Value of conventional ultrasound signs and shear-wave elastography in predicting the risk of cervical lymph node metastasis with capsular invasion of thyroid papillary carcinoma
Objective To investigate the value of conventional ultrasound signs and shear-wave elastography elastic ratio(SWE-ER)in predicting the risk of cervical lymph node metastasis(CLNM)in papillary thyroid carcinoma(PTC)invasion.Methods Eighty-seven patients with PTC confirmed by postoperative pathology from June 2022 to March 2024 in Baoji People's Hospital were collected,including 93 cancer nodules.The patients were divided into CLNM group and non-CLNM group according to postoperative pathology.The characteristics of conventional ultrasound images of the relationship between thyroid cancer nodules and the capsule(the contact between cancer nodules and the capsule,the continuity of the capsule,and the invasion range of the capsule)and the SWE-ER value were retrospectively analyzed.ROC curves of the relationship between SWE-ER,nodules and the capsule at different thresholds were drawn by pathological diagnosis as the gold standard,and the value of predicting the risk of cervical lymph node metastasis at different thresholds was compared.Independent risk factors for CLNM were calculated by binary Logistic regression equation.Results The average meridian of cancer nodules in CLNM group was higher than that in non-CLNM group(P＜0.05).Compared with non-CLNM,there were statistically significant differences in capsule contact,capsule continuity and capsule invasion area in the perituberous length of cancer in CLNM group(P＜0.001).The mean value of SWE-ER in the CLNM group was lower than that in the non-CLNM group(P＜0.05).Using pathology as the gold standard,ROC curves were developed to assess the risk of CLNM under different cut-off values.The area under the ROC curve with the capsule invasion occupying 1/4 of the circumference of cancer nodules as cut-off value was 0.756(95%CI:0.652-0.859),indicating the highest diagnostic efficiency.Multivariate analysis by binary Logistic regression showed that thyroid capsule interruption,capsule invasion in 1/4-1/2 of the circumference of cancer nodule,capsule invasion in≥1/2 of the circumference of cancer nodule were independent risk factors for CLNM(P＜0.05).The contact between SWE-ER and the capsule of cancer nodules was not an independent risk factor for CLNM of PTC(P＞0.05).Conclusion The relationship between thyroid cancer nodule and capsule,especially the invasion range of thyroid cancer nodule capsule has high diagnostic value in ultrasonic prediction of CLNM.The involvement of the capsule in 1/4-1/2 of the circumference of cancer nodule,and the involvement of the capsule in≥1/2 of the circumference of cancer nodule were independent risk factors for CLNM,while SWE-ER and whether cancer nodule contacted with the capsule were not independent risk factors for CLNM in PTC.
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