PI index > 1 and AUC index > 1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that hyper-enhancement, centripetal perfusion, and ring enhancement are independent CEUS characteristics related to malignant LNs for their differentiation from benign LNs (all p < 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to identify malignant cervical LNs from benign cervical LNs.
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Affiliation(s)
- Fengkai Fang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Gong
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liyan Liao
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fei Ye
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhongkun Zuo
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaodu Li
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qi Zhang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kui Tang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yan Xu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Rongsen Zhang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sijie Chen
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chengcheng Niu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Chengcheng Niu,
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Wang B, Cao Q, Cui XW, Dietrich CF, Yi AJ. A model based on clinical data and multi-modal ultrasound for predicting cervical lymph node metastasis in patients with thyroid papillary carcinoma. Front Endocrinol (Lausanne) 2022; 13:1063998. [PMID: 36578956 PMCID: PMC9791085 DOI: 10.3389/fendo.2022.1063998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore diagnostic performance based on clinical characteristics, conventional ultrasound, Angio PLUS (AP), shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) for the preoperative evaluation of cervical lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) and to find a reliable predictive model for evaluating CLNM. MATERIALS AND METHODS A total of 206 thyroid nodules in 206 patients were included. AP, SWE, and CEUS were performed for all thyroid nodules. Univariate analysis and multivariate logistic regression analysis were performed to ascertain the independent risk factors. The sensitivity, specificity, and the area under the curve (AUC) of independent risk factors and the diagnostic model were compared. RESULTS Sex, age, nodule size, multifocality, contact extent with adjacent thyroid capsule, Emax, and capsule integrity at CEUS were independent risk predictors for CLNM in patients with PTC. A predictive model was established based on the following multivariate logistic regression: Logit (p) = -2.382 + 1.452 × Sex - 1.064 × Age + 1.338 × Size + 1.663 × multifocality + 1.606 × contact extent with adjacent thyroid capsule + 1.717 × Emax + 1.409 × capsule integrity at CEUS. The AUC of the predictive model was 0.887 (95% CI: 0.841-0.933), which was significantly higher than using independent risk predictors alone. CONCLUSION Our study found that male presence, age < 45 years, size ≥ 10 mm, multifocality, contact extent with adjacent thyroid capsule > 25%, Emax ≥ 48.4, and interrupted capsule at CEUS were independent risk predictors for CLNM in patients with PTC. We developed a diagnostic model for predicting CLNM, which could be a potentially useful and accurate method for clinicians; it might be beneficial to surgical decision-making and patient management and for improving prognosis.
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Affiliation(s)
- Bin Wang
- Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China
| | - Qing Cao
- Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xin-Wu Cui, ; Ai-jiao Yi,
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Ai-jiao Yi
- Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China
- *Correspondence: Xin-Wu Cui, ; Ai-jiao Yi,
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21
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Li QL, Ma T, Wang ZJ, Huang L, Liu W, Chen M, Sang T, Ren XG, Tong J, Cao CL, Dong J, Li J. The value of contrast-enhanced ultrasound for the diagnosis of metastatic cervical lymph nodes of papillary thyroid carcinoma: A systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:60-69. [PMID: 34625988 DOI: 10.1002/jcu.23073] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
To investigate the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) for the diagnosis of cervical lymph nodes metastasis (CLNM) of papillary thyroid carcinoma (PTC), eight available datasets of seven qualified articles before March 31, 2021 were included after a comprehensive search. Meta-analysis results showed that CEUS demonstrated acceptable diagnostic performance in the diagnosis of CLNM of PTC. Furthermore, meta-regression analysis was conducted to identify the reasons for heterogeneity and the results indicated that the criteria of CEUS for the diagnosis of CLNM in PTC need to be unified.
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Affiliation(s)
- Qiao-Li Li
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Ting Ma
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Zi-Jing Wang
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Lei Huang
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Wen Liu
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Ming Chen
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Tian Sang
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Xue-Gang Ren
- Department of Medical Ultrasound, Alar Hospital of the First Division of Xinjiang Production and Construction Corps, Alar, China
| | - Jin Tong
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Chun-Li Cao
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Jian Dong
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Jun Li
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, China
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Ultrasound-Based Radiomic Nomogram for Predicting Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma. Acad Radiol 2021; 28:1675-1684. [PMID: 32782219 DOI: 10.1016/j.acra.2020.07.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE AND OBJECTIVES Accurate preoperative identification of lateral cervical lymph node metastasis (LNM) is important for decision-making and clinical management of patients with papillary thyroid carcinoma (PTC). The aim of this study was to develop an ultrasound (US)-based radiomic nomogram to preoperatively predict the lateral LNM in PTC patients. METHODS In this retrospective study, a total of 886 patients were enrolled and randomly divided into 2 groups. Radiomic features were extracted from the preoperative US images. A radiomic signature was constructed using the least absolute shrinkage and selection operator algorithm in the training set. Multivariate logistic regression was performed to develop the radiomic nomogram, which incorporating the radiomic signature and the selected clinical characteristics. The performance of the nomogram was assessed by its discrimination, calibration, and clinical usefulness in both the training and validation sets. RESULTS The radiomic signature was significantly associated with the lateral LNM in both cohorts (p< 0.001). The nomogram that consisted of radiomic signature, US-reported cervical lymph node (CLN) status, and CT-reported CLN status demonstrated good discrimination and calibration in the training and validation sets with an AUC of 0.946 and 0.914, respectively. The decision curve analysis indicated that the radiomic nomogram was worthy of clinical application. CONCLUSION The radiomic nomogram proposed here has good performance for noninvasively predicting the lateral LNM and might be used to facilitate clinical decision-making and potentially improve the survival outcome in selected patients.
