The Application Value of the Central Lymph Node Metastasis Risk Assessment Model in Papillary Thyroid Microcarcinoma of Stage cN0: A Study of 828 Patients

Abstract

BackgroundThe aim of this study is to build a risk assessment system for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC) of stage cN0 and to explore its application value in clinical practice.MethodsA total of 500 patients with PTMC who underwent thyroid operation from 2013 to 2015 in Ningbo First Hospital were selected as the model group. Independent risk factors related to CLNM in PTMC were analyzed and determined, and a risk assessment system for CLNM was preliminarily established. Furthermore, the clinicopathological data from 328 PTMC patients with the same conditions as the model group from 2016 to 2017 were further collected as the validation group to verify the diagnostic value of the risk assessment system.ResultsThe risk assessment system was based on the score rating (score ≤ 5 was classified as low risk, 6–8 was classified as medium risk, and ≥9 was classified as high-risk). The area under the receiver operating characteristic curve (ROC) was 0.687 (95% CI: 0.635–0.783). According to the risk assessment system, 328 PTMC patients in the validation group were scored. Among the low-risk group, the moderate-risk group, and the high-group, 96.8%, 58.1%, and 43.2% were the CLNM (-) patients, and 3.1%, 41.9%, and 65.8% were CLNM (+) patients, respectively. The area under ROC was 0.837 (95% CI: 0.778–0.869).ConclusionsThe risk assessment system in this study is of diagnostic value and can provide a theoretical foundation for intraoperative decision-making of prophylactic central neck dissection (pCND).

Clinical features and imaging examination assessment of cervical lymph nodes for thyroid carcinoma

“…According to the lymphatic drainage pathway, LNM typically occurs initially in the central compartment before involving the lateral compartment, sometimes presenting as skip metastasis [ 6 , 7 ]. The incidence of CLNM in PTC patients is high, ranging from 21 to 60% [ 8 , 9 ], and approximately 20% of PTC cases are accompanied by LLNM at the initial diagnosis [ 10 , 11 ]. Considerable studies have shown that LLNM might increase the risk of local recurrence and reduce the survival rate [ 10 ].…”

Development and validation of clinical predictive models for differentiated thyroid carcinoma and cervical lymph node metastasis: A retrospective cohort study

“…However, the models established in many studies have used the classi cation results of thyroid aspiration cytology or capsular invasion as predictors. 16,38,39 These predictors are directly related to the pathological status of thyroid cancer and are not used for early screening purposes. A real-world study conducted in China con rmed that the sensitivity of preoperative diagnosis of CLNM by ultrasound alone is very limited.…”