scholarly journals A Nomogram Based on Clinicopathological and Ultrasound Imaging Characteristics for Predicting Cervical Lymph Node Metastasis in cN0 Unilateral Papillary Thyroid Microcarcinoma

2021 ◽  
Vol 8 ◽  
Author(s):  
Lina Zhang ◽  
Yuwei Ling ◽  
Ye Zhao ◽  
Kaifu Li ◽  
Jing Zhao ◽  
...  

Objective: The aim of this study was to establish a practical nomogram for preoperatively predicting the possibility of cervical lymph node metastasis (CLNM) based on clinicopathological and ultrasound (US) imaging characteristics in patients with clinically node-negative (cN0) unilateral papillary thyroid microcarcinoma (PTMC) in order to determine a personal surgical volume and therapeutic strategy.Methods: A total of 269 consecutive patients diagnosed with cN0 unilateral PTMC by postoperative pathological examination from January 2018 to December 2020 were retrospectively analyzed. All the patients underwent lobectomy or thyroidectomy with routine prophylactic central lymph node dissection (CLND) and were divided into a CLNM group and a non-CLNM group. Using logistic regression, the least absolute shrinkage and selection operator (LASSO) regression analysis was applied to determine the risk factors for CLNM in patients with unilateral cN0 PTMC. A nomogram including risk-factor screening using LASSO regression for predicting the CLNM in patients with cN0 unilateral PTMC was further developed and validated.Results: Risk factors identified by LASSO regression, including age, sex, tumor size, presence of extrathyroidal extension (ETE), tumor diameter/lobe thickness (D/T), tumor location, and coexistent benign lesions, were potential predictors for CLNM in patients with cN0 unilateral PTMC. Meanwhile, age (odds ratio [OR] = 0.261, 95% CI.104–0.605; P = 0.003), sex (men: OR = 3.866; 95% CI 1.758–8.880; P < 0.001), ETE (OR = 3.821; 95% CI 1.168–13.861; P = 0.032), D/T (OR = 72.411; 95% CI 5.483–1212.497; P < 0.001), and coexistent benign lesions (OR = 3.112 95% CI 1.407–7.303; P = 0.007) were shown to be significantly related to CLNM by multivariant logistic regression. A nomogram for predicting CLNM in patients with cN0 unilateral PTMC was established based on the risk factors identified by the LASSO regression analysis. The receiver operating characteristic (ROC) curve for predicting CLNM by nomogram showed that the area under the curve (AUC) was 0.777 and exhibited an excellent consistency.Conclusions: A nomogram based on clinical and US imaging characteristics for predicting the probability of CLNM in patients with cN0 unilateral PTMC was developed, which showed a favorable predictive value and consistency. Further prospective research to observe the oncological outcomes is necessary to determine whether the nomogram could potentially guide a personalized surgical volume and surgical approach.

2020 ◽  
Author(s):  
Ying Zou ◽  
Huanlei Zhang ◽  
Wenfei Li ◽  
Yu Guo ◽  
Fang Sun ◽  
...  

Abstract BackgroundThe prediction of ipsilateral lateral cervical lymph node metastasis (ipsi-LLNM) was crucial to the operation plan in patients with papillary thyroid carcinoma (PTC). This study aimed to investigate the risk factors for ipsi-LLNM using dual-energy computed tomography (DECT) and thyroid functional indicators in patients with PTC. MethodsThe medical records of 406 patients with a pathological diagnosis of PTC were retrospectively reviewed from Jan 2016 to Dec 2019. Demographic, clinical, pathological findings, and parameters from DECT were evaluated. Risk factors for ipsi-LLNM were explored by univariate and multivariate analyses. Receiver operating characteristic (ROC) curves were used to evaluate the cut-off value of each risk factor.ResultsTotally 406 patients with PTC were analyzed, including 128 with ipsi-LLNM and 278 without. There were statistical differences of parameters between the two groups (P < .0001), including serum Tg, Anti-Tg, Anti-TPO, the volume of the primary lesion, calcification, extrathyroidal extension (ETE), and iodine concentration (IC) in arterial and venous phases. Independent risk factors for ipsi-LLNM included serum Tg, Anti-Tg, ETE, and IC in arterial and venous phases (P < .05). Ipsi-LLNM was more likely to occur when the following conditions were met: with ETE, Tg > 100.01 ng/ml, Anti-Tg > 89.43 IU/ml, IC in arterial phase > 3.4 mg/ml and IC in venous phase > 3.1 mg/ml.ConclusionsApplication of DECT parameters and thyroid functional indicators can improve the diagnostic performance in the evaluation of ipsi-LLNM in patients with PTC.


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