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Published in: BMC Cancer 1/2023

Open Access 01-12-2023 | Metastasis | Research

Clinical features and imaging examination assessment of cervical lymph nodes for thyroid carcinoma

Authors: Bei Wei, Jincao Yao, Chanjuan Peng, Shanshan Zhao, Hui Wang, Liping Wang, Xi Zhu, Yuting Kong, Liyu Chen, Dong Xu

Published in: BMC Cancer | Issue 1/2023

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Abstract

Backgrounds

The purpose of this study is to investigate the relationship between clinical characteristics and cervical lymph node metastasis (LNM) in patients with thyroid carcinoma, as well as estimate the preoperative diagnosis values of ultrasound (US) and contrast enhanced computed tomography (CECT) examinations on the neck for detection of cervical LNM in thyroid carcinoma.

Methods

A retrospective analysis of 3 026 patients with surgically proven thyroid carcinoma was conducted. Patients’ clinical characteristics, including gender, age, tumor size, bilateral lesions, multifocality, adenomatous nodules, Hashimoto’s thyroiditis (HT), and extrathyroidal extension, were collected to explore their association with cervical LNM in thyroid carcinoma. Preoperative assessments for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were conducted through US and CECT. The diagnostic value of US, CECT and US combined with CECT for detection of LNM located in various cervical compartments was estimated based on the pathological results.

Results

The risk of cervical LNM was higher in thyroid cancer patients who were male, age < 55 years old, tumor size > 10 mm, bilateral lesions, and extrathyroidal extension, while multifocality, adenomatous nodules and HT had no significant effect on LNM. US, CECT and US combined with CECT all had a higher sensitivity to LLNM (93.1%, 57.8%, 95.4%) than to CLNM (32.3%, 29.0%, 43.4%). US and CECT had a high specificity to both CLNM and LLNM (94.3–97.8%).

