&lt;p&gt;Individualized Prediction Of Metastatic Involvement Of Lymph Nodes Posterior To The Right Recurrent Laryngeal Nerve In Papillary Thyroid Carcinoma&lt;/p&gt;

Zhu, Jiang; Huang, Rui; Hu, Daixing; Dou, Yi; Ren, Haoyu; Yang, Zhixin; Deng, Congrui; Xiong, Wei; Wang, Denghui; Yu, Mengxiao; Li, Xuesong; Su, Xinliang

doi:10.2147/ott.s220926

Cited by 9 publications

(12 citation statements)

References 34 publications

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“…Therefore, to improve the accuracy of evaluation of the nodal status, more attention should be paid to the intraoperative information (18). Intraoperative frozen section examination can be conveniently used to guide a real-time diagnosis of the DLN status (11). According to DLN status, we found the rate of CLNM differs significantly in cN0 (87.7% vs. 43.2%) and cN1 (98.1% vs. 68.8%).…”

Section: Discussionmentioning

confidence: 92%

Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma

Zhu¹,

Huang²,

Yü³

et al. 2021

Gland Surg

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Background: As is known, identifying risk factors precisely for lymph node metastasis (LNM) plays a vital role in initial treatment for papillary thyroid carcinoma (PTC). Nonetheless, whether Delphian lymph node (DLN) metastasis has value in predicting LNM remains an open question. This study covered a sample of 1,575 patients, which is the largest sample group so far, aiming to assess the predictive validity of DLN metastasis in PTC. Methods: This retrospective cohort study was conducted with 1,575 eligible PTC patients who underwent thyroid operation between July 2013 and December 2018 and clinicopathologic parameters of patients with DLN metastasis were compared with those without DLN metastasis. Results: The incidence of DLN metastasis, according to our research samples, is 24.4% (384/1,575 patients). And results show that DLN positivity was closely associated with adverse prognostic factors including younger age, larger tumor size, extrathyroid extension, tumor location in the isthmus or upper lobe of the thyroid, number of LNM >5, higher recurrence. After carefully adjusting important confounding factors, we find that in multivariate logistic regression analyses, DLN metastasis is an independent predictor for both central LNM (CLNM, adjusted OR =7.81, P<0.001) and lateral LNM (LLNM, adjusted OR =3.40, P<0.001). Moreover, the stratified analyses also show convincing evidence of a positive correlation between DLN metastasis and LNM in levels II-IV in the vast majority of subgroups.Conclusions: The present study suggests that DLN metastasis is an independent risk factor for CLNM and LLNM of levels II-IV. The cervical lymph nodes should be meticulously evaluated to guide tailored treatment during operation in patients with DLN involvement.

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Section: Discussionmentioning

confidence: 92%

Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma

Zhu¹,

Huang²,

Yü³

et al. 2021

Gland Surg

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“…After reading the titles and abstracts, we excluded articles that were not in accordance with the inclusion criteria, and 36 articles remained. Then, we screened the full texts, and 14 articles were ultimately included in this study (4,6,7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) (Table 1). The flowchart of article screening is shown in Figure 1.…”

Section: Results Of Filtering Literaturementioning

confidence: 99%

“…Twelve articles (4,6,7,(10)(11)(12)(13)(14)(15)(16)(17)19) were included in this study. In total, 3,368 patients had a tumour size >1 cm, and 6,012 patients had a tumour size ≤1 cm.…”

Section: Tumour Sizementioning

confidence: 99%

“…Eight studies (4,10,(12)(13)(14)(15)(16)19) involving 616 patients with LLN metastasis and 2,554 patients without LLN metastasis were analysed. In the analysis of risk factors for LLN metastasis, the results showed a significant difference between the two groups (OR=8.27, 95% CI: 6.37-10.75, P<0.001, I 2 =22%, Figure 11).…”

Section: Lateral Lymph Node (Lln) Metastasismentioning

confidence: 99%

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A meta-analysis of risk factors for lymph node posterior to the right recurrent laryngeal nerve metastasis in papillary thyroid carcinoma

