Original Contribution
Correlation between Ultrasonic Features of Medullary Thyroid Carcinoma and Cervical Lymph Node Metastasis

https://doi.org/10.1016/j.ultrasmedbio.2020.12.023Get rights and content

Abstract

The aim of this study was to investigate the factors that affect cervical lymph node metastasis (CLNM) in individuals with medullary thyroid carcinoma (MTC) in terms of ultrasonic characteristics and other parameters. Single-factor χ2 analysis showed that the ultrasonic characteristics of tumor size >10 mm, unclear boundary, irregular pattern and capsular invasion, as well as pre-operative calcitonin level >302.50 pg/mL (p < 0.001) and age ≤52.50 y (p = 0.036), were risk factors for CLNM in individuals with MTC. Multivariate logistic regression analysis showed that age ≤52.50 y (odds ratio = 3.796; 95% confidence interval, 1.010–14.259; p = 0.048), irregular pattern (odds ratio = 5.262; 95% confidence interval, 1.200–23.084; p = 0.028) and tumor size >10 mm (odds ratio = 7.789; 95% confidence interval, 1.123–54.005; p = 0.038) were independent risk factors for CLNM in individuals with MTC. Individuals with MTC aged ≤52.50 y with an irregular pattern and tumor size >10 mm were more likely to develop CLNM. In addition, those with a pre-operative calcitonin level >302.50 pg/mL were more likely to have CLNM.

Introduction

Medullary thyroid carcinoma (MTC) is a moderate malignant tumor derived from parafollicular cells; its incidence is only 1%–2% of all thyroid carcinomas (Wells et al. 2015). Individuals with MTC are prone to developing cervical lymph node metastasis (CLNM), the incidence of which can reach 70% (Stamatakos et al. 2013). CLNM can affect the prognosis of individuals with MTC (Momin et al. 2017). Whether prophylactic neck lymph node dissection should be performed in individuals with MTC, and the extent of lymph node dissection, is still controversial (Dralle and Machens 2013; Stamatakos et al. 2013; Haugen et al. 2015; Mitchell et al. 2016); therefore, pre-operative judgment of cervical lymph nodes is particularly important. At present, ultrasonography is the first choice for diagnosing thyroid disease. However, the sensitivity of ultrasound in identifying metastatic neck lymph nodes of MTC is relatively low (only 43%; Brammen et al. 2018). Therefore, this study attempted to determine the factors that affect CLNM in MTC based on the ultrasonic characteristics of the MTC primary tumor and the clinical data of patients.

Section snippets

Clinical data

A total of 85 individuals with MTC admitted to the hospital from April 2009 to October 2018 were retrospectively analyzed. All underwent thyroidectomy and cervical lymph node dissection, and MTC was confirmed by post-operative pathology. Thirty-seven underwent only central area lymph node dissection, 32 underwent central area + unilateral lymph node dissection and 16 underwent central area + bilateral lymph node dissection. Participants were divided into the CLNM group (n = 57, 67.06%) and the

General information

Eighty-five participants with MTC were included in this study: 46 male (54.12%) and 39 female (45.88%), aged 8–77 y, with an average age of 50.11 ± 13.34 y. Twenty-eight had no CLNM (32.94%) and 57 had CLNM (67.06%), 17 cases of which were metastatic in the central area, five in the lateral neck area and 35 in both the central and lateral neck areas. Age (continuous variable) and lymph node metastasis (binary variable) were analyzed by the receiver operating characteristic curve, and the best

Discussion and Summary

MTC is a moderate malignant tumor derived from thyroid parafollicular cells, has a low incidence and accounts for a very small proportion of thyroid cancer. Its biological characteristics and malignancy are different from those of other types of thyroid cancer, which are derived from thyroid follicular cells. People with MTC are prone (70%) to CLNM (Stamatakos et al. 2013). In this study, all 85 participants underwent central area lymph node dissection: 37 underwent only central area lymph node

Acknowledgments

This work was supported by the National Natural Science Foundation of China (81871370, 82071946) and the Natural Science Foundation of Zhejiang Province (LSD19 H180001).

Conflict of interest disclosure

The authors declare no competing interests.

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Qiaodan Zhu and Zhiying Shao contributed equally to this manuscript.

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