Conclusion

Preoperative clinical characteristics and imaging examinations on patients with thyroid carcinoma are crucial to the evaluation of cervical lymph nodes and conducive to individualizing surgical treatments by clinicians. US combined with CECT are superior to single US or CECT alone in detection of CLNM and LLNM.
Literature
1.
go back to reference Kim J, Gosnell JE, Roman SA. Geographic influences in the global rise of thyroid carcinoma. Nat Rev Endocrinol. 2020;16(1):17–29.CrossRefPubMed Kim J, Gosnell JE, Roman SA. Geographic influences in the global rise of thyroid carcinoma. Nat Rev Endocrinol. 2020;16(1):17–29.CrossRefPubMed
2.
go back to reference Lim H, Devesa SS, Sosa JA et al. Trends in thyroid carcinoma incidence and mortality in the United States, 1974–2013. JAMA, 2017, 317(13): 1338–48. Lim H, Devesa SS, Sosa JA et al. Trends in thyroid carcinoma incidence and mortality in the United States, 1974–2013. JAMA, 2017, 317(13): 1338–48.
3.
go back to reference Podnos YD, Smith D, Wagman LD, et al. The implication of lymph node Metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005;71(9):731–4.CrossRefPubMed Podnos YD, Smith D, Wagman LD, et al. The implication of lymph node Metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005;71(9):731–4.CrossRefPubMed
4.
go back to reference Kim SY, Kim BW, Pyo JY, et al. Macrometastasis in Papillary thyroid carcinoma patients is Associated with higher recurrence in lateral Neck nodes. World J Surg. 2018;42(1):123–9.CrossRefPubMed Kim SY, Kim BW, Pyo JY, et al. Macrometastasis in Papillary thyroid carcinoma patients is Associated with higher recurrence in lateral Neck nodes. World J Surg. 2018;42(1):123–9.CrossRefPubMed
5.
go back to reference Li J, Sun P, Huang T, et al. Preoperative prediction of central lymph node Metastasis in cN0T1/T2 papillary thyroid carcinoma: a nomogram based on clinical and ultrasound characteristics. Eur J Surg Oncol. 2022;48(6):1272–9.CrossRefPubMed Li J, Sun P, Huang T, et al. Preoperative prediction of central lymph node Metastasis in cN0T1/T2 papillary thyroid carcinoma: a nomogram based on clinical and ultrasound characteristics. Eur J Surg Oncol. 2022;48(6):1272–9.CrossRefPubMed
6.
go back to reference Liu C, Xiao C, Chen J, et al. Risk factor analysis for predicting cervical lymph node Metastasis in papillary thyroid carcinoma: a study of 966 patients. BMC Cancer. 2019;19(1):622.CrossRefPubMedPubMedCentral Liu C, Xiao C, Chen J, et al. Risk factor analysis for predicting cervical lymph node Metastasis in papillary thyroid carcinoma: a study of 966 patients. BMC Cancer. 2019;19(1):622.CrossRefPubMedPubMedCentral
7.
go back to reference Weng HY, Yan T, Qiu WW, et al. The prognosis of skip Metastasis in papillary thyroid microcarcinoma is Better Than that of continuous Metastasis. J Clin Endocrinol Metab. 2022;107(6):1589–98.CrossRefPubMed Weng HY, Yan T, Qiu WW, et al. The prognosis of skip Metastasis in papillary thyroid microcarcinoma is Better Than that of continuous Metastasis. J Clin Endocrinol Metab. 2022;107(6):1589–98.CrossRefPubMed
8.
go back to reference Teixeira G, Teixeira T, Gubert F, et al. The incidence of central neck micrometastatic Disease in patients with papillary thyroid carcinoma staged preoperatively and intraoperatively as N0. Surgery. 2011;150(6):1161–7.CrossRefPubMed Teixeira G, Teixeira T, Gubert F, et al. The incidence of central neck micrometastatic Disease in patients with papillary thyroid carcinoma staged preoperatively and intraoperatively as N0. Surgery. 2011;150(6):1161–7.CrossRefPubMed
9.
go back to reference Wang J, Sheng X, Dai Y, et al. The application value of the Central Lymph Node Metastasis Risk Assessment Model in Papillary thyroid Microcarcinoma of Stage cN0: a study of 828 patients. Front Endocrinol (Lausanne). 2022;13:843573.CrossRefPubMed Wang J, Sheng X, Dai Y, et al. The application value of the Central Lymph Node Metastasis Risk Assessment Model in Papillary thyroid Microcarcinoma of Stage cN0: a study of 828 patients. Front Endocrinol (Lausanne). 2022;13:843573.CrossRefPubMed
10.
go back to reference So YK, Kim MJ, Kim S, et al. Lateral lymph node Metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg. 2018;50:94–103.CrossRefPubMed So YK, Kim MJ, Kim S, et al. Lateral lymph node Metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg. 2018;50:94–103.CrossRefPubMed
