scholarly journals Diagnostic Model Incorporating Clinicopathological Characteristics of Delphian Lymph Node Metastasis Risk Profiles in Papillary Thyroid Cancer

2021 ◽  
Vol 12 ◽  
Author(s):  
Xingchen Li ◽  
Yuansheng Duan ◽  
Dandan Liu ◽  
Hongwei Liu ◽  
Mengqian Zhou ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Diagnostic Model ◽  
Papillary Thyroid ◽  
Central Lymph Node ◽  
Node Metastasis ◽  
Central Lymph

The Delphian lymph node (DLN), also known as the prelaryngeal node, is one component of the central lymph node. The DLN has been well studied in laryngeal cancer, although its significance in papillary thyroid cancer (PTC) remains unclear. We retrospectively analyzed 936 patients with PTC who underwent thyroidectomy by a single surgeon in Tianjin Cancer Hospital from 2017 to 2019. Moreover, 250 PTC patients who underwent thyroidectomy by another surgeon in Tianjin Cancer Hospital from January 2019 to April 2019 were used as a validation cohort. Among the 936 patients with PTC, 581 patients (62.1%) had DLNs, of which 177 samples with metastasis (177/581, 30.5%) were verified. DLN metastasis was significantly correlated with sex, age, tumor size, bilateral cancer, multifocality, extrathyroidal extension, lymphovascular invasion and central and lateral neck lymph node metastasis. Multivariate analysis revealed that independent risk factors for DLN metastasis included age, gender, tumor size, extrathyroid extension, lymphovascular invasion and central lymph node metastasis, which determined the nomogram. In particular, tumor size was proven to be one of the most predominant single predictors. The diagnostic model had an area under the curve (AUC) of 0.829 (95% confidence interval, 0.804–0.854). The internal and external validations of the nomogram were 0.819 and 0.745, respectively. Our results demonstrate that DLN metastasis appears to be a critical parameter for predicting metastatic disease of the central compartments. Furthermore, this study provides a precise criterion for assessing DLN metastasis and has great clinical significance for treating PTC.

Diagnostic model incorporating clinicopathological characteristics of Delphian lymph node metastasis risk profiles in papillary thyroid cancer

2020 ◽  
Author(s):  
Xingchen Li ◽  
Yuansheng Duan ◽  
Dandan Liu ◽  
Hongwei Liu ◽  
Mengqian Zhou ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
External Validation ◽  
Diagnostic Model ◽  
Extrathyroid Extension ◽  
Central Lymph Node ◽  
Node Metastasis ◽  
Central Lymph

Abstract Background Delphian lymph node (DLN), also known as prelaryngeal node, is the component of central lymph node (Level VI). DLN has been well studied in laryngeal cancer while less in papillary thyroid cancer (PTC). However, increasing attention has been payed to its clinical value in PTC lymph node metastasis. The aim of this study was to assess the clinicopathologic risk factors for DLN metastasis and to calibrate an informative diagnosis model for predicting risk stratification in DLN metastasis. Methods Retrospectively analysis 936 PTC patients who underwent thyroidectomy by a single surgeon, in the department of Head and Neck Surgery of Tianjin Cancer Hospital from 2017 to 2019. Moreover, 250 PTC patients underwent thyroidectomy by another surgeon at Tianjin Cancer Hospital between January 2019 and April 2019 were used as a validation cohort. Univariate analysis and multivariable logistic regression were used to identify clinicopathologic risk factors associated with DLN metastasis. A diagnostic model was generated using logistic regression, and internal validation and external validation were also performed. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC) and calibration plot. A nomogram plot was drawn to predict individual risk based on the diagnosis prediction model. Results In 936 cases, 581 (62.1%) show DLN, and 177 (177/581,30.5%) were verified metastasis. DLN metastasis was significantly associated with gender, age, tumor size, bilateral cancer, multifocality, extrathyroidal extension, lymphovascular invasion and central and lateral neck lymph node metastasis. Multivariate analysis revealed that age, gender, tumor size, extrathyroid extension, lymphovascular invasion and central lymph node metastasis were independent risk factor of DLN metastasis. The nomogram included age, gender, tumor size, extrathyroid extension, lymphovascular invasion and central lymph node metastasis, and all these features had a specificity of 100%. Particularly, tumor size was the best single predictor. The diagnostic model had an area under the curve (AUC) of 0.829 (95% confidence interval, 0.804–0.854). Internal and external validation of nomogram was 0.819 and 0.745, respectively. Conclusions DLN metastasis appears to be an important parameter that predict metastatic disease of the central compartments. To assess DLN metastasis in more precise criterions, has great clinical significance for PTC treatment selection.

Multifocal Papillary Thyroid Cancer Increases the Risk of Central Lymph Node Metastasis

Thyroid ◽  
2015 ◽  
Vol 25 (9) ◽  
pp. 1008-1012 ◽  
Author(s):  
Ayham Al Afif ◽  
Blair A. Williams ◽  
Mathew H. Rigby ◽  
Martin J. Bullock ◽  
S. Mark Taylor ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Papillary Thyroid Cancer ◽  
Papillary Thyroid ◽  
Central Lymph Node Metastasis ◽  
Central Lymph Node ◽  
Node Metastasis ◽  
Central Lymph

scholarly journals A Specific Predicting Model for Screening Skip Metastasis From Patients With Negative Central Lymph Nodes Metastasis in Papillary Thyroid Cancer

2021 ◽  
Vol 12 ◽  
Author(s):  
Zheyu Yang ◽  
Yu Heng ◽  
Qiwu Zhao ◽  
Zichao Cao ◽  
Lei Tao ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Papillary Thyroid Cancer ◽  
Tumor Size ◽  
Capsular Invasion ◽  
Papillary Thyroid ◽  
Skip Metastasis ◽  
Node Metastasis ◽  
Central Lymph

