Integrating BRAFV600E mutation, ultrasonic and clinicopathologic characteristics for predicting the risk of cervical central lymph node metastasis in papillary thyroid carcinoma

Abstract

Background The advantages of prophylactic central lymph node dissection (CLND) for clinically node-negative patients remained a great deal of controversies. Our research was aimed to analyze the relationship between cervical central lymph node metastasis (CLNM) and BRAFV600E mutation, ultrasonic and clinicopathologic characterizes in papillary thyroid carcinoma (PTC). Methods and materials In current study, a total of 112 consecutive PTC patients who experienced thyroidectomy plus cervical central neck dissection were included in our research. All PTC were pre-operatively analyzed by ultrasonic features, including tumor size, multifocality or not, tumor location, internal components, echogenicity, microcalcification, margins, orientation, taller than wide shape, and internal vascularity. The presence of clinicopathologic factors, including age, sex, T stage, Hashimoto’s thyroiditis, and BRAFV600E mutation was then investigated. Univariate and multivariate analysis were conducted to check into the relationship between predictive factors and cervical CLNM in PTC patients, and then a predictive model was also established. Results Pathologically, 58.0% (65/112) of the PTC patients harbored cervical CLNM. Univariate and multivariate analysis were conducted to identify age < 55 years, tumor size > 10 mm, microcalcification, non-concomitant Hashimoto’s thyroiditis and BRAFV600E mutation were predictive factors for cervical CLNM in PTC. The risk score for cervical CLNM in PTC patients was calculated: risk score = 1.284 × (if age < 55 years) + 1.241 × (if tumor size > 10 mm) + 1.143 × (if microcalcification) – 2.097 × (if concomitant Hashimoto’s thyroiditis) + 1.628 × (if BRAFV600E mutation). Conclusion Age < 55 years old, PTC > 10 mm, microcalcification, non-concomitant Hashimoto’s thyroiditis and BRAFV600E mutation are predictive factors for cervical CLNM. BRAFV600E mutation by pre-operative US-FNA technology synergized with clinicopathologic and ultrasonic features is expected to guide the appropriate surgical management for PTC patients.

A radiomics nomogram for the ultrasound-based evaluation of central cervical lymph node metastasis in papillary thyroid carcinoma

“…Some previous studies suggested that BRAF V600E was associated with the aggressiveness of PTC and poor prognosis. Zhang et al found that the BRAF V600E mutation was also a predictive factor for cervical LN metastasis in addition to age, tumour size, microcalcification and nonconcomitant Hashimoto's thyroiditis (39). To the best of our knowledge, there is no report that a US radiomics model involving BRAF V600E mutation status would be developed to predict central cervical LN metastasis in PTC patients.…”

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

“…Our results showed that D ≤10 mm was a risk factor for skip metastases of PTCs. Zhang et al reported that tumor size was significantly associated with lymph node metastasis ( 22 ), and the frequency of CLNM is known to increase with tumor size in PTC ( 23 ). Compared with small nodules (D ≤10 mm), large nodules are more invasive, and a wider range of lymph nodes may be involved, which could lead to a higher risk of concurrent CLNM and LLNM ( 24 ).…”

Integrating US-guided FNAB, BRAFV600E mutation, and clinicopathologic characteristics to predict cervical central lymph-node metastasis in preoperative patients with cN0 papillary thyroid carcinoma

“…The use of molecular diagnostic testing has had a significant impact on the diagnosis and management of thyroid nodules and thyroid cancer [ 30 ]. Our retrospective study utilized preoperative FNAB specimens to detect BRAF mutations.…”