Ultrasonography for the Prediction of High-Volume Lymph Node Metastases in Papillary Thyroid Carcinoma: Should Surgeons
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ORIGINAL SCIENTIFIC REPORT
Ultrasonography for the Prediction of High-Volume Lymph Node Metastases in Papillary Thyroid Carcinoma: Should Surgeons Believe Ultrasound Results? Chunhao Liu1 • Lei Zhang2 • Yuewu Liu1 • Yu Xia3 • Yue Cao1 • Ziwen Liu1 • Ge Chen1 Ning Liu4 • Zhonghua Shang5 • Jinbao Yang6 • Qinghe Sun7 • Xiaoyi Li1
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Accepted: 9 August 2020 Ó The Author(s) 2020
Abstract Background Lymph node metastasis (LNM) often occurs in papillary thyroid carcinoma (PTC); the efficacy of ultrasound for predicting high-volume lymph node metastases (LNMs) in patients with PTC remains unexplored. Methods The medical records of 2073 consecutive PTC patients were reviewed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate the efficacy of ultrasound. Risk factors for LNM/high-volume LNMs and lymph node involvement on ultrasound (usLNM) were identified by univariate and multivariate analyses. Results Of all the patients, 936 (45.2%) patients had LNMs, and 254 (12.3%) patients had high-volume LNMs. The sensitivity of ultrasound for detecting LNM/high-volume LNMs was 27.9% and 63.8%, respectively; the specificity was 93.1% and 90.3%, respectively. The NPV for ultrasound in detecting high-volume LNMs was 94.7%. In multivariate analysis, male sex (OR = 2.108, p \ 0.001), tumor diameter [ 1.0 cm (OR = 2.304, p \ 0.001) and usLNM (?) (OR = 12.553, p \ 0.001) were independent clinical risk factors for high-volume LNMs. Tumor diameter [ 1 cm (OR = 3.036, p \ 0.001) and male sex (OR = 1.642, p \ 0.001) were independent clinical risk factors for usLNM; a skilled sonographer (OR = 1.121, p = 0.358) was not significantly associated with usLNM. Conclusions Lymph node involvement found by ultrasound has great predictive value for high-volume LNMs; the NPV is very high for patients without lymph node involvement on ultrasound. The ultrasound results do not appear to be influenced by the experience of the sonographer.
Chunhao Liu and Lei Zhang have contributed equally.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05755-0) contains supplementary material, which is available to authorized users. & Xiaoyi Li [email protected] 1
2
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing 100730, China Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
3
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
4
McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
5
Department of General Surgery, Sec
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