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Predicting central lymph node metastasis in papillary thyroid cancer: A nomogram based on clinical, ultrasound and contrast‑enhanced computed tomography characteristics. | LitMetric

AI Article Synopsis

  • - The study investigates risk factors for central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) by analyzing preoperative data from 786 patients, aiming to create a prediction model to inform treatment plans.
  • - Key independent predictors of CLNM identified include being younger than 45, male gender, absence of Hashimoto thyroiditis, isthmic tumor location, presence of microcalcification, inhomogeneous enhancement on imaging, and capsule invasion.
  • - The developed nomogram for predicting CLNM showed strong performance, with area under the curve (AUC) values of 0.826 in the training group and 0.818 in the validation group, indicating that incorporating contrast-enhanced CT features

Article Abstract

Central lymph node (CLN) status is considered to be an important risk factor in patients with papillary thyroid carcinoma (PTC). The aim of the present study was to identify risk factors associated with CLN metastasis (CLNM) for patients with PTC based on preoperative clinical, ultrasound (US) and contrast-enhanced computed tomography (CT) characteristics, and establish a prediction model for treatment plans. A total of 786 patients with a confirmed pathological diagnosis of PTC between January 2021 to December 2022 were included in the present retrospective study, with 550 patients included in the training group and 236 patients enrolled in the validation group (ratio of 7:3). Based on the preoperative clinical, US and contrast-enhanced CT features, univariate and multivariate logistic regression analyses were used to determine the independent predictive factors of CLNM, and a personalized nomogram was constructed. Calibration curve, receiver operating characteristic (ROC) curve and decision curve analyses were used to assess discrimination, calibration and clinical application of the prediction model. As a result, 38.9% (306/786) of patients with PTC and CLNM(-) status before surgery had confirmed CLNM using postoperative pathology. In multivariate analysis, a young age (≤45 years), the male sex, no presence of Hashimoto thyroiditis, isthmic location, microcalcification, inhomogeneous enhancement and capsule invasion were independent predictors of CLNM in patients with PTC. The nomogram integrating these 7 factors exhibited strong discrimination in both the training group [Area under the curve (AUC)=0.826] and the validation group (AUC=0.818). Furthermore, the area under the ROC curve for predicting CLNM based on clinical, US and contrast-enhanced CT features was higher than that without contrast-enhanced CT features (AUC=0.818 and AUC=0.712, respectively). In addition, the calibration curve was appropriately fitted and decision curve analysis confirmed the clinical utility of the nomogram. In conclusion, the present study developed a novel nomogram for preoperative prediction of CLNM, which could provide a basis for prophylactic central lymph node dissection in patients with PTC.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332582PMC
http://dx.doi.org/10.3892/ol.2024.14611DOI Listing

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