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23
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Sorrenti S, Dolcetti V, Fresilli D, Del Gaudio G, Pacini P, Huang P, Camponovo C, Leoncini A, D’Andrea V, Pironi D, Frattaroli F, Trimboli P, Radzina M, Cantisani V. The Role of CEUS in the Evaluation of Thyroid Cancer: From Diagnosis to Local Staging. J Clin Med 2021; 10:jcm10194559. [PMID: 34640574 PMCID: PMC8509399 DOI: 10.3390/jcm10194559] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/25/2022] Open
Abstract
Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate thyroid parenchyma as recommended by EFSUMB guidelines, for use in clinical research field, although its role is not yet clear. Several papers show the potential utility of CEUS in the differential diagnosis of benign and malignant thyroid nodules and in the analysis of lymph node involvement in neoplastic pathology. Therefore, we carried out an evaluation of the literature concerning the role of CEUS in three specific areas: the characterization of the thyroid nodule, the evaluation of minimally invasive treatment and loco-regional staging of the lymph node in proven thyroid cancer. According to evidence reported, CEUS can also play an operative role in nodular thyroid pathology as it is able to guide ablation procedures on thyroid nodule and metastatic lymph nodes, to assess the radicality of surgery, to evaluate disease relapse at the level of the margins of ablated regions and to monitor the clinical evolution of necrotic areas in immediate post-treatment setting.
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Affiliation(s)
- Salvatore Sorrenti
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Vincenzo Dolcetti
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Daniele Fresilli
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Giovanni Del Gaudio
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Patrizia Pacini
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou 310009, China;
- Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Chiara Camponovo
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
| | - Andrea Leoncini
- Servizio di Radiologia e Radiologia Interventistica, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
| | - Vito D’Andrea
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Daniele Pironi
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Fabrizio Frattaroli
- Department of Surgery “P. Stefanini”, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia;
- Medical Faculty, University of Latvia; Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1007 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
- Correspondence:
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Zou Y, Shi Y, Liu J, Cui G, Yang Z, Liu M, Sun F. A Comparative Analysis of Six Machine Learning Models Based on Ultrasound to Distinguish the Possibility of Central Cervical Lymph Node Metastasis in Patients With Papillary Thyroid Carcinoma. Front Oncol 2021; 11:656127. [PMID: 34254039 PMCID: PMC8270759 DOI: 10.3389/fonc.2021.656127] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022] Open
Abstract
Current approaches to predict central cervical lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) have failed to identify patients who would benefit from preventive treatment. Machine learning has offered the opportunity to improve accuracy by comparing the different algorithms. We assessed which machine learning algorithm can best improve CLNM prediction. This retrospective study used routine ultrasound data of 1,364 PTC patients. Six machine learning algorithms were compared to predict the possibility of CLNM. Predictive accuracy was assessed by sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve (AUC). The patients were randomly split into the training (70%), validation (15%), and test (15%) data sets. Random forest (RF) led to the best diagnostic model in the test cohort (AUC 0.731 ± 0.036, 95% confidence interval: 0.664–0.791). The diagnostic performance of the RF algorithm was most dependent on the following five top-rank features: extrathyroidal extension (27.597), age (17.275), T stage (15.058), shape (13.474), and multifocality (12.929). In conclusion, this study demonstrated promise for integrating machine learning methods into clinical decision-making processes, though these would need to be tested prospectively.
