Comprehensive analysis of clinicopathologic and sonographic features in thyroid cancer with skip lymph node metastasis: establish and assessment of a prediction nomogram

Jiwang, Liang; Jinghui, Bai; Fengqin, Fang; Tao, Yu; Yuejiao, Zhao

doi:10.1016/j.bjorl.2023.101301

Cited by 2 publications

(2 citation statements)

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“…The 2015 American Thyroid Association (ATA) guidelines recommended therapeutic LLND only for patients with biopsy-proven LLNM, and the application of prophylactic central-compartment neck dissection (ipsilateral or bilateral) should be careful ( 6 ). However, the incidence of skip metastasis in PTC is about 6.5–27.5% ( 5 ). Skip metastasis is closely associated to local recurrence and prognosis ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…The metastatic pathway of PTC is generally continuous: it firstly invades the central lymph node (CLN), then the ipsilateral lateral lymph node (LLN), and finally involves the contralateral LLN and mediastinal lymph node ( 3 , 4 ). Skip metastases are defined as metastases in the LLN without CLN and the incidence of skip metastases is 6.5–27.5% ( 5 ). The 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommended therapeutic lateral lymph node dissection (LLND) only for patients with biopsy-proven lateral cervical lymph node metastases ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and nomogram to predict skip metastasis in papillary thyroid carcinoma

Zhao,

Li,

Tao

et al. 2024

Gland Surg

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Background Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. Skip metastases of PTCs are easily misdiagnosed before surgery, and it could lead to re-operation and affect the prognosis. Although there are a few studies about nomograms for predicting central lymph node metastases (CLNM) or lateral lymph node metastases (LLNM) of PTCs, there are few studies about nomograms for skip metastases. Based on the clinical and ultrasonographic characteristics of patients with PTCs, the aim of our study was to investigate the risk factors and establish a nomogram for predicting the risk of skip metastases in PTCs. Methods This study enrolled 218 PTCs patients with lateral cervical lymph node metastases and their data were analyzed retrospectively. According to the postoperative pathological results, the patients were divided into skip-positive group and skip-negative group. In order to establish the nomogram, univariate and multivariate analyses were used to estimate risk factors of skip metastases. The receiver operating characteristic (ROC) curve, internal calibration plot and decision curve analysis (DCA) were used to evaluate the nomogram model’s efficacy. Results There were statistical differences between skip-positive group and skip-negative group in tumor location, the maximum diameter (D) and capsule invasion (P<0.05). No statistical differences were observed in sex, age, Hashimoto’s thyroiditis, multifocality, anteroposterior diameter/transverse diameter (A/T) ratio, shape, margin, microcalcification, intra-nodular vascularity and preoperative serum thyroglobulin (Tg) (P≥0.05). The risk factors of skip metastases in PTCs were D ≤10 mm, location in the upper portion and capsule invasion. The area under the curve (AUC) of nomogram was 0.877, the accuracy was 85.32%, the sensitivity was 60.98%, and the specificity was 90.96%. The calibration curve and the Hosmer-Lemeshow goodness of fit test showed that the consistency between the nomogram and the actual observation was good. The DCA showed that most PTC patients might benefit from the predictive nomogram model. Conclusions A nomogram for predicting skip metastases in PTCs may be useful in clinical diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%