Nomograms Combining Ultrasonic Features With Clinical and Pathological Features for Estimation of Delphian Lymph Node Metastasis Risk in Papillary Thyroid Carcinoma

Abstract

BackgroundThis work explores the clinical significance of Delphian lymph nodes (DLN) in thyroid papillary carcinoma (PTC). At the same time, a nomogram is constructed based on clinical, pathological, and ultrasonic (US) features to evaluate the possibility of DLN metastasis (DLNM) in PTC patients. This is the first study to predict DLNM using US characteristics.MethodsA total of 485 patients, surgically diagnosed with PTC between February 2017 and June 2021, all of whom underwent thyroidectomy, were included in the study. Using the clinical, pathological, and US information of patients, the related factors of DLNM were retrospectively analyzed. The risk factors associated with DLNM were identified through univariate and multivariate analyses. According to clinical + pathology, clinical + US, and clinical + US + pathology, the predictive nomogram for DLNM was established and validated.ResultsOf the 485 patients with DLN, 98 (20.2%) exhibited DLNM. The DLNM positive group had higher positive rates of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM), and T3b–T4b thyroid tumors than the negative rates. The number of CLNM and LLNM lymph nodes in the DLNM+ group was higher as compared to that in the DLNM- group. Multivariate analysis demonstrated that the common independent risk factors of the three prediction models were male, bilaterality, and located in the isthmus. Age ≥45 years, located in the lower pole, and nodural goiter were protective factors. In addition, the independent risk factors were classified as follows: (I) P-extrathyroidal extension (ETE) and CLNM based on clinical + pathological characteristics; (II) US-ETE and US-CLNM based on clinical + US characteristics; and (III) US-ETE and CLNM based on clinical +US + pathological features. Better diagnostic efficacy was reported with clinical + pathology + US diagnostic model than that of clinical + pathology diagnostic model (AUC 0.872 vs. 0.821, p = 0.039). However, there was no significant difference between clinical + pathology + US diagnostic model and clinical + US diagnostic model (AUC 0.872 vs. 0.821, p = 0.724).ConclusionsThis study found that DLNM may be a sign that PTC is more invasive and has extensive lymph node metastasis. By exploring the clinical, pathology, and US characteristics of PTC progression to DLNM, three prediction nomograms, established according to different combinations of features, can be used in different situations to evaluate the transfer risk of DLN.

Accuracy of papillary thyroid cancer prognostic nomograms: a systematic review

“…Fifteen articles were excluded because they were repeated publication/overlapped samples ( n = 4), no surgical approach ( n = 3), outcomes different to those considered in the study ( n = 2), the nomograms were not reported ( n = 2), statistical model used to determine risk factors differed from logistic regression or Cox regression ( n = 2), nomograms used to evaluate the diagnostic accuracy of diffusion-weighted imaging ( n = 1), and a study related to micro PTC ( n = 1). Finally, 18 studies, for a total of 20 models, were included ( 10 , 19 , 20 , 29 , 35 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ). The studies included a total of 90,969 patients ( Table 1 ).…”

“…More than 50,000 patients were enrolled in the training set, 44,138 were used for validation of whom 3412 were in the external validation. Seventeen of the 19 studies were conducted in China ( 10 , 19 , 20 , 29 , 35 , 48 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 60 , 61 ), except for Kim's study, which was conducted in South Korea ( 54 ). Two studies began in 1997 and were completed in 2011 ( 49 ) and 2016 ( 54 ).…”

“…The other studies spanned a period between 2000 and 2020. Thirteen studies applied an internal validation procedure ( 10 , 20 , 29 , 35 , 48 , 49 , 50 , 51 , 52 , 55 , 56 , 57 , 61 ). Specifically, five studies used an apparent validation ( 10 , 29 , 48 , 51 , 56 ), six studies used split-sample validation with different ratios ( 20 , 35 , 49 , 50 , 61 ), and the remaining two studies used bootstrap validation ( 52 , 55 ).…”

“…The complete list of risk factors for each study is shown in Table 2 . Fifteen studies used multivariate logistic regression to identify factors after univariate logistic regression was previously performed ( 10 , 19 , 20 , 29 , 35 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 60 , 61 ), whereas only three studies used multivariate Cox regression analysis ( 19 , 48 , 49 ). Overall, 132 identified factors using a P -value below a predetermined value (0.1 or 0.05) were reported in nomograms, with a mean of 6 factors for each nomogram.…”

Nomogram for preoperative estimation risk of cervical lymph node metastasis in medullary thyroid carcinoma

“…Moreover, nomograms play important roles in personalized risk stratification and help doctors in choosing the treatments when no guidelines exist, especially in the field of cancer ( 20 ). Previous studies ( 21 – 24 ) have demonstrated that nomograms have been useful in predicting CLNM risk in PTC patients, but there were relatively few reports for predicting CLNM risk in MTC patients. In our present study, a noninvasive nomogram model for the preoperative prediction of CLNM of MTC was built using US features.…”