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Affiliation(s)
- Ying Zou
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Shi
- Department of Ultrasonography, Binzhou Medical University Hospital, Binzhou City, China
| | - Jihua Liu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guanghe Cui
- Department of Ultrasonography, Binzhou Medical University Hospital, Binzhou City, China
| | - Zhi Yang
- Department of Ultrasonography, Binzhou Medical University Hospital, Binzhou City, China
| | - Meiling Liu
- Department of Ultrasonography, Binzhou Medical University Hospital, Binzhou City, China
| | - Fang Sun
- Department of Ultrasonography, Binzhou Medical University Hospital, Binzhou City, China
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Sun F, Zou Y, Huang L, Shi Y, Liu J, Cui G, Zhang X, Xia S. Nomogram to assess risk of central cervical lymph node metastasis in patients with cN0 papillary thyroid carcinoma. Endocr Pract 2021; 27:1175-1182. [PMID: 34174413 DOI: 10.1016/j.eprac.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study developed and validated an individualized prediction risk model for the need for central cervical lymph node dissection in patients with cN0 papillary thyroid carcinoma (PTC) diagnosed by ultrasound. METHODS Upon retrospective review, derivation and internal validation cohorts comprised 1585 consecutive patients with PTC treated from January 2017 to December 2019 at Hospital A. The external validation cohort consisted of 406 consecutive patients treated at Hospital B from January 2016 to June 2020. Independent risk factors for central cervical lymph node metastasis (CLNM) were determined through univariable and multivariable logistic regression analysis. An individualized risk prediction model was constructed and illustrated as a nomogram, which was internally and externally validated. RESULTS The following risk factors of CLNM were established: the solitary primary thyroid nodule's diameter, shape, calcification, and capsular abutment-to-lesion perimeter ratio. The areas under the receiver operating characteristic curves of the risk prediction model for the internal and external validation cohorts were 0.921 and 0.923, respectively. The calibration curve showed good agreement between the nomogram-estimated probability of CLNM and the actual CLNM rate in the three cohorts. The decision curve analysis confirmed the clinical usefulness of the nomogram. CONCLUSION This study developed and validated a model for predicting risk of CLNM in the individual patient with cN0 PTC, which should be an efficient tool for guiding clinical treatment.
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Affiliation(s)
- Fang Sun
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China; Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, Shandong 256603, China
| | - Ying Zou
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China
| | - Lixiang Huang
- Department of Radiology, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, China; Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China
| | - Yan Shi
- Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, Shandong 256603, China
| | - Jihua Liu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin 300193, China
| | - Guanghe Cui
- Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, Shandong 256603, China
| | - Xuening Zhang
- Department of Radiology, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, China.
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nan Kai District, Tianjin 300192, China.
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Zhou YF, Zhang YF, Fu HJ, Yang WP, Zhao CK, Xu HX. Improving the diagnosis of AUS/FLUS thyroid nodules using an algorithm with combination of BRAFV600E mutation analysis and ultrasound pattern-based risk stratification. Clin Hemorheol Microcirc 2021; 77:273-285. [PMID: 33185592 DOI: 10.3233/ch-200985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
PURPOSE To propose a diagnostic algorithm for improving the diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) thyroid nodules. METHODS This study retrospectively enrolled 77 consecutive patients with 81 AUS/FLUS nodules who underwent preoperative BRAFV600E mutation analysis. A new diagnostic algorithm was proposed that BRAFV600E mutation analysis for the Fine-needle aspiration cytology specimen was firstly carried out, in which positive BRAFV600E mutation indicated malignancy and classification of the nodules with negative BRAFV600E mutation was further performed based on ultrasound pattern-based risk stratification of American Thyroid Association Guidelines. The diagnostic performance of the new diagnostic algorithm was evaluated. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the receiver operating characteristic curve (AUROC) of new diagnostic algorithm were 94.6%, 84.0%, 91.4%, 86.9%, 90.1%, and 0.893, respectively. The proposed diagnostic algorithm significantly increased the diagnostic performances (AUROC: 0.893 vs. 0.837 and 0.795), sensitivity (94.6% vs. 71.4% and 75.0%), and accuracy (90.1% vs. 79.0% and 77.8%) compared with BRAFV600E mutation analysis alone and ultrasound pattern-based risk stratification alone (all P < 0.05). CONCLUSION The proposed diagnostic algorithm is helpful for improving the diagnosis of AUS/FLUS nodules, which might be as a routine approach.
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Affiliation(s)
- Ya-Fang Zhou
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Jun Fu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei-Ping Yang
- Department of Medical Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
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27
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Wang Y, Nie F, Wang G, Liu T, Dong T, Sun Y. Value of Combining Clinical Factors, Conventional Ultrasound, and Contrast-Enhanced Ultrasound Features in Preoperative Prediction of Central Lymph Node Metastases of Different Sized Papillary Thyroid Carcinomas. Cancer Manag Res 2021; 13:3403-3415. [PMID: 33907464 PMCID: PMC8064616 DOI: 10.2147/cmar.s299157] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Early and accurate preoperative diagnosis of central lymph node metastasis (CLNM) is crucial to improve surgical management of patients with clinical lymph node-negative papillary thyroid carcinoma (PTC). Towards improving diagnosis of CLNM, we assessed the value of combining preoperative clinical characteristics, conventional ultrasound, and contrast-enhanced ultrasound (CEUS) in preoperative prediction of CLNM of different sized PTCs. Patients and Methods Patients were divided according to tumor size: a PTC group (>10 mm) and a papillary thyroid microcarcinoma (PTMC) group (≤10 mm). We retrospectively analyzed the clinical and ultrasonographic features of 120 PTC patients and 165 PTMC patients. Multivariate logistic regression analysis was used to screen independent risk factors and establish prediction models. Receiver operating characteristic curves were used to determine the best cut-off values for continuous variables and assess the performance of prediction models. Results Independent risk predictors of CLNM for the PTC group were extrathyroidal extension in CEUS (OR=7.923), tumor size >14 mm (OR=5.491), and multifocality (OR=3.235). For the PTMC group, the independent risk factors were the distance from the thyroid capsule =0 mm (OR=4.629), male (OR=3.315), tumor size >5 mm (OR=3.304), and microcalcification (OR=2.560). The predictive model of combined method had better performance in predicting CLNM of PTC compared with models based on CEUS and conventional ultrasound alone (area under the curve: 0.832 vs 0.739, P=0.0011; 0.832 vs 0.678, P=0.0012). For PTMC, comparing with CEUS, the combined method and conventional ultrasound performed better than CEUS alone in predicting CLNM (area under the curve: 0.783 vs 0.636, P=0.0016; 0.738 vs 0.636, P=0.0196). Conclusion The predictive models of combined method obtained from significant preoperative clinical and ultrasonographic features can potentially improve the preoperative diagnosis and individual treatment of CLNM in patients with PTC and PTMC. CEUS may be helpful in predicting CLNM of PTC, but CEUS would be ineffective in predicting CLNM of PTMC.