11.
go back to reference Feng JW, Yang XH, Wu BQ, et al. Predictive factors for central lymph node and lateral cervical lymph node metastases in papillary thyroid carcinoma. Clin Transl Oncol. 2019;21(11):1482–91.CrossRefPubMed Feng JW, Yang XH, Wu BQ, et al. Predictive factors for central lymph node and lateral cervical lymph node metastases in papillary thyroid carcinoma. Clin Transl Oncol. 2019;21(11):1482–91.CrossRefPubMed
12.
go back to reference Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid carcinoma: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid carcinoma. Thyroid. 2016;26(1):1–133.CrossRefPubMedPubMedCentral Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid carcinoma: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid carcinoma. Thyroid. 2016;26(1):1–133.CrossRefPubMedPubMedCentral
13.
go back to reference Haugen BR. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid carcinoma: What is new and what has changed? Cancer, 2017, 123(3): 372–381. Haugen BR. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid carcinoma: What is new and what has changed? Cancer, 2017, 123(3): 372–381.
14.
go back to reference Tong Y, Zhang J, Wei Y, et al. 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(1):82.CrossRefPubMedPubMedCentral Tong Y, Zhang J, Wei Y, et al. 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(1):82.CrossRefPubMedPubMedCentral
15.
go back to reference Lee DW, Ji YB, Sung ES, et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol. 2013;39(2):191–6.CrossRefPubMed Lee DW, Ji YB, Sung ES, et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol. 2013;39(2):191–6.CrossRefPubMed
16.
go back to reference Ahn JE, Lee JH, Yi JS, et al. Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid carcinoma. World J Surg. 2008;32(7):1552–8.CrossRefPubMed Ahn JE, Lee JH, Yi JS, et al. Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid carcinoma. World J Surg. 2008;32(7):1552–8.CrossRefPubMed
17.
go back to reference Guidelines for the diagnosis. And treatment of thyroid nodules and differentiated thyroid carcinoma. Chin J Nuclear Med Mol Imaging, 2013(02): 96–115. Guidelines for the diagnosis. And treatment of thyroid nodules and differentiated thyroid carcinoma. Chin J Nuclear Med Mol Imaging, 2013(02): 96–115.
18.
go back to reference Kim SJ, Myong JP, Jee HG, et al. Combined effect of Hashimoto’s thyroiditis and BRAF(V600E) mutation status on aggressiveness in papillary thyroid carcinoma. Head Neck. 2016;38(1):95–101.CrossRefPubMed Kim SJ, Myong JP, Jee HG, et al. Combined effect of Hashimoto’s thyroiditis and BRAF(V600E) mutation status on aggressiveness in papillary thyroid carcinoma. Head Neck. 2016;38(1):95–101.CrossRefPubMed
19.
go back to reference Hanege FM, Tuysuz O, Celik S, et al. Hashimoto’s thyroiditis in papillary thyroid carcinoma: a 22-year study. Acta Otorhinolaryngol Ital. 2021;41(2):142–5.CrossRefPubMedPubMedCentral Hanege FM, Tuysuz O, Celik S, et al. Hashimoto’s thyroiditis in papillary thyroid carcinoma: a 22-year study. Acta Otorhinolaryngol Ital. 2021;41(2):142–5.CrossRefPubMedPubMedCentral
20.
go back to reference Chung YS, Kim JY, Bae JS, et al. Lateral lymph node Metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection. Thyroid. 2009;19(3):241–6.CrossRefPubMed Chung YS, Kim JY, Bae JS, et al. Lateral lymph node Metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection. Thyroid. 2009;19(3):241–6.CrossRefPubMed
21.
go back to reference Leboulleux S, Girard E, Rose M, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2007;92(9):3590–4.CrossRefPubMed Leboulleux S, Girard E, Rose M, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2007;92(9):3590–4.CrossRefPubMed
22.
go back to reference Choi JS, Kim J, Kwak JY, et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol. 2009;193(3):871–8.CrossRefPubMed Choi JS, Kim J, Kwak JY, et al. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol. 2009;193(3):871–8.CrossRefPubMed
23.
go back to reference Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer. 2006;106(3):524–31.CrossRefPubMed Lundgren CI, Hall P, Dickman PW, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer. 2006;106(3):524–31.CrossRefPubMed
24.
