Suspicious Ultrasound Characteristics Correlate with Multiple Factors that Predict Central Lymph Node Metastasis of Papillary Thyroid Carcinoma: Significant Role of HBME-1

  • Objective: Papillary thyroid carcinoma (PTC) is frequently associated with central lymph node metastasis (CLNM). Here we aimed to identify possible risk factors, including suspicious ultrasound (US) features coexisting with thyroid diseases, including immunohistochemical markers and BRAFV600E. These were used to establish a model to predict the risk of CLNM.

    Methods: From January 2016 to March 2018, we identified a cohort of patients with classic PTC who underwent cervical US and were diagnosed by postoperative pathology. Fine-needle aspiration biopsies were analyzed for the presence of BRAFV600E, and immunohistochemistry was used to detect tumor markers. US imaging was performed in accordance with a standardized protocol. A model to determine the risk of CLNM was established using the outcomes of univariate and multivariate analyses.

    Results: Age ?45 years, male sex, mean tumor diameter ?1.0 cm, taller-than-wide tumor shape, multiple PTCs, capsule contact, and HBME-1 expression were significant independent risk predictors of CLNM. Hashimoto’s thyroiditis, nodular goiter, and BRAFV600E were not significantly associated with CLNM. The cutoff value (area under the curve = 0.760) for predicting risk was determined from receiver operating characteristic curves (sensitivity, 75.6%; specificity, 60.7%).

    Conclusions: Male sex, age ?45 years, mean tumor diameter ?1.0 cm, taller-than-wide shape, multiple tumors, capsule contact, and HBME-1 expression were independent predictors of the risk of CLNM of patients with PTC. The risk model may be useful for evaluating patients’ prognoses and selection of the optimal surgical strategy.

 

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