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Affiliation(s)
- Yanfang Wang
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Fang Nie
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Guojuan Wang
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Ting Liu
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Tiantian Dong
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Yamin Sun
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
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Gao L, Xi X, Gao Q, Tang J, Yang X, Zhu S, Zhao R, Lai X, Zhang X, Zhang B, Jiang Y. Blood-Rich Enhancement in Ultrasonography Predicts Worse Prognosis in Patients With Papillary Thyroid Cancer. Front Oncol 2021; 10:546378. [PMID: 33489868 PMCID: PMC7821421 DOI: 10.3389/fonc.2020.546378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 11/16/2020] [Indexed: 01/03/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) can be used to evaluate microcirculation in cancers, which in turn is associated with the biologic features and ultimately patient prognosis. We conducted a retrospective analysis to examine potential association between CEUS parameters and prognosis in patients with papillary thyroid cancer (PTC). The analysis included 306 patients who underwent CEUS prior to thyroidectomy at our center during a period from 2012 to 2019. Subjects with excellent response (ER) were compared to the non-ER group (including indeterminate response, biochemical incomplete response and structural incomplete response). During the median follow-up of 34 months, ER was observed in 195 (63.7%) subjects. The remaining 111 (36.3%) patients developed non-ER events, with distant metastasis in five (1.6%) cases. In a multivariate COX regression, non-ER event was associated with the male sex (OR = 1.83, 95%CI: 1.21-2.76) and blood-rich enhancement in CEUS (OR = 1.69, 95%CI: 1.04-2.75). Based on this finding, we developed a predictive model: high risk for developing non-ER events was defined as having both risk factors; low risk was defined as having none or only one risk. In receiver operating characteristic (ROC) analysis, the area under the curve was 0.59 (95%CI: 0.52-0.66). The sensitivity and specificity were 17.1 and 95.4%, respectively. The positive and negative predictive values were 67.9 and 66.9%, respectively. In conclusion, blood-rich enhancement in CEUS is associated with non-ER events after thyroidectomy in patients with PTC.
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Affiliation(s)
- Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuehua Xi
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Qiong Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiajia Tang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shenling Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruina Zhao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xingjian Lai
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyan Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Qi T, Rong X, Feng Q, Sun H, Cao H, Yang Y, Feng H, Zhu L, Wang L, Du Q. Somatic Mutation Profiling of Papillary Thyroid Carcinomas by Whole-exome Sequencing and Its Relationship with Clinical Characteristics. Int J Med Sci 2021; 18:2532-2544. [PMID: 34104084 PMCID: PMC8176168 DOI: 10.7150/ijms.50916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/16/2021] [Indexed: 01/18/2023] Open
Abstract
The incidence of papillary thyroid carcinomas (PTCs) has increased rapidly during the past several decades. Until now, the mechanisms underlying the tumorigenesis of PTCs have remained largely unknown. Next-generation-sequencing (NGS) provides new ways to investigate the molecular pathogenesis of PTCs. To characterize the somatic alterations associated with PTCs, we performed whole-exome sequencing (WES) of PTCs from 23 Chinese patients. This study revealed somatic mutations in genes with relevant functions for tumorigenesis, such as BRAF, BCR, CREB3L2, DNMT1, IRS2, MSH6, and TP53. We also identified novel somatic gene alterations which may be potentially involved in PTC progression. Gene set enrichment analysis revealed that the cellular response to hormone stimulus, epigenetic modifications, such as protein/histone methylation and protein alkylation, as well as MAPK, PI3K-AKT, and FoxO/mTOR signaling pathways, were significantly altered in the PTCs studied here. Moreover, Protein-Protein Interaction (PPI) network analysis of our mutated gene selection highlighted EP300, KRAS, PTEN, and TP53 as major core genes. The correlation between gene mutations and clinicopathologic features of the PTCs defined by conventional ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) were assessed. These analyses established significant associations between subgroups of mutations and respectively taller-than-wide, calcified, and peak time iso- or hypo-enhanced and metastatic PTCs. In conclusion, our study supplements the genomic landscape of PTCs and identifies new actionable target candidates and clinicopathology-associated mutations. Extension of this study to larger cohorts will help define comprehensive genomic aberrations in PTCs and validate target candidates. These new targets may open methods of individualized treatments adapted to the clinicopathologic specifics of the patients.