go back to reference Parameswaran R, Shulin Hu J, Min En N, et al. Patterns of Metastasis in follicular thyroid carcinoma and the difference between early and delayed presentation. Ann R Coll Surg Engl. 2017;99(2):151–4.CrossRefPubMedPubMedCentral Parameswaran R, Shulin Hu J, Min En N, et al. Patterns of Metastasis in follicular thyroid carcinoma and the difference between early and delayed presentation. Ann R Coll Surg Engl. 2017;99(2):151–4.CrossRefPubMedPubMedCentral
25.
go back to reference Oyer SL, Fritsch VA, Lentsch EJ. Comparison of survival rates between papillary and follicular thyroid carcinomas among 36,725 patients. Ann Otol Rhinol Laryngol. 2014;123(2):94–100.CrossRefPubMed Oyer SL, Fritsch VA, Lentsch EJ. Comparison of survival rates between papillary and follicular thyroid carcinomas among 36,725 patients. Ann Otol Rhinol Laryngol. 2014;123(2):94–100.CrossRefPubMed
26.
go back to reference Stamatakos M, Paraskeva P, Katsaronis P, et al. Surgical approach to the management of medullary thyroid carcinoma: when is lymph node dissection needed? Oncology. 2013;84(6):350–5.CrossRefPubMed Stamatakos M, Paraskeva P, Katsaronis P, et al. Surgical approach to the management of medullary thyroid carcinoma: when is lymph node dissection needed? Oncology. 2013;84(6):350–5.CrossRefPubMed
27.
go back to reference Zhu Q, Shao Z, Zhang X, et al. Correlation between Ultrasonic Features of Medullary Thyroid Carcinoma and cervical lymph node Metastasis. Ultrasound Med Biol. 2021;47(4):967–72.CrossRefPubMed Zhu Q, Shao Z, Zhang X, et al. Correlation between Ultrasonic Features of Medullary Thyroid Carcinoma and cervical lymph node Metastasis. Ultrasound Med Biol. 2021;47(4):967–72.CrossRefPubMed
28.
go back to reference Zhang H, Zhao YC, Wu Q, et al. The prognostic value of lymph node Metastasis and the eighth edition of AJCC for patients with anaplastic thyroid carcinoma. Clin Endocrinol (Oxf). 2021;95(3):498–507.CrossRefPubMed Zhang H, Zhao YC, Wu Q, et al. The prognostic value of lymph node Metastasis and the eighth edition of AJCC for patients with anaplastic thyroid carcinoma. Clin Endocrinol (Oxf). 2021;95(3):498–507.CrossRefPubMed
29.
go back to reference Mao J, Zhang Q, Zhang H, et al. Risk factors for Lymph Node Metastasis in Papillary thyroid carcinoma: a systematic review and Meta-analysis. Front Endocrinol (Lausanne). 2020;11:265.CrossRefPubMed Mao J, Zhang Q, Zhang H, et al. Risk factors for Lymph Node Metastasis in Papillary thyroid carcinoma: a systematic review and Meta-analysis. Front Endocrinol (Lausanne). 2020;11:265.CrossRefPubMed
30.
go back to reference Song E, Jeon MJ, Park S, et al. Influence of coexistent Hashimoto’s thyroiditis on the extent of cervical lymph node dissection and prognosis in papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2018;88(1):123–8.CrossRefPubMed Song E, Jeon MJ, Park S, et al. Influence of coexistent Hashimoto’s thyroiditis on the extent of cervical lymph node dissection and prognosis in papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2018;88(1):123–8.CrossRefPubMed
31.
32.
go back to reference Ma H, Li L, Li K, et al. Hashimoto’s thyroiditis, nodular goiter or follicular adenoma combined with papillary thyroid carcinoma play protective role in patients. Neoplasma. 2018;65(3):436–40.CrossRefPubMed Ma H, Li L, Li K, et al. Hashimoto’s thyroiditis, nodular goiter or follicular adenoma combined with papillary thyroid carcinoma play protective role in patients. Neoplasma. 2018;65(3):436–40.CrossRefPubMed
33.
go back to reference Sitges-Serra A, Gallego-Otaegui L, Suárez S, et al. Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma. Surgery. 2017;161(3):712–9.CrossRefPubMed Sitges-Serra A, Gallego-Otaegui L, Suárez S, et al. Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma. Surgery. 2017;161(3):712–9.CrossRefPubMed
34.
go back to reference Jin SH, Kim IS, Ji YB, et al. Efficacy of prophylactic central neck dissection in hemithyroidectomy for papillary thyroid carcinoma. Eur Arch Otorhinolaryngol. 2020;277(3):873–9.CrossRefPubMed Jin SH, Kim IS, Ji YB, et al. Efficacy of prophylactic central neck dissection in hemithyroidectomy for papillary thyroid carcinoma. Eur Arch Otorhinolaryngol. 2020;277(3):873–9.CrossRefPubMed
35.
