The role of ACRTIRADS category in predicting cervical lymph node metastasis
#br# FAN Xing1, ZHENG Kun1, CHEN Wenying2, GU Jun2
(1. Department of Ultrasound Medicine, Suzhou Science and Technology City Hospital Affiliated to Nanjing Medical University, Suzhou Jiangsu 215163; 2. Department of Ultrasound Medicine, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Jiangsu 215000,China)
Abstract:[Abstract]Objective: To investigate the value of ACR TIRADS categories in predicting cervical lymph node metastasis in thyroid papillary carcinoma (PTC)patients with Hashimoto′s thyroiditis(HT). Methods: A retrospective analysis was performed in 271 PTC patients with HT. They were divided into metastasis group and nonmetastasis group according to the presence or absence of cervical lymph node metastasis. The differences of preoperative ultrasonography between the two groups were compared, then Kwak TIRADS and ACR TIRADS categories were graded according to the ultrasonography features. Binary logistic regression analysis was performed to determine the independent predictors of cervical lymph node metastasis. The ROC curve was drawn to evaluate the diagnostic efficiency of each factor. Results: Age, sex, maximum diameter, aspect ratio, and ACR TIRADS score were correlated with cervical lymph node metastasis in PTC patients with HT (all P<0.05). Binary logistic regression analysis showed that maximum diameter, ACR TIRADS score and aspect ratio>1 were independent factors for predicting cervical lymph node metastasis(OR=1.169,1.392,2.765, all P<0.05). The area under ROC curve (AUC) of the combined prediction model was 0.887 (95% CI: 0.849-0.925), the sensitivity and specificity were 86.2% and 75.0%, respectively. Conclusion:ACR TIRADS score is the independent predictor of cervical lymph node metastasis in PTC patients with HT. The combined prediction model can provide some imaging references for clinical treatment.
[1]Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J]. Thyroid, 2016, 26(1): 1-133.
[2]陈宝定,赵双双,陈延玮,等.未分化甲状腺癌分子机制和治疗进展[J].江苏大学学报(医学版), 2021, 31(2): 93-100.
[3]Sturgeon C, Yang A, Elaraj D. Surgical management of lymph node compartments in papillary thyroid cancer[J]. Surg Oncol Clin N Am, 2016, 25(1): 17-40.
[4]中华医学会超声医学分会浅表器官和血管学组,中国甲状腺与乳腺超声人工智能联盟. 2020甲状腺结节超声恶性危险分层中国指南:CTIRADS[J].中华超声影像学杂志, 2021, 30(3): 185-200.
[5]Battistella E, Pomba L, Costantini A, et al. Hashimoto′s thyroiditis and papillary cancer thyroid coexistence exerts a protective effect: a single centre experience[J]. Indian J Surg Oncol, 2022, 13(1): 164-168.
[6]董华,张遵城,郭永涛,等.甲状腺结节合并桥本氏甲状腺炎与甲状腺癌风险关系的临床研究[J].中华内分泌外科杂志, 2018, 12(3): 244-246.
[7]毛森,赵鲁平,李小花,等. 2020中国超声甲状腺影像报告和数据系统在甲状腺结节鉴别诊断中的应用价值[J].中华医学杂志, 2021, 101(45): 3748-3753.
[8]Huh S, Yoon JH, Lee HS, et al. Comparison of diagnostic performance of the ACR and Kwak TIRADS applying the ACR TIRADS′ size thresholds for FNA[J]. Eur Radiol, 2021, 31(7): 5243-5250.
[9]Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk[J]. Radiology, 2011, 260(3): 892-899.
[10]Tessler FN, Middleton WD, Grant EG, et al. ACR thyroid imaging, reporting and data system (TIRADS): White paper of the ACR TIRADS committee[J]. Am Coll Radiol, 2017, 14(5): 587-595.
[11]Cabanillas ME,McFadden DG, Durante C. Thyroid cancer[J]. Lancet, 2016, 388(10061): 2783-2795.
[12]Callender GG, Carling T, ChristisonLagay E, et al. Surgery for thyroid cancer[J]. Endocrinol Metab Clin North Am, 2014, 43(2): 443-458.
[13]Chen BD, Zhang Z, Wang KK, et al. A multivariable model of BRAFV600E and ultrasonographic features for predicting the risk of central lymph node metastasis in cN0 papillary thyroid microcarcinoma[J]. Cancer Manag Res, 2019, 11: 7211-7217.
[14]Shaha AR. Central lymph node metastasis in papillary thyroid carcinoma[J]. World J Surg, 2018, 42(3): 630-631.
[15]Ragusa F, Fallahi P, Elia G, et al. Hashimotos′ thyroiditis: Epidemiology, pathogenesis,clinic and therapy[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(6): 10136-10137.
[16]FeldtRasmussen U. Hashimoto′s thyroiditis as a risk factor for thyroid cancer[J]. Curr Opin Endocrinol Diabetes Obes, 2020, 27(5): 364-371.
[17]Marotta V, Sciammarella C, Chiofalo MG, et al. Hashimoto′s thyroiditis predicts outcome in intrathyroidal papillary thyroid cancer[J]. Endocr Relat Cancer, 2017, 24(9): 485-493.
[18]Jin K, Li L, Liu Y, The characteristics and risk factors of central compartment lymph node metastasis in cN0 papillary thyroid carcinoma coexistent with Hashimoto′s thyroiditis[J]. Gland Surg, 2020, 9(6): 2026-2034.
[19]陈可悦,吕国荣,沈浩霖,等.基于ACR TIRADS评分构建甲状腺乳头状癌颈中央区淋巴结转移风险预测模型及其诊断效能评估[J].临床耳鼻咽喉头颈外科杂志, 2021, 35(9): 773-778.
[20]Xia E, Chi Y, Jin L, et al. Preoperative prediction of lymph node metastasis in patients with papillary thyroid carcinoma by an artificial intelligence algorithm[J]. Am J Transl Res, 2021, 13(7): 7695-7704.
[21]Kang SY, Ahn HR, Youn HJ, et al. Prognosis of papillary thyroid carcinoma in relation to preoperative subclinical hypothyroidism[J]. Ann R Coll Surg Engl, 2021, 103(5): 367-373.