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Affiliation(s)
- Tingyue Qi
- Department of Ultrasound, Medical Imaging Center, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China.,Department of Critical Care Medicine, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Xin Rong
- Department of Ultrasound, Medical Imaging Center, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Qingling Feng
- Department of Critical Care Medicine, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Hongguang Sun
- Department of Ultrasound, Medical Imaging Center, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Haiyan Cao
- Department of Ultrasound, Medical Imaging Center, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Yan Yang
- Department of Ultrasound, Medical Imaging Center, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Hao Feng
- Department of Ultrasound, Medical Imaging Center, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Linhai Zhu
- Department of Thyroid and Breast Surgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Lei Wang
- Department of Pathology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China
| | - Qiu Du
- Department of Neurosurgery, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, China.,Central Laboratory, the Affiliated Hospital of Yangzhou University, Yangzhou 225012, Yangzhou University, China
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30
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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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Luo ZY, Hong YR, Yan CX, Wang Y, Ye Q, Huang P. Utility of quantitative contrast-enhanced ultrasound for the prediction of lymph node metastasis in patients with papillary thyroid carcinoma. Clin Hemorheol Microcirc 2020; 80:37-48. [PMID: 33252064 DOI: 10.3233/ch-200909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to find the optimal parameters and cutoffs to differentiate metastatic lymph nodes (LNs) from benign LNs in the patients with papillary thyroid carcinoma (PTC) on the quantitative contrast-enhanced ultrasound (CEUS) features. METHODS A total of 134 LNs in 105 patients with PTCs were retrospectively enrolled. All LNs were evaluated by conventional ultrasound (US) and CEUS before biopsy or surgery. The diagnostic efficacy of CEUS parameters was analyzed. RESULTS Univariate analysis indicated that metastatic LNs more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, ring-enhancing margins, higher PI, larger AUC, longer TTP and DT/2 than benign LNs at pre-operative CEUS (p < 0.001, for all). Multivariate analysis showed that centripetal or asynchronous perfusion (OR = 3.163; 95% CI, 1.721-5.812), hyper-enhancement(OR = 0.371; 95% CI, 0.150-0.917), DT/2 (OR = 7.408; 95% confidence interval CI, 1.496-36.673), and AUC (OR = 8.340; 95% CI, 2.677-25.984) were predictive for the presence of metastatic LNs. The sensitivity and accuracy of the quantitative CEUS were higher than qualitative CEUS (75% vs 55 % and 83.6% vs 76.1 % , respectively). CONCLUSIONS Quantitative CEUS parameters can provide more information to distinguish metastatic from benign LNs in PTC patients; In particular, DT/2 and AUC have a higher sensitivity and accuracy in predicting the presence of metastatic LNs and reduce unnecessary sampling of benign LNs.
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Affiliation(s)
- Zhi-Yan Luo
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yu-Rong Hong
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Cao-Xin Yan
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yong Wang
- Department of Surgery, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Qin Ye
- Department of Pathology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
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Liu BJ, Zhang YF, Zhao CK, Wang HX, Li MX, Xu HX. Conventional ultrasound characteristics, TI-RADS category and shear wave speed measurement between follicular adenoma and follicular thyroid carcinoma. Clin Hemorheol Microcirc 2020; 75:291-301. [PMID: 32280082 DOI: 10.3233/ch-190750] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of the study was to explore the differences of conventional ultrasound characteristics, thyroid imaging reporting and data system (TI-RADS) category and shear wave speed (SWS) measurement between follicular adenoma (FA) and follicular thyroid carcinoma (FTC). Twenty-eight FTCs and 67 FAs proven by surgery were retrospectively included for analysis. Conventional ultrasound and point-shear wave elastography (p-SWE) were performed in all of the included patients. The ultrasound features, American Thyroid Association (ATA) TI-RADS category and American College of Radiology (ACR) TI-RADS category, SWS measurement were compared between the two groups. Receiver operating characteristic (ROC) curve was performed and area under ROC curve (AUC) was obtained for significant features. There were no statistical differences in mean age (46.9±15.7years vs. 48.6±13.6years, P = 0.639), gender (9 males, 32.1% vs. 18 males, 29.0%, P = 0.766) and mean diameter (28.3±16.2 mm vs. 33.8±11.9 mm, P = 0.077) between FTCs and FAs. Hypoechogenicity, lobulated or irregular margin, macrocalcification were more common in FTCs than FAs (all P < 0.05). Mean SWS of FTCs (2.29±0.64 m/s) was slightly higher than that of FAs (1.94±0.68 m/s) (P = 0.023). The AUCs were 0.655, 0.744, and 0.744 with the cut-off SWS≥1.89 m/s, ACR TI-RADS category 4 and intermediate suspicion of ATA TI-RADS category. The sensitivity and AUC were 82.1% and 0.812 with combined ultrasound features of hypoechogenicity, lobulated or irregular margin and macrocalcification. In Conclusion, SWS measurement and TI-RADS categories were useful for the identification of FTCs from FAs.