go back to reference Wang Y, Deng C, Shu X, et al. Risk factors and a prediction model of lateral lymph node Metastasis in CN0 papillary thyroid carcinoma patients with 1–2 Central Lymph Node metastases. Front Endocrinol (Lausanne). 2021;12:716728.CrossRefPubMed Wang Y, Deng C, Shu X, et al. Risk factors and a prediction model of lateral lymph node Metastasis in CN0 papillary thyroid carcinoma patients with 1–2 Central Lymph Node metastases. Front Endocrinol (Lausanne). 2021;12:716728.CrossRefPubMed
36.
go back to reference Jerkovich F, Abelleira E, Bueno F, et al. Active surveillance of small metastatic lymph nodes as an alternative to Surgery in selected patients with low-risk papillary thyroid Cancer: a retrospective cohort study. Thyroid. 2022;32(10):1178–83.PubMed Jerkovich F, Abelleira E, Bueno F, et al. Active surveillance of small metastatic lymph nodes as an alternative to Surgery in selected patients with low-risk papillary thyroid Cancer: a retrospective cohort study. Thyroid. 2022;32(10):1178–83.PubMed
37.
go back to reference Yeh MW, Bauer AJ, Bernet VA, et al. American Thyroid Association statement on preoperative imaging for thyroid cancer Surgery. Thyroid. 2015;25(1):3–14.CrossRefPubMedPubMedCentral Yeh MW, Bauer AJ, Bernet VA, et al. American Thyroid Association statement on preoperative imaging for thyroid cancer Surgery. Thyroid. 2015;25(1):3–14.CrossRefPubMedPubMedCentral
38.
go back to reference Padovani RP, Kasamatsu TS, Nakabashi CC, et al. One month is sufficient for urinary iodine to return to its baseline value after the use of water-soluble iodinated contrast agents in post-thyroidectomy patients requiring radioiodine therapy. Thyroid. 2012;22(9):926–30.CrossRefPubMedPubMedCentral Padovani RP, Kasamatsu TS, Nakabashi CC, et al. One month is sufficient for urinary iodine to return to its baseline value after the use of water-soluble iodinated contrast agents in post-thyroidectomy patients requiring radioiodine therapy. Thyroid. 2012;22(9):926–30.CrossRefPubMedPubMedCentral
39.
go back to reference Morita S, Mizoguchi K, Suzuki M, et al. The accuracy of (18)[F]-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node Metastasis in patients with papillary thyroid carcinoma. World J Surg. 2010;34(11):2564–9.CrossRefPubMed Morita S, Mizoguchi K, Suzuki M, et al. The accuracy of (18)[F]-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node Metastasis in patients with papillary thyroid carcinoma. World J Surg. 2010;34(11):2564–9.CrossRefPubMed
40.
go back to reference Choi YJ, Yun JS, Kook SH, et al. Clinical and imaging assessment of cervical lymph node Metastasis in papillary thyroid carcinomas. World J Surg. 2010;34(7):1494–9.CrossRefPubMed Choi YJ, Yun JS, Kook SH, et al. Clinical and imaging assessment of cervical lymph node Metastasis in papillary thyroid carcinomas. World J Surg. 2010;34(7):1494–9.CrossRefPubMed
41.
go back to reference Jeong HS, Baek CH, Son YI, et al. Integrated 18F-FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT. Clin Endocrinol (Oxf). 2006;65(3):402–7.CrossRefPubMed Jeong HS, Baek CH, Son YI, et al. Integrated 18F-FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT. Clin Endocrinol (Oxf). 2006;65(3):402–7.CrossRefPubMed
42.
go back to reference Zhao H, Li H. Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid carcinoma: diagnosis of central and lateral compartment nodal metastases. Eur J Radiol. 2019;112:14–21.CrossRefPubMed Zhao H, Li H. Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid carcinoma: diagnosis of central and lateral compartment nodal metastases. Eur J Radiol. 2019;112:14–21.CrossRefPubMed
43.
go back to reference Nixon IJ, Wang LY, Palmer FL, et al. The impact of nodal status on outcome in older patients with papillary thyroid carcinoma. Surgery. 2014;156(1):137–46.CrossRefPubMed Nixon IJ, Wang LY, Palmer FL, et al. The impact of nodal status on outcome in older patients with papillary thyroid carcinoma. Surgery. 2014;156(1):137–46.CrossRefPubMed
Metadata
Title
Clinical features and imaging examination assessment of cervical lymph nodes for thyroid carcinoma
Authors
Bei Wei
Jincao Yao
Chanjuan Peng
Shanshan Zhao
Hui Wang
Liping Wang
Xi Zhu
Yuting Kong
Liyu Chen
Dong Xu
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-023-11721-5

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