DETERMINATION OF ULTRASOUND SIGNS OF PAPILLAR THYROID CANCER AS PREDICTORS OF LOCAL METASTASIS
Keywords:Papillary thyroid cancer, risk factors, metastases, prognostic factor
Background. To improve the prognosis of local metastasis of papillary thyroid cancer, it is important to identify preoperative ultrasound signs of the tumor as predictors of metastasis. The purpose of the work is to determine the ultrasound signs of papillary thyroid cancer that can be predictors of local metastasis.
Materials and methods. A retrospective cohort monocentral study was conducted. 301 patients operated on for papillary thyroid cancer with low risk of recurrence in volumes: thyroidectomy or hemithyroidectomy, central lymph node dissection between January 2018 and December 2020. The main group: 117 patients with metastases according to the results of histopathological examination. Control group: 184 patients without metastases. The following ultrasound features of the tumor were taken into account: subcapsular location; size; uneven borders; blurring of boundaries; fibrous changes; the presence of calcification; the presence of cystic degeneration, heterogeneous echostructure. Statistical analysis was performed using StatPlus Pro v.7 (AnalystSoft Inc.) and statistical calculators VassarStats (VassarStats: Web Site for Statistical Computation, http://vassarstats.net/) and MedCalc (MedCalc Software Ltd., https:// www.medcalc.org/calc/index.php). The comparison of particles was performed using Fisher's angular transformation. The chi-square test with Yates' correction and Kramer's V test were used to calculate the significance of individual tests, association strength, odds ratios, and corresponding operational characteristics; the confidence interval was determined by Wilk's method. ROC analysis was performed with determination of the area under the ROC curve with appropriate confidence intervals.
Results. Such ultrasound signs of papillary thyroid cancer as subcapsular location and the presence of calcifications are related to the presence of regional metastases (p<0.01). In addition to the listed signs, a significant difference in the frequency of occurrence was also found for the ultrasound sign "blurred boundaries" (p<0.05). Such signs as "unevenness of borders", "cyst-like degeneration", "fibrosis changes" and "heterogeneous echostructure" of the tumor according to the ultrasound examination are not related to regional metastasis of papillary thyroid cancer. A relationship between the size of the tumor and the presence of metastases of papillary thyroid cancer was also revealed. In order to test the hypothesis that there is a relationship between the size and the detection of metastases, ROC analysis was performed. Results confirm the existence of such a connection. The value of the area under the curve (AUC), determined by the DeLong method, is 0.740 (95% CI: 0.684 - 0.795), which corresponds to the average quality of the test. Coefficient Youden is 0.4051. When choosing a cut-off point ≥ 10 mm, the sensitivity of the test is 0.829 (or 82.9%) and the specificity is 0.576 (57.6%).
Conclusions. Calcification, subcapsular location, indistinct contours, and tumor size greater than 1.0 cm can be independent predictors of metastasis of papillary thyroid cancer. Uneven contours, cyst-like degeneration, fibrous changes, heterogeneity of the echostructure of the tumor cannot be predictors of metastasis.
Zhang Y, Luo YK, Zhang MB, et al. Sci Rep 2017;7(1): 6670. http//doi.org/10.1038/s41598-017-07118-7.
Jiang Lh, Yin K, Wen Ql, et al. Sci Rep 2020;10(710). http//doi.org/10.1038/s41598-019-55991-1
Gao X, Luo W, He L, et al. Front Endocrinol (Lausanne) 2022;12: 789310. http//doi.org/10.3389/fendo.2021.789310.
Li F, Pan D, He Y, et al. BMC Surg 2020;20(1): 315. http//doi.org/10.1186/s12893-020-00974-7.
Liu T, Zhou S, Yu J, et al. Technol Cancer Res Treat 2019;18: 1533033819831713. http//doi.org/10.1177/1533033819831713.
Qu H, Sun GR, Liu Y, He QS. Clin Endocrinol (Oxf) 2015;83(1): 124-132. http//doi.org/10.1111/cen.12583.
Zhang L, Ling Y, Zhao Y, et al. Front Surg 2021;8: 742328. http//doi.org/ 10.3389/fsurg.2021.742328.
Xia E, Chi Y, Jin L, et al. Am J Transl Res 2021;13(7): 7695-7704.
Liu LS, Liang J, Li JH, et al. Eur Arch Otorhinolaryngol 2017;274(3): 1327-1338. http//doi.org/10.1007/s00405-016-4302-0.
Wang Y, Nie F, Wang G, et al. Cancer Manag Res 2021;13: 3403-3415. http//doi.org/ 10.2147/CMAR.S299157.
Tovkai O, Palamarchuk V, Lishchynskyi P. Klinichna endokrynologija ta endokrynna hirurgija 2020;71(3): 7-15. https://doi.org/10.30978/CEES-2020-3-7
Zhao H, Li H. Eur J Radiol 2019;112: 14-21. http//doi.org/10.1016/j.ejrad.2019.01.006.
Feng JW, Yang XH, Wu BQ, et al. Clin Transl Oncol 2019;21(11): 1482-1491. http//doi.org/10.1007/s12094-019-02076-0.