Skip metastasis is a specific type of papillary thyroid cancer lymph node metastasis (LNM). The present study aimed to clarify the typical clinical characteristics of skip metastasis and optimize the prediction model, so as to provide a more individual treatment mode for skip metastasis. We retrospectively analyzed 1075 PTC patients with different lymph node metastasis statuses from two clinical centers. Comparisons have been made between patients with skip metastasis and other types of LNM. Univariate and multivariate analyses were performed to detect the risk factors for skip metastasis with negative LNM, and a nomogram for predicting skip metastasis was established. The rate of skip metastasis was 3.4% (37/1075). Compared with other types of LNM, significant differences showed in tumor size, upper portion location, thyroid capsular invasion, and ipsilateral nodular goiter with the central lymph node metastasis (CLNM) group, and in age and gender with the lateral lymph node metastasis (LLNM) group. Four variables were found to be significantly associated with skip metastasis and were used to construct the model: thyroid capsular invasion, multifocality, tumor size > 1 cm, and upper portion. The nomogram had good discrimination with a concordance index of 0.886 (95% confidence interval [CI], 0.823 to 0.948). In conclusion, the significant differences between skip metastasis and other types of LNM indicated that the lymph node drainage pathway of skip metastasis is different from either CLNM or LLNM. Furthermore, we established a nomogram for predicting risk of skip metastasis, which was able to effectively predict the potential risk of skip metastasis in patients without preoperative LNM clue.

scholarly journals Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yanjie Shuai ◽  
Kai Yue ◽  
Yuansheng Duan ◽  
Mengqian Zhou ◽  
Yan Fang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Lymphovascular Invasion ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Central Lymph Node ◽  
Central Lymph Node Dissection ◽  
Node Metastasis ◽  
Central Lymph

IntroductionTo assess the risk factor for the central lymph node (CLN) metastasis and investigated the surgery extent of lymph node dissection for patients with isthmic PTC (papillary thyroid carcinoma).Materials and MethodsA total of 669 patients with a single nodule of isthmic PTC were retrospectively reviewed. The propensity score matching was performed twice separately. 176 patients respectively from patients who underwent thyroidectomy plus bilateral central lymph node dissection (BCLND) and who underwent thyroidectomy plus unilateral central lymph node dissection (UCLND) were matched. 77 patients were respectively selected from patients who underwent thyroidectomy plus BCLND and who underwent thyroidectomy with no central lymph node dissection (NCLND) were matched.ResultsAmong all the patients who underwent BCLND, 81/177 (45.76%) was confirmed with histologically positive CLN metastasis, and the occult lymph node metastasis is 25.42%. A tumor size of 1.05 cm was calculated as the cutoff point for predicting CLN metastasis by ROC curve analysis with 177 patients who underwent BCLND. The 5-year recurrence-free survival (RFS) rates were 92.9% in the NCLND group and 100% in the BCLND group with P<0.05, while there was no statistical difference in 5-year RFS between the BCLND group and UCLND group (P=0.11). The multivariate logistic regression analysis identified that age<55, tumor size>1cm, capsule invasion and lymphovascular invasion were significantly associated with CLN metastasis, while only age and lymphovascular invasion were proved to be independent risk factors related to contralateral CLN metastasis.ConclusionsThe thyroidectomy with NCLND could be insufficient for patients with isthmic PTC especially for those patients with high risk of central lymph node metastasis, considering that the rate of occult lymph node metastasis could not be ignored.

scholarly journals Clinical Study of Ultrasonographic Risk Factors for Central Lymph Node Metastasis of Papillary Thyroid Carcinoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Yang Guang ◽  
Wen He ◽  
Wei Zhang ◽  
Hongxia Zhang ◽  
Yukang Zhang ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Maximum Diameter ◽  
Papillary Thyroid ◽  
Central Lymph Node Metastasis ◽  
Central Lymph Node ◽  
Node Metastasis ◽  
Central Lymph ◽  
Thyroid Capsule

BackgroundThyroid cancer is the most common malignancy of the endocrine system worldwide. Papillary thyroid cancer (PTC) is the most common pathologic type. The preoperative diagnosis of PTC and central lymph node metastasis (CLNM) or metastatic tendency is of great clinical significance to the diagnosis, treatment and prognosis of these patients. This study was conducted to investigate the correlation between ultrasound features and central CLNM of PTC.MethodsThis study retrospectively analyzed patients who underwent PTC surgery and central lymph node dissection in the Department of Surgery, Beijing Tiantan Hospital, from January 2019 to February 2020. According to the inclusion and exclusion criteria, data from 136 patients were ultimately included, and the clinical and ultrasonic data of the patients were analyzed by multivariate regression to evaluate the correlation among grayscale ultrasound (US), superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) features of thyroid nodules and CLNM of PTCs.ResultsThe multivariate analysis showed that tumor size, multifocality, microcalcification characteristics, SMI vascularization, and CEUS evaluation of contact with the adjacent capsule were correlated with PTC metastasis (P=0.008, P=0.001, P=0.028, P=0.041, and P< 0.001, respectively). Comparisons of the area under the ROC curves revealed that the area under the ROC curve of the degree of nodular invasion into the thyroid capsule was the largest (AUC: 0.754). The sensitivity and specificity for evaluating CLNM of PTC were 67.7% and 83.1%, respectively.ConclusionsUltrasound characteristics of the following features are associated with a high risk of lymph node metastasis in PTCs: maximum diameter of nodules ≥1 cm, multifocality, ≥5 microcalcifications, abundant blood flow of SMI in nodules and nodule contact with the thyroid capsule ≥25% under CEUS. Ultrasound has clinical value in the preoperative evaluation of CLNM of PTCs.

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