Risk factors and nomogram to predict skip metastasis in papillary thyroid carcinoma

Area of Science:

• Endocrinology
• Oncology
• Surgical Pathology

Background:

• Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy.
• Skip metastases in PTC are often misdiagnosed, potentially leading to re-operation and impacting prognosis.
• Existing nomograms primarily focus on central or lateral lymph node metastases, with limited options for predicting skip metastases.

Purpose of the Study:

• To investigate the risk factors associated with skip metastases in papillary thyroid carcinoma.
• To establish a predictive nomogram for skip metastases in PTC based on clinical and ultrasonographic characteristics.

Main Methods:

• Retrospective analysis of 218 PTC patients with lateral cervical lymph node metastases.
• Univariate and multivariate analyses to identify risk factors for skip metastases.
• Evaluation of the nomogram's efficacy using ROC curves, calibration plots, and decision curve analysis (DCA).

Main Results:

• Tumor location, maximum diameter (≤10 mm), and capsule invasion were identified as significant risk factors for skip metastases.
• The developed nomogram demonstrated an AUC of 0.877, with 85.32% accuracy, 60.98% sensitivity, and 90.96% specificity.
• The nomogram showed good consistency with actual observations and potential benefit for most PTC patients according to DCA.

Conclusions:

• A nomogram for predicting skip metastases in PTC can be a valuable tool for clinical diagnosis and treatment planning.
• Identifying skip metastases risk preoperatively can help optimize surgical strategies and patient management.
• Further validation of the nomogram in diverse patient populations is warranted.