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Affiliation(s)
- Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Han-Xiang Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Ming-Xu Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
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Tao L, Zhou W, Zhan W, Li W, Wang Y, Fan J. Preoperative Prediction of Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma via Conventional and Contrast-Enhanced Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2071-2080. [PMID: 32352187 DOI: 10.1002/jum.15315] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/23/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the independent risk factors for cervical lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) and establish a prediction model via conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). METHODS A total of 275 patients with single PTC, who were admitted to our hospital from January 2016 to December 2018, were enrolled in this study. The clinical characteristics and features of the tumor on conventional US and CEUS were retrospectively analyzed. A binary logistic regression model was established, and the diagnostic efficacy of conventional US and CEUS was compared. RESULTS The binary logistic regression analysis showed that age younger than 38 years, size of 10.0 mm or greater, solid composition, peak of the nodule interior of 28.3750 or greater, and area under the curve (AUC) of the peripheral ring of less than 3.2500 were independent risk factors of CLNM (P < .05, for all). Prediction model: Logit (p) = -4.135 + 1.040 (age) + 1.920 (size) + 1.769 (composition) + 1.230 (peak of nodule interior) + 0.812 (AUC of peripheral ring). The model positively predicted CLNM at a value of L > -0.199. The AUC, sensitivity, and negative predictive value of the receiver operating characteristic curve for the model were 0.727, 71.7%, and 75.2%, respectively, which were significantly higher than those of conventional US (Z = -2.403; P = .016; Z = -5.330; P < .001; and Z = -2.390; P = .017). The specificity of the model was 73.7%, which was lower than that of conventional US (Z = 3.508; P < .001). CONCLUSIONS The preoperative prediction model established via conventional US and CEUS may be helpful to evaluate CLNM in patients with PTC and determine the appropriate treatment options.
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Affiliation(s)
- Lingling Tao
- Department of Ultrasound, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Li
- Department of Ultrasound, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Wang
- Department of Ultrasound, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinfang Fan
- Department of Ultrasound, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Georgieva M, Kammerer S, Prantl L, Jung F, Stroszczynski C, Jung EM. Imaging of breast implant and implant-associated complications: Capsular contracture and intra- or extracapsular rupture. Clin Hemorheol Microcirc 2020; 76:221-231. [PMID: 32925022 DOI: 10.3233/ch-209218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In recent years, follow-up after breast reconstruction with silicone implants and the detection of complications have been relieved by the possibility of improved diagnostic methods. METHODS Between January 2015 and December 2019 a total of 40 patients (29-84 years) with silicone implants were included in this retrospective study. The implants were examined clinically and with modern imaging: general ultrasound imaging (US), magnetic resonance imaging (MRI), high resolution computed tomography (CT) and positron emission tomography -computed tomography (PET-CT). If necessary, a histological/cytological sample was taken. The breast implants were assessed by three radiologists specialized in breast imaging. The grade of capsular contracture was classified according to the Baker classification. RESULTS All 40 women obtained a clinical examination and an US diagnostic to identify early and more common complications such as implant folding and capsular fibrosis. Depending on the clinical examination and ultrasound findings additional MRI (n = 10), CT (n = 9) and/or PET-CT (n = 2) were performed. 16 patients had implants folding proven with US (n = 16), MRI (n = 6) and CT (n = 1). The grade of capsular fibrosis was determined according to the Baker classification. The following results were obtained in our study: 25 breast implants with Baker grade I and eleven breast implants with Baker grade II, both proven with US; one breast implants with Baker grade III and one breast implant with Baker grade IV, proven with US (n = 2), MRI (n = 1) and CT (n = 1). One patient had intracapsular rupture and one patient had extracapsular rupture, both detected on CT and surgically proven. No patient had a silicone accumulation in the lymph nodes. One patient had pathologically enlarged axillary lymph nodes, which were evaluated as inflammatory changes in PET-CT. Long-term complications such as the development of malignant breast tumors could not be observed. CONCLUSION To detect early complications after breast implant surgery, a regular clinical examination is indispensable. Imaging methods complement each other and if they are used multimodal, it is easier to identify early complications. Modern diagnostic modalities like ultrasound and magnetic resonance imaging expand the spectrum and improve diagnostic safety.
