Nomogram prediction for cervical lymph node metastasis in multifocal papillary thyroid microcarcinoma

Area of Science:

• Oncology
• Radiology
• Medical Imaging

Background:

• Accurate preoperative prediction of cervical lymph node metastasis (LNM) in papillary thyroid microcarcinoma (mPTMC) is crucial for surgical planning.
• Ultrasound-based radiomics offers a non-invasive approach to assess LNM risk.

Purpose of the Study:

• To develop and validate an ultrasound radiomics nomogram for preoperative assessment of lymph node (LN) status in mPTMC patients.
• To identify independent risk factors for LNM in mPTMC to improve surgical decision-making.

Main Methods:

• A total of 450 mPTMC patients were enrolled (348 in modeling, 102 in validation).
• Logistic regression analyses identified risk factors for LNM using patient data, ultrasound characteristics, and ACR TI-RADS scores.
• A radiomics nomogram was constructed and validated for predictive performance.

Main Results:

• Male sex, age <40, lesion size >0.5 cm, capsular invasion, and high ACR TI-RADS scores (>9 and >19) were independent risk factors for LNM.
• The prediction model achieved an AUC and C-index of 0.838, with good calibration and significant net benefit shown by DCA.
• External validation confirmed the reliability of the prediction nomogram.

Conclusions:

• The developed radiomics nomogram, incorporating ACR TI-RADS scores, demonstrates favorable predictive value for preoperative LN assessment in mPTMC.
• This tool can assist in surgical decision-making and determining the extent of tumor resection for mPTMC patients.