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A nomogram for predicting lateral lymph node metastasis in cN0 unifocal papillary thyroid microcarcinoma
Hui Huang1, Siyuan Xu1,2, Song Ni3
1Department of Head and Neck Surgical Oncology, National Cancer Centre, National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
A new nomogram helps predict occult lateral lymph node metastasis (LLNM) in papillary thyroid microcarcinoma (PTMC). Upper lobe tumors, extrathyroidal extension, and central lymph node metastases are key risk factors for LLNM.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Occult lateral lymph node metastasis (LLNM) in papillary thyroid microcarcinoma (PTMC) impacts treatment decisions, including the need for lateral neck dissection (LND).
- Accurate identification of LLNM risk factors is crucial for optimizing patient management in cN0 unifocal PTMC.
Purpose of the Study:
- To develop and validate a predictive nomogram for occult lateral lymph node metastasis (LLNM) in clinically node-negative (cN0) unifocal papillary thyroid microcarcinoma (PTMC).
Main Methods:
- Retrospective analysis of 4872 patients with cN0 unifocal PTMC treated between January 2013 and June 2018.
- Logistic regression analysis identified independent risk factors for LLNM.
- A nomogram was constructed and its predictive accuracy evaluated using the area under the receiver operating characteristic curve (AUC).
Main Results:
- The overall incidence of LLNM was 3.2%.
- Significant risk factors for LLNM included upper lobe tumor location (OR=2.56), tumor size >7 mm (OR=2.59), extrathyroidal extension (ETE) (OR=1.41), and the presence of central lymph node metastases (CLNMs) (OR=2.91 for 1-2 CLNMs, OR=5.84 for ≥3 CLNMs).
- The developed nomogram achieved an AUC of 0.777, indicating good predictive performance.
Conclusions:
- Upper lobe tumor location, size >7 mm, ETE, and CLNMs (particularly ≥3) are independent predictors of LLNM in cN0 unifocal PTMC.
- The nomogram demonstrates favorable predictive value and consistency for identifying patients at high risk of LLNM.
- This tool can aid in tailoring the decision-making process for lateral neck dissection (LND).