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Affiliation(s)
- M Georgieva
- Department of Radiology, University Hospital Regensburg, Germany
| | - S Kammerer
- Department of Radiology, University Hospital Regensburg, Germany
| | - L Prantl
- Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - F Jung
- Brandenburg University of Technology, Molecular Cell Biology, Senftenberg, Germany
| | - C Stroszczynski
- Department of Radiology, University Hospital Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Hospital Regensburg, Germany
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Zhan J, Zhang LH, Yu Q, Li CL, Chen Y, Wang WP, Ding H. Prediction of cervical lymph node metastasis with contrast-enhanced ultrasound and association between presence of BRAF V600E and extrathyroidal extension in papillary thyroid carcinoma. Ther Adv Med Oncol 2020; 12:1758835920942367. [PMID: 32843902 PMCID: PMC7418479 DOI: 10.1177/1758835920942367] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: This study aimed to evaluate the correlation between cervical lymph node metastasis (CLNM) and each of the ultrasound features, immunohistochemical factors, and B-type Raf (BRAFV600E) mutation. Methods: A retrospective analysis was performed on 405 patients with single papillary thyroid carcinoma (PTC) nodules, all of whom underwent preoperative sonographic examinations, including gray-scale ultrasound, color Doppler ultrasound, and contrast-enhanced ultrasound (CEUS). All PTC patients were evaluated using 14 clinical and sonographic features, eight immunohistochemical factors, and BRAFV600E. Multivariate analyses were performed to identify the risk factors for CLNM, and an equation for CLNM was established. The diagnostic value of each modality was compared with a receiver operating characteristic (ROC) curve. Results: Among the 405 PTC nodules removed surgically, CLNM was confirmed in 138 patients, whereas extrathyroidal extension was confirmed in 185 patients. Multivariate analyses indicated significant differences between CLNM and non-CLNM groups in three conventional ultrasound features (p < 0.05), whereas other sonographic features, eight immunohistochemical factors, and BRAFV600E did not indicate significant differences. A ROC curve of 0.757 in the equation exhibited a significant difference compared with the solo factors (p < 0.05 for all). Hyper or isoechoic enhancement at peak time on CEUS was associated with CLNM, whereas the presence of the BRAFV600E mutation was associated with extrathyroidal extensions although BRAF appeared to be uncorrelated with CLNM in the present study. Conclusion: Intensity at peak time, homogeneity, and size are the three most significant features in predicting CLNM in PTC patients, and the presence of the BRAFV600E mutation was associated with extrathyroidal extensions when PTCs showed a hyper or isoechoic enhancement at peak time in CEUS.
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Affiliation(s)
- Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai P.R. China
| | - Long-Hui Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Qing Yu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Chao-Lun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai P.R. China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Fenglin Road No.180, Shanghai, 200032, P.R. China
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Wu L, Shi Y, Liu B, Zhao M. Expression of lncRNA-HOTAIR in the serum of patients with lymph node metastasis of papillary thyroid carcinoma and its impact. Oncol Lett 2020; 20:907-913. [PMID: 32566019 PMCID: PMC7285833 DOI: 10.3892/ol.2020.11620] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/22/2020] [Indexed: 12/27/2022] Open
Abstract
The present study aimed to investigate the expression of long non-coding HOX transcript antisense RNA (lncRNA-HOTAIR) in the serum of patients with lymph node metastasis of papillary thyroid carcinoma (PTC) and the underlying mechanism. A total of 89 patients with PTC at Beijing Geriatric Hospital were recruited in this study. Based on the results of color Doppler ultrasound examination, the patients were evaluated for cervical lymph node metastases, and were thereby divided into a metastasis-negative group and a metastasis-positive group. Quantitative fluorescent PCR was used to assess the expression of HOTAIR in serum samples. The PTC cell line TPC-1 was randomly divided into a control and siRNA group. The control group was transfected with a nonsense sequence, while the siRNA group was transfected with si-HOTAIR. After transfection, cell proliferation was evaluated using the MTT assay, and cell migration and invasion were assessed using the cell scratch assay and Transwell assay. Expression levels of vimentin, E-cadherin and proteins associated with the Wnt/β-catenin signaling pathway were assessed using western blot analysis. Based on the results of the ultrasound examination, 53 patients were allocated to the metastasis-negative group, and 36 to the metastasis-positive group. The expression level of lncRNA-HOTAIR was higher in the metastasis-positive group than that in the metastasis-negative group (P<0.05). Compared with the control group, cell proliferation was reduced while cell migration rate and the number of migrating cells were increased in the siRNA group. Compared with the control group, the expression levels of WIF1 and E-cadherin were significantly increased, while the levels of β-catenin and vimentin were significantly decreased. In conclusion, lncRNA-HOTAIR is overexpressed in the serum of patients with lymph node metastasis of PTC. In vitro experiments showed that HOTAIR promoted the proliferation and metastasis of PTC cells by regulating epithelial-mesenchymal transition (EMT) mediated by the Wnt/catenin pathway. Thus, lncRNA-HOTAIR is proposed as a molecular target for the treatment of lymph node metastasis of PTC.
