Ultrasonic Feature Prediction of Large-Number Central Lymph Node Metastasis in Clinically Node-Negative Solitary Papillary Thyroid Carcinoma

ABSTRACT

Background

The purpose of this study was to investigate the preoperative prediction of large-number central lymph node metastasis (CLNM) in single thyroid papillary carcinoma (PTC) with negative clinical lymph nodes.

Methods

A total of 634 patients with clinically lymph node-negative single PTC who underwent thyroidectomy and central lymph node dissection at the First Affiliated Hospital of Anhui Medical University and the Nanchong Central Hospital between September 2018 and September 2021 were analyzed retrospectively. According to the CLNM status, the patients were divided into two groups: small-number (≤5 metastatic lymph nodes) and large-number (>5 metastatic lymph nodes). Univariate and multivariate analyses were used to determine the independent predictors of large-number CLNM. Simultaneously, a nomogram based on risk factors was established to predict large-number CLNM.

Results

The incidence of large-number CLNM was 7.7%. Univariate and multivariate analyses showed that age, tumor size, and calcification were independent risk factors for predicting large-number CLNM. The combination of the three independent predictors achieved an AUC of 0.806. Based on the identified risk factors that can predict large-number CLNM, a nomogram was developed. The analysis of the calibration map showed that the nomogram had good performance and clinical application.

Conclusion

In patients with single PTC with negative clinical lymph nodes large-number CLNM is related to age, size, and calcification in patients with a single PTC with negative clinical lymph nodes. Surgeons and radiologists should pay more attention to patients with these risk factors. A nomogram can help guide the surgical decision for PTC.

KEYWORDS:

• Large-number central lymph node metastasis
• negative clinical lymph nodes
• preoperative prediction
• single thyroid papillary carcinoma

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Abbreviations

PTC	=	Papillary thyroid carcinoma
CLNM	=	central lymph node metastasis
LNMs	=	metastatic lymph nodes
ATA	=	American Thyroid Association
US	=	ultrasound
ECE	=	extracapsular extension
CCLT	=	confidant chronic lymphocytic thymitis

Additional information

Funding

The work was supported by the the Science and Technology Project of Nanchong City [22JCYJPT0004]; Nanchong school science and technology strategic cooperation project [19SXHZ0165].