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

Abstract

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.

Diagnostic value of high-frequency ultrasound combined with fine needle aspiration cytology and BRAF gene for papillary thyroid microcarcinoma

“…It has been demonstrated that preoperative imaging examination for patients can help physicians make judgments on lymph nodes with typical sonographic features, and perform biopsy during surgery, which can lead to early diagnosis and timely intervention, thereby improving prognosis [17]. HFUS possesses advantages of non-invasion, easy operation, high repeatability, etc., making it the preferred examination method for multiple tissue and organ lesions.…”

Analysis of Risk Factors Associated With Central Lymph Node Metastasis in Papillary Thyroid Carcinoma With cT1N0 Stage

“…It is thus critical that risk factors related to CLNM incidence in patients with PTC be better defined in order to guide clinical decision-making. Several studies to date have assessed PTMC(T1a) patients and identified potential clinical and US features associated with CLNM risk, including male sex, younger age multifocality, and extrathyroidal extension, but these findings have not been consistent across studies and analyses of individuals with cT1b stage disease are currently lacking ( 15 – 17 ).…”

The diagnostic value of a nomogram based on multimodal ultrasonography for thyroid-nodule differentiation: A multicenter study

“…Contrast-enhanced US (CEUS) is a relatively recent technology that can reflect and observe the hemodynamics of normal and diseased tissues. It has high sensitivity and specificity and is a valuable auxiliary examination method ( 5 , 6 ); it has been widely utilized for the evaluation of the liver, kidney, testis, and other parenchymal organs ( 7 ). CEUS can also improve the detection rate of blood vessels in thyroid nodules, particularly tiny blood vessels, which is very critical since angiogenesis is the foundation of tumor formation.…”