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Affiliation(s)
- Lan Wu
- Department of Ultrasound, Beijing Geriatric Hospital, Beijing 100095, P.R. China
| | - Yanqing Shi
- Department of Ultrasound, Beijing Geriatric Hospital, Beijing 100095, P.R. China
| | - Baoguo Liu
- Head and Neck Surgery, Beijing Cancer Hospital, Beijing 100142, P.R. China
| | - Mengting Zhao
- Department of Ultrasound, Beijing Geriatric Hospital, Beijing 100095, P.R. China
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Chen B, Zhang Z, Wang K, Shang M, Zhao S, Ding W, Du R, Yu Z, Xu X. Association of BRAFV600E mutation with ultrasonographic features and clinicopathologic characteristics of papillary thyroid microcarcinoma: A retrospective study of 116 cases. Clin Hemorheol Microcirc 2020; 73:545-552. [PMID: 31306113 DOI: 10.3233/ch-190568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To analyze the association of BRAFV600E mutation with ultrasonographic (US) features and clinicopathologic characteristics in Chinese patients with papillary thyroid microcarcinoma (PTMC). METHODS AND MATERIALS We retrospectively reviewed 116 consecutive Chinese patients with PTMC diagnosed by postoperative pathology. The incidence of the BRAFV600E mutation was calculated. The US features and clinicopathologic characteristics were compared between BRAF-positive and BRAF-negative patients. RESULTS The BRAFV600E mutation was detected in 60.3% of patients (70 of 116). Multifocality (OR: 3.681, P = 0.031), non-parallel orientation (OR: 3.181, P = 0.041) and lymph node metastasis (OR: 4.615, P = 0.009) were significantly associated with BRAFV600E mutation. Other US and clinicopathologic characteristics were not significantly related to the presence of BRAF mutation. CONCLUSION Multifocality, non-parallel orientation and cervical lymph node metastasis are risk factors for BRAFV600E mutation in PTMC. These factors potentially guide treatment planning or prognosis evaluation.
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Affiliation(s)
- Baoding Chen
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China.,Department of Pharmaceutics, School of Pharmacy and Center for Drug/Gene Delivery and Tissue Engineering, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zheng Zhang
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Keke Wang
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Mengyuan Shang
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Shuangshuang Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Wenbo Ding
- Department of Medical Ultrasound, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Rui Du
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhuan Yu
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Ximing Xu
- Department of Pharmaceutics, School of Pharmacy and Center for Drug/Gene Delivery and Tissue Engineering, Jiangsu University, Zhenjiang, Jiangsu, China
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Homogeneity Parameter in Contrast-Enhanced Ultrasound Imaging Improves the Classification of Abnormal Cervical Lymph Node after Thyroidectomy in Patients with Papillary Thyroid Carcinoma. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9296010. [PMID: 31886269 PMCID: PMC6899314 DOI: 10.1155/2019/9296010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/09/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
Abstract
Objective To explore the conventional and contrast-enhanced ultrasound (CEUS) features of cervical lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) patients postoperatively and analyze its pathological basis. Materials and Methods Conventional and CEUS were performed in 86 abnormal cervical lymph nodes (ACLNs) from 56 PTC patients who had received thyroidectomy. Then, fine-needle aspiration (FNA) was taken to confirm pathological results, a multivariate analysis was performed to correlate the sonographic features of the CLNM, and then an equation for CLNM was established. Results Fifty-four lymph nodes were confirmed to be metastasis of PTC by FNA. Intensity at peak time, homogeneity, and color flow patterns, cystic change, or microcalcification and echogenicity were significantly associated with CLNM. Multivariate analysis showed three strongest features (homogeneity, intensity of peak, and cystic change or calcification) to be significantly associated with the evidence of CLNM. Then, the equation was established with the following significant predictive factors: P = 1/1 + exp∑[−3.213 + 2.77 ∗ cystic or calcification + 0.13 ∗ CDFI patterns + 3.65 ∗ homogeneity + 2.43 ∗ intensity at peak time]. Conclusion Depiction of a heterogeneous hyperenhancement of cervical lymph nodes within CEUS studies and cystic change or microcalcification in conventional ultrasound were identified as predictive for metastatic lymph node invasion, and the equation was more accurate for predicting CLNM compared to single B-mode ultrasound and CEUS feature.
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Brebant V, Heine N, Lamby P, Heidekrueger PI, Forte A, Prantl L, Aung T. Augmented reality of indocyanine green fluorescence in simplified lymphovenous anastomosis in lymphatic surgery. Clin Hemorheol Microcirc 2019; 73:125-133. [DOI: 10.3233/ch-199220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- V. Brebant
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - N. Heine
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - P. Lamby
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - PI Heidekrueger
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - A.J. Forte
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - L. Prantl
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - T. Aung
- University Center of Plastic-, Aesthetic, Hand- and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
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