Preoperative prediction of central lymph node metastasis in cN0T1/T2 papillary thyroid carcinoma: A nomogram based on clinical and ultrasound characteristics |
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| Affiliation: | 1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore;2. Ministry of Health Holdings, Singapore;3. Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore;4. Duke-National University of Singapore Medical School, Singapore;1. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands;2. Department of Surgery, ETZ (Elisabeth-TweeSteden) Hospital, Tilburg, the Netherlands;3. Department of GROW, School for Developmental Biology & Oncology, Maastricht University, Maastricht, the Netherlands;1. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan;2. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan;1. Department of Medical and Surgical Sciences (DIMEC), IRCCS Sant’Orsola-Malpighi, Obstetric and Gynecologic Unit, University of Bologna, Bologna, Italy;2. Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France;3. INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France;4. INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France;1. Department of Gynecology and Obstetrics, CHU Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France;2. Department of Gynecology and Obstetrics, Tours University Hospital, 2 Boulevard Tonnellé, Cedex Tours, 37000, France;3. Department of Gynecology and Obstetrics, Hopital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France;4. Department of Gynecology and Obstetrics, Hopital Bichat, 46 Rue Henri Huchard, 75018, Paris, France;5. Department of Surgical Oncology, Institut de Cancerologie de l''ouest, Boulevard Pr Jacques Monod, 44800, Saint-Herblain, France;6. Department of Surgery, Institut Bergonié, Comprehensive Cancer Center, 229 Cr de l’Argonne, 33000, Bordeaux, France;7. Department of Gynecology and Obstetrics, CHI Poissy, 30 Rue du Maréchal Gallieni, 78100, Saint Germain en Laye, France;8. Department of Gynecology and Obstetrics, CHU Reims, 45 Rue Cognacq Jay, 51000, Reims, France |
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| Abstract: | BackgroundPreoperative status of central lymph nodes is a key determinant of the initial surgical extent for papillary thyroid carcinoma (PTC). We aimed to develop and validate a nomogram based on preoperative clinical characteristics and ultrasound features to predict central lymph node status in patients with clinically lymph node-negative (cN0) T1/T2 PTC.MethodsThis retrospective study included 729 patients with cN0T1/T2 PTC who were treated between January 2015 and March 2020. Based on the ratio of 6:4, 431 patients who underwent surgeries relatively earlier comprised the training set to develop the nomogram, while the other 298 who underwent surgeries relatively later comprised validation set to validate the performance of nomogram. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to identify predictors of central lymph node metastasis (CLNM). These variables were used to construct a nomogram for predicting the risk of CLNM. The predictive performance, discriminative ability, calibration, and clinical utility of the nomogram model were evaluated in both sets.ResultsA total of 313 (42.9%) PTC patients were identified with CLNM. On multivariate logistic regression analyses, malegender, younger age, larger maximum diameter, multifocality, capsular invasion, infiltrative margins, intra-nodular vascularity, and aspect ratio >1 were independent risk factors for CLNM. Nomogram integrating these 8 factors showed excellent discrimination in the training [area under the curve (AUC): 0.788] and validation (AUC: 0.829) sets, and obtained well-fitted calibration curves. The cut-off value of this nomogram was 0.410 (～245 points). Decision curve analysis confirmed the clinical utility of the nomogram.ConclusionThe CLNM-predicting nomogram can facilitate stratification of cN0T1/T2 PTC patients. Prophylactic central neck lymph node dissection can be considered for those with high nomogram scores. |
