A Novel Scoring System for Predicting the Metastases of Posterior Right Recurrent Laryngeal Nerve Lymph Node Involvement in Patients With Papillary Thyroid Carcinoma by Preoperative Ultrasound

Abstract

ObjectiveOur goal was to investigate the correlation between papillary thyroid carcinoma (PTC) characteristics on ultrasonography and metastases of lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN). There is still no good method for clinicians to judge whether a patient needs LN-prRLN resection before surgery, and we also wanted to establish a new scoring system to determine whether patients with papillary thyroid carcinoma require LN-prRLN resection before surgery.Patients and MethodsThere were 482 patients with right or bilateral PTC who underwent thyroid gland resection from December 2015 to December 2017 recruited as study subjects. The relationship between the PTC characteristics on ultrasonography and the metastases of LN-prRLN was analyzed by univariate and logistic regression analyses. Based on the risk factors identified in univariate and logistic regression analysis, a nomogram-based LN-prRLN prediction model was established.ResultLN-prRLN were removed from all patients, of which 79 had LN-prRLN metastasis, with a metastasis rate of 16.39%. Multivariate logistic regression analysis revealed that LN-prRLN metastasis was closely related to sex, age, blood supply, larger tumors (> 1 cm) and capsular invasion. A risk prediction model has been established and fully verified. The calibration curve used to evaluate the nomogram shows that the consistency index was 0.75 ± 0.065.ConclusionPreoperative clinical data, such as sex, age, abundant blood supply, larger tumor (> 1 cm) and capsular invasion, are positively correlated with LN-prRLN metastasis. Our scoring system can help surgeons non-invasively determine which patients should undergo LN-prRLN resection before surgery. We recommend that LN-prRLN resection should be performed when the score is above 103.1.

Pattern and Predictive Factors of Metastasis in Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in Papillary Thyroid Carcinoma

“…This study did not find a significant association between gender, age, tumor size, uni-multifocality, prelaryngeal lymph nodes metastasis, left CLN metastasis, and LN-prRLN metastasis. However, a significant association was reported by previous studies on PTC (14)(15)(16)(17). Using univariate and multivariate analyses, we confirmed that ETE, lateral lymph node metastasis, the number of metastatic LN-arRLN were independent predictors of LN-prRLN metastasis, which was consistent with previous reports (6,14,15,18).…”

Constructing a nomogram based on the distribution of thyroid nodules and suspicious lateral cervical lymph nodes in fine-needle aspiration biopsies to predict metastasis in papillary thyroid carcinoma

“…Gong Y and Ito Y’s research ( 19 , 20 ) shows that, compared with the nodules located at the middle pole of the thyroid gland, nodules at the upper pole and middle-upper third of the thyroid gland are extremely prone to LLNM. This is mainly because the lymphatic drainage system of the thyroid gland is similar to the venous drainage system ( 21 ). In our study, the prevalence of LLNM was 63.2% (i.e., in 50 out of 79 patients) in the upper pole or the upper part of the high plane of the isthmus of the thyroid gland, which was higher than the thyroid nodules in middle pole and isthmus (22.7%).…”

Predictive Factors for Skip Lymph Node Metastasis and Their Implication on Recurrence in Papillary Thyroid Carcinoma

“…Moreover, the detection rate of LN involvement in the central compartment is lower than that in the lateral compartment during preoperative evaluation [ 18 ]. Lu et al suggested a scoring system for predicting the metastases of specific LN in the central compartment [ 19 ]. However, CND should be mandatory in PTC patients with lateral neck LN metastases to avoid persistent disease and false negative skip metastases.…”