Related Experiment Video
Updated: Aug 27, 2026
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Dual nomograms to predict central and lateral cervical lymph node metastasis in papillary thyroid carcinoma with
KeJie Yu1, XianJiang Wu1, WeiDong Zhang1
1Department of Thyroid Surgery, Ningbo No. 2 Hospital, Wenzhou Medical University, Ningbo, Zhejiang, China.
Background:
In papillary thyroid carcinoma (PTC) patients with suspected Hashimoto's thyroiditis (HT) indicated by elevated preoperative thyroglobulin antibodies (TgAb) and thyroid peroxidase antibodies (TPOAb), reactive lymphadenopathy can mimic metastatic disease on imaging. This overlap complicates preoperative cervical lymph node assessment and may lead to either unnecessary dissection or missed metastases. We aimed to develop and validate separate nomograms to predict central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in PTC patients with concurrent HT.
Methods:
We retrospectively enrolled 660 PTC patients with preoperatively confirmed HT who underwent thyroid surgery in Ward A of Ningbo No. 2 Hospital (training cohort). Independent predictors of CLNM and LLNM were identified using univariate analyses followed by multivariable logistic regression, and two nomograms were constructed. An independent cohort of 459 patients from Ward B served as an external validation set. Model discrimination, calibration, and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA), respectively.
Results:
For CLNM, age, calcification, capsular status, and maximum tumor diameter (MTD) were independent predictors. For LLNM, tumor margins, capsular status, and MTD were independent predictors. In the training cohort, the CLNM nomogram achieved an AUC of 0.760 and the LLNM nomogram an AUC of 0.864. Both models showed good calibration and favorable net benefit on DCA. External validation confirmed stable performance (AUC 0.726 for CLNM; 0.832 for LLNM).
Conclusion:
We developed and externally validated two practical nomograms based on readily available preoperative clinical and ultrasonographic features to estimate CLNM and LLNM risk in PTC patients with concurrent HT. These tools may support preoperative risk stratification and help tailor the extent of neck dissection.
