Risk stratification for central lymph node metastasis in mono-focal papillary thyroid carcinoma patients with encapsulated tumor as confirmed by preoperative ultrasound: a multi-center analysis

Yangyang Ji ^1,2, Yu Heng ¹, Zhenwei Wang ¹

⁰ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.

Endocrine +

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July 25, 2024

View abstract on PubMed

Summary

This study developed nomograms to predict central lymph node metastasis (CLNM) risk in encapsulated papillary thyroid carcinoma (PTC). These tools guide decisions on prophylactic central lymph node dissection (CLND) and follow-up strategies for better patient management.

Area Of Science

Oncology
Surgical Oncology
Diagnostic Imaging

Background

Encapsulated papillary thyroid carcinoma (PTC) with mono-focal tumors were traditionally considered low risk for central lymph node metastasis (CLNM).
Accurate risk stratification is crucial for guiding prophylactic central lymph node dissection (CLND) and optimizing follow-up strategies.

Purpose Of The Study

To quantitatively predict the probability of CLNM in mono-focal encapsulated PTC using pre- and post-operative factors.
To develop tools that aid in selecting appropriate prophylactic CLND and follow-up strategies.

Main Methods

Retrospective analysis of 1014 mono-focal PTC patients with encapsulated tumors from three medical centers.
Patients were divided into training (534) and validation (480) groups.
Multivariate analyses were performed to identify independent risk factors for CLNM.

Main Results

Key independent risk factors for CLNM included age < 55 years, male gender, clinical maximum tumor diameter (cMTD) > 0.5 cm, pathological maximum tumor diameter (pMTD) > 0.5 cm, and microscopic thyroid capsular invasion (mTCI).
Two nomograms (pre- and post-operative) were constructed to predict CLNM risk.
The pre-model nomogram assesses the necessity of prophylactic CLND, while the post-model nomogram informs postoperative follow-up.

Conclusions

Developed comprehensive nomograms for quantitative risk assessment of CLNM in mono-focal encapsulated PTC.
These tools enhance clinical decision-making for prophylactic CLND and postoperative management of neck regions.
The nomograms provide valuable stratification for patients undergoing ultrasound-confirmed encapsulated PTC management.

Keywords:

Central lymph node metastasis Encapsulated tumor Mono-focal Papillary thyroid carcinoma Risk stratification