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| Keywords: | Papillary thyroid carcinoma cN0T1/T2 Central lymph node metastasis Ultrasound characteristics Nomogram Individualized treatment PTC" },{" #name" :" keyword" ," $" :{" id" :" pc_qXqPaFx3KN" }," $$" :[{" #name" :" text" ," _" :" papillary thyroid carcinoma US" },{" #name" :" keyword" ," $" :{" id" :" pc_ubBMQXfgAk" }," $$" :[{" #name" :" text" ," _" :" ultrasound cN0" },{" #name" :" keyword" ," $" :{" id" :" pc_RTgSNrhZlf" }," $$" :[{" #name" :" text" ," _" :" clinically lymph node-negative LASSO" },{" #name" :" keyword" ," $" :{" id" :" pc_X5bcMwJuRR" }," $$" :[{" #name" :" text" ," _" :" least absolute shrinkage and selection operator CLNM" },{" #name" :" keyword" ," $" :{" id" :" pc_khSywOQqfL" }," $$" :[{" #name" :" text" ," _" :" central lymph node metastasis AT" },{" #name" :" keyword" ," $" :{" id" :" pc_kJ2icRMUfg" }," $$" :[{" #name" :" text" ," _" :" aspect ratio TSH" },{" #name" :" keyword" ," $" :{" id" :" pc_S6AHEI26Oh" }," $$" :[{" #name" :" text" ," _" :" thyroid stimulating hormone CLND" },{" #name" :" keyword" ," $" :{" id" :" pc_Qw8empUqYl" }," $$" :[{" #name" :" text" ," _" :" central neck lymph node dissection PCLND" },{" #name" :" keyword" ," $" :{" id" :" pc_YCF9qS7r6a" }," $$" :[{" #name" :" text" ," _" :" prophylactic central neck lymph node dissection FNA" },{" #name" :" keyword" ," $" :{" id" :" pc_dEzgFaKoOp" }," $$" :[{" #name" :" text" ," _" :" fine-needle aspiration biopsy LLNM" },{" #name" :" keyword" ," $" :{" id" :" pc_vUdjWIAByU" }," $$" :[{" #name" :" text" ," _" :" lateral neck lymph node metastasis ETE" },{" #name" :" keyword" ," $" :{" id" :" pc_5Gklj8qq0X" }," $$" :[{" #name" :" text" ," _" :" extrathyroidal extension LT" },{" #name" :" keyword" ," $" :{" id" :" pc_pzl2snWXsV" }," $$" :[{" #name" :" text" ," _" :" lobectomy IT" },{" #name" :" keyword" ," $" :{" id" :" pc_QH0lfwaTM4" }," $$" :[{" #name" :" text" ," _" :" isthmusectomy TT" },{" #name" :" keyword" ," $" :{" id" :" pc_AtmDQ7XNz3" }," $$" :[{" #name" :" text" ," _" :" total thyroidectomy HT" },{" #name" :" keyword" ," $" :{" id" :" pc_A2ynLFCX0K" }," $$" :[{" #name" :" text" ," _" :" Hashimoto's thyroiditis IQR" },{" #name" :" keyword" ," $" :{" id" :" pc_rXWoXzmYG6" }," $$" :[{" #name" :" text" ," _" :" inter-quartile range C-index" },{" #name" :" keyword" ," $" :{" id" :" pc_9VDMw63TbU" }," $$" :[{" #name" :" text" ," _" :" concordance index ROC curve" },{" #name" :" keyword" ," $" :{" id" :" pc_CLYU6Xro4G" }," $$" :[{" #name" :" text" ," _" :" receiver operating characteristic curve DCA" },{" #name" :" keyword" ," $" :{" id" :" pc_PKMVw4lfDn" }," $$" :[{" #name" :" text" ," _" :" decision curve analysis AUC" },{" #name" :" keyword" ," $" :{" id" :" pc_zXqaF9gUwL" }," $$" :[{" #name" :" text" ," _" :" area under the receiver operating characteristic curve CI" },{" #name" :" keyword" ," $" :{" id" :" pc_PQzibztLOp" }," $$" :[{" #name" :" text" ," _" :" confidence interval PTMC" },{" #name" :" keyword" ," $" :{" id" :" pc_9j3tYESKTU" }," $$" :[{" #name" :" text" ," _" :" papillary thyroid microcarcinoma |
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