Zhou

Zhao

et al. 2021

Gland Surg

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Background: Whether the lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) should be dissected is still controversial. This meta-analysis aimed to assess the risk factors for LN-prRLN metastasis in papillary thyroid carcinoma (PTC). Methods:We retrieved relevant studies published before May 2020 from the Wanfang Data, CNKI, PubMed, Embase, Web of Science and Cochrane Library databases. Heterogeneity was assessed with the Q-test and inconsistency index and sensitivity analysis and subgroup analysis were then used to find the source of heterogeneity. Begg test and generate a funnel chart to assess publication bias.Results: We retrieved 236 articles, 14 articles were selected as the subjects of our research. Fourteen studies involving 10,580 patients were analysed in this study. The LN-prRLN metastasis rate was 9.22% (975/10,580). The results of the meta-analysis showed that sex (P<0.001), age (P<0.001), tumour size (P<0.001), multifocality (P<0.001), capsular invasion (P=0.04), extrathyroidal extension (P<0.001), superficial central lymph node (VIa-LN) metastasis (P<0.001), and lateral lymph node (LLN) metastasis (P<0.001) were correlated with LN-prRLN metastasis. Discussion: Male sex, age ≤45 years, tumour size >1 cm, multifocality, capsular invasion or extrathyroidal extension, and VIa-LN metastasis or LLN metastasis in PTC patients were significant risk factors for predicting LN-prRLN metastasis. B ultrasound and CT scans are expected to predict LN-prRLN metastasis in the future.Registration: This research is registered on the PROSPERO website (registration number: CRD42020200898).

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“…At our institution, it is customary to perform pCLND for PTC patients and the detailed surgical procedures were described in previous articles (13,14). Soft tissues in the prelaryngeal and pretracheal regions were removed and marked as the Delphian (Figure 1) and pretracheal LNs, respectively.…”

Section: Surgical Strategymentioning

confidence: 99%

Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma

Zhu

Zheng

et al. 2021

Front. Med.

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Purpose: While there are no clear indications of whether central lymph node dissection is necessary in patients with T1-T2, non-invasive, clinically uninvolved central neck lymph nodes papillary thyroid carcinoma (PTC), this study seeks to develop and validate models for predicting the risk of central lymph node metastasis (CLNM) in these patients based on machine learning algorithms.Methods: This is a retrospective study comprising 1,271 patients with T1-T2 stage, non-invasive, and clinically node negative (cN0) PTC who underwent surgery at the Department of Endocrine and Breast Surgery of The First Affiliated Hospital of Chongqing Medical University from February 1, 2016, to December 31, 2018. We applied six machine learning (ML) algorithms, including Logistic Regression (LR), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), and Neural Network (NNET), coupled with preoperative clinical characteristics and intraoperative information to develop prediction models for CLNM. Among all the samples, 70% were randomly selected to train the models while the remaining 30% were used for validation. Indices like the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and accuracy were calculated to test the models' performance.Results: The results showed that ~51.3% (652 out of 1,271) of the patients had pN1 disease. In multivariate logistic regression analyses, gender, tumor size and location, multifocality, age, and Delphian lymph node status were all independent predictors of CLNM. In predicting CLNM, six ML algorithms posted AUROC of 0.70–0.75, with the extreme gradient boosting (XGBoost) model standing out, registering 0.75. Thus, we employed the best-performing ML algorithm model and uploaded the results to a self-made online risk calculator to estimate an individual's probability of CLNM (https://jin63.shinyapps.io/ML_CLNM/).Conclusions: With the incorporation of preoperative and intraoperative risk factors, ML algorithms can achieve acceptable prediction of CLNM with Xgboost model performing the best. Our online risk calculator based on ML algorithm may help determine the optimal extent of initial surgical treatment for patients with T1-T2 stage, non-invasive, and clinically node negative PTC.

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<p>Individualized Prediction Of Metastatic Involvement Of Lymph Nodes Posterior To The Right Recurrent Laryngeal Nerve In Papillary Thyroid Carcinoma</p>

Cited by 9 publications

References 34 publications

Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma

Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma

A meta-analysis of risk factors for lymph node posterior to the right recurrent laryngeal nerve metastasis in papillary thyroid carcinoma

Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma

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