Prediction of cervical lymph node metastasis with contrast-enhanced ultrasound and association between presence of BRAFV600E and extrathyroidal extension in papillary thyroid carcinoma

Jia Zhan; Long-Hui Zhang; Qing Yu; Chao-Lun Li; Yue Chen; Wen-Ping Wang; Hong Ding

doi:10.1177/1758835920942367

Prediction of cervical lymph node metastasis with contrast-enhanced ultrasound and association between presence of BRAF^V600E and extrathyroidal extension in papillary thyroid carcinoma

Ther Adv Med Oncol. 2020 Aug 6:12:1758835920942367. doi: 10.1177/1758835920942367. eCollection 2020.

Authors

Jia Zhan¹, Long-Hui Zhang², Qing Yu², Chao-Lun Li², Yue Chen¹, Wen-Ping Wang², Hong Ding³

Affiliations

¹ Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai P.R. China.
² Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.
³ Department of Ultrasound, Zhongshan Hospital, Fudan University, Fenglin Road No.180, Shanghai, 200032, P.R. China.

Abstract

Objective: This study aimed to evaluate the correlation between cervical lymph node metastasis (CLNM) and each of the ultrasound features, immunohistochemical factors, and B-type Raf (BRAF^V600E) mutation.

Methods: A retrospective analysis was performed on 405 patients with single papillary thyroid carcinoma (PTC) nodules, all of whom underwent preoperative sonographic examinations, including gray-scale ultrasound, color Doppler ultrasound, and contrast-enhanced ultrasound (CEUS). All PTC patients were evaluated using 14 clinical and sonographic features, eight immunohistochemical factors, and BRAF^V600E. Multivariate analyses were performed to identify the risk factors for CLNM, and an equation for CLNM was established. The diagnostic value of each modality was compared with a receiver operating characteristic (ROC) curve.

Results: Among the 405 PTC nodules removed surgically, CLNM was confirmed in 138 patients, whereas extrathyroidal extension was confirmed in 185 patients. Multivariate analyses indicated significant differences between CLNM and non-CLNM groups in three conventional ultrasound features (p < 0.05), whereas other sonographic features, eight immunohistochemical factors, and BRAF^V600E did not indicate significant differences. A ROC curve of 0.757 in the equation exhibited a significant difference compared with the solo factors (p < 0.05 for all). Hyper or isoechoic enhancement at peak time on CEUS was associated with CLNM, whereas the presence of the BRAF^V600E mutation was associated with extrathyroidal extensions although BRAF appeared to be uncorrelated with CLNM in the present study.

Conclusion: Intensity at peak time, homogeneity, and size are the three most significant features in predicting CLNM in PTC patients, and the presence of the BRAF^V600E mutation was associated with extrathyroidal extensions when PTCs showed a hyper or isoechoic enhancement at peak time in CEUS.

Keywords: BRAF gene; contrast-enhanced ultrasound; extrathyroidal extension; lymph node metastasis; papillary thyroid carcinoma.