Risk factors of skip lateral cervical lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis

Zhao, Lingqian; Wu, Fan; Zhou, Tianhan; Lu, Kaining; Jiang, Kecheng; Luo, Dingcun

doi:10.1007/s12020-021-02967-9

Cited by 9 publications

(12 citation statements)

References 32 publications

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“…Consistent with previous studies ( 16 , 22 , 27 , 28 ), our study found that youth was a risk factor for CLNM in patients with PTC. In addition, it has been confirmed ( 29 ) that the survival rate of PTC patients combined with CLNM was significantly lower in those under 45 years of age, and the diagnostic threshold for age in our study was 42 years.…”

Section: Discussionsupporting

confidence: 93%

Development and validation of a nomogram for preoperative prediction of ipsilateral cervical central lymph node metastasis in papillary thyroid cancer: a population-based study

Zhao,

Li,

Zhang

2024

Gland Surg

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Background The incidence of papillary thyroid cancer (PTC) has increased dramatically, and it is susceptible to cervical lymph node metastasis (LNM), predominantly in the ipsilateral cervical central lymph node metastasis (CLNM). Ipsilateral cervical CLNM affects patients’ surgical options and survival rates. In this study, we integrated multiple factors to establish a nomogram-based preoperative prediction model of ipsilateral cervical CLNM in PTC. Methods Data were retrospectively collected from 609 patients with PTC admitted to Peking University International Hospital, all of whom underwent ipsilateral cervical lymph node dissection. They were randomly divided into a modeling set and validation set in the ratio of 7:3. Binary logistic regression was used to analyze independent risk factors for ipsilateral cervical CLNM in PTC and to construct a nomogram model. The performance of nomogram CLNM prediction was evaluated by the receiver operating characteristic (ROC) curve and calibration curve. Results Binary Logistic Regression showed that age, history of osteoporosis, complicated by Hashimoto’s thyroiditis, enlarged lymph nodes in the central neck, and extrathyroidal extension were risk factors for ipsilateral cervical CLNM. Combining these five independent risk factors, a nomogram prediction model was developed. In the modeling set, the area under the curve (AUC) of the nomogram ROC was 0.782 [95% confidence interval (CI): 0.730–0.833], and the sensitivity and specificity of the model were 0.761 and 0.763, respectively, with a well-calibrated curve fit. Moreover, the model presented better discrimination than any of the independent risk factors. The nomogram performed well in the validation set (AUC 0.753; 95% CI: 0.648–0.858). Conclusions A non-invasive, and accurate nomogram prediction model for ipsilateral cervical CLNM of PTC was established. It can help physicians identify patients with a high risk of ipsilateral cervical CLNM of PTC preoperative for individualized treatment.

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Section: Discussionsupporting

confidence: 93%

Development and validation of a nomogram for preoperative prediction of ipsilateral cervical central lymph node metastasis in papillary thyroid cancer: a population-based study

Zhao,

Li,

Zhang

2024

Gland Surg

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“…Weng and colleagues ( 4 ) also note that patients with superior pole tumors were more likely to develop skip metastases from PTMC than patients with tumors in other parts of the thyroid. Their data agree with many others who have found superior pole tumors of both papillary and medullary histology to be more likely to spread via skip metastases than tumors in other parts of the thyroid gland ( 5 , 6 ). In fact, the lymphatic drainage of the superior poles of the thyroid gland courses along the superior thyroid artery and may bypass the central compartment entirely ( 5 ).…”

supporting

confidence: 91%

“…Interestingly, skip metastases have been noted to more commonly occur in PTMC than in larger tumors ( 6 ). It is possible that tumors larger than 1 cm grow outside the region of isolated superior pole lymphatic drainage, and therefore spread both to the central and lateral nodes.…”

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confidence: 99%

“…Furthermore, in addition to the number of nodes involved, the size of the metastatic deposits and the presence of extranodal extension are better predictors of locoregional recurrence than the cervical compartment involved ( 8 ). The majority of PTC patients with lateral neck disease also have central neck disease ( 3 , 6 ); thus the presence of lateral neck metastases may simply be correlated with poor prognosis because it is a surrogate for disease burden in the majority of PTC patients.…”

mentioning

confidence: 99%

“…Many patients with lateral neck disease are treated with total thyroidectomy and adjuvant radioactive iodine (RAI) based on the assumption that tumor spread to lateral compartments equates to more aggressive disease. Although skip metastases are rare in PTC—representing approximately 2% of patients ( 4 , 6 )—perhaps we should treat them identically to patients with isolated central neck disease, and perform total thyroidectomy and adjuvant RAI treatment only in those with high risk of recurrence because of higher burden of nodal metastasis. That is, those patients with small metastases to fewer than 5 lymph nodes perhaps may safely be spared total thyroidectomy and subsequent RAI.…”

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confidence: 99%

See 2 more Smart Citations

Isolated Lateral Neck Nodal Metastases in Patients With Papillary Thyroid Cancer: Does Cervical Compartment Matter?

Ullmann

Duh

2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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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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Risk factors of skip lateral cervical lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis

Cited by 9 publications

References 32 publications

Development and validation of a nomogram for preoperative prediction of ipsilateral cervical central lymph node metastasis in papillary thyroid cancer: a population-based study

Development and validation of a nomogram for preoperative prediction of ipsilateral cervical central lymph node metastasis in papillary thyroid cancer: a population-based study

Isolated Lateral Neck Nodal Metastases in Patients With Papillary Thyroid Cancer: Does Cervical Compartment Matter?

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

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