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An ultrasound-based nomogram for predicting central lymph node metastasis in papillary thyroid microcarcinoma
Xiaochen Zhang1, Jianing Zhu1, Xin Ai2
1Department of Ultrasound in Medicine, Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou.
Medical Ultrasonography
|July 30, 2024
Summary
A new nomogram predicts central lymph node metastasis in papillary thyroid microcarcinoma (PTMC) using ultrasound features. This tool aids in deciding on prophylactic central neck dissection for PTMC patients.
Area of Science:
- Oncology
- Radiology
- Surgical Pathology
Background:
- Papillary thyroid microcarcinoma (PTMC) management is debated, particularly regarding prophylactic central lymph node dissection (CLND) in clinically node-negative patients.
- Active surveillance is not suitable for all PTMC cases, necessitating better tools to identify those at risk of metastasis.
Purpose of the Study:
- To develop and validate an ultrasound-based nomogram for predicting central lymph node metastasis (CLNM) in PTMC patients.
- To assist in clinical decision-making for prophylactic CLND in PTMC.
Main Methods:
- Retrospective analysis of 636 PTMC patients with confirmed CLNM status.
- Univariate and multivariate regression analyses to identify risk factors for CLNM.
- Development and validation of a nomogram using ultrasound features, assessed by ROC, calibration, and decision curve analyses.
Main Results:
- A nomogram incorporating age, sex, combined CLNM status, tumor size, and capsule invasion was developed.
- The nomogram demonstrated good predictive performance with an AUC of 0.720 in the training set and 0.704 in the validation set.
Conclusions:
- An ultrasound-based nomogram effectively predicts CLNM in PTMC patients.
- The nomogram shows excellent predictive performance and can guide the decision for prophylactic central neck dissection.
- Patients with high nomogram scores warrant consideration for prophylactic CLND.
