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| Predicting the risk of postoperative cervical lymph node metastasis in papillary thyroid carcinoma: A composite model based on ultrasound and clinical indicators |
| HE Lei, XIONG Bing, LUO Yinli, CHEN Shunping |
| Department of Ultrasound, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China |
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HE Lei,XIONG Bing,LUO Yinli, et al. Predicting the risk of postoperative cervical lymph node metastasis in papillary thyroid carcinoma: A composite model based on ultrasound and clinical indicators[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2024, 54(6): 458-464.
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Abstract Objective: To explore the predictive value of preoperative ultrasonographic features combined with clinical indices for the risk of cervical lymph node metastasis after surgery for papillary thyroid carcinoma (PTC). Methods: A retrospective collection of 43 patients with cervical lymph node metastasis of PTC confirmed by pathology after a second surgery at the First Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2020 was included in as the metastasis group. Meanwhile, 89 patients who had undergone initial PTC surgery from January 2013 to December 2014 and were followed up for at least 8 years without recurrence of cervical lymph nodes were collected as the non-metastasis group. Patients were randomly sampled in a 7:3 ratio into a training set (n=92) and a validation set (n=40). In the training set, a predictive model was constructed through univariate and multivariate logistic regression analyses and visualized with nomograms. The model was validated using the validation set, and its efficacy and clinical value were assessed by ROC curve and decision
curve analysis (DCA). Results: Statistically significant differences were observed between the metastasis and nonmetastasis groups in terms of surgical methods, intraoperative lymph node metastasis, thyroid nodule location,echogenicity, maximum diameter of thyroid nodules, ultrasonographic indication of lymph node enlargement,lymph node long-to-short axis ratio, and lymph node blood flow characteristics (all P<0.05). Multivariate logistic regression analysis identified the method of surgery (OR=0.332, 95%CI=0.134-0.828, P=0.018), intraoperative lymph node metastasis (OR=2.978, 95%CI=1.112-7.953, P=0.03), thyroid nodule location (middle vs. lower pole,OR=6.624, 95%CI=1.986-22.095, P=0.002) and maximum diameter of thyroid nodules (OR=1.064, 95%CI=1.002-1.130, P=0.042) as independent predictors of cervical lymph node metastasis after surgery. The model exhibited an area under the curve (AUC) of 0.872 (95%CI=0.795-0.949) in the training set and an AUC of 0.863 (95%CI=0.749-0.976) in the validation set, with DCA showing a net benefit in predicting the risk of postoperative PTC cervical lymph node metastasis at a threshold probability of 0.1 to 0.7. Conclusion: Based on preoperative ultrasonographic characteristics and clinical pathological indices, the constructed model effectively forecasts the risk of cervical lymph node metastasis after PTC surgery, offering valuable guidance for clinical decisionmaking.
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Received: 24 February 2024
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