A Radiomic Nomogram for the Ultrasound-Based Evaluation of Extrathyroidal Extension in Papillary Thyroid Carcinoma.

Xian Wang,Qing Zhang,Xiaoqin Qian,Feiju Xu,Hui Sun,Enock Adjei Agyekum,Yongzhen Ren,Guoliang Zhang,Wenzhi Lv,Shudong Hu,Jin Zhang,Xiangshu Bo

doi:10.3389/fonc.2021.625646

Abstract

PurposeTo construct a sequence diagram based on radiological and clinical factors for the evaluation of extrathyroidal extension (ETE) in patients with papillary thyroid carcinoma (PTC).Materials and MethodsBetween January 2016 and January 2020, 161 patients with PTC who underwent preoperative ultrasound examination in the Affiliated People’s Hospital of Jiangsu University were enrolled in this retrospective study. According to the pathology results, the enrolled patients were divided into a non-ETE group and an ETE group. All patients were randomly divided into a training cohort (n = 97) and a validation cohort (n = 64). A total of 479 image features of lesion areas in ultrasonic images were extracted. The radiomic signature was developed using least absolute shrinkage and selection operator algorithms after feature selection using the minimum redundancy maximum relevance method. The radiomic nomogram model was established by multivariable logistic regression analysis based on the radiomic signature and clinical risk factors. The discrimination, calibration, and clinical usefulness of the nomogram model were evaluated in the training and validation cohorts.ResultsThe radiomic signature consisted of six radiomic features determined in ultrasound images. The radiomic nomogram included the parameters tumor location, radiological ETE diagnosis, and the radiomic signature. Area under the curve (AUC) values confirmed good discrimination of this nomogram in the training cohort [AUC, 0.837; 95% confidence interval (CI), 0.756–0.919] and the validation cohort (AUC, 0.824; 95% CI, 0.723–0.925). The decision curve analysis showed that the radiomic nomogram has good clinical application value.ConclusionThe newly developed radiomic nomogram model is a noninvasive and reliable tool with high accuracy to predict ETE in patients with PTC.

Highlights

Papillary thyroid carcinoma (PTC) occurs in 90% of patients with thyroid carcinoma [1,2,3]
Area under the curve (AUC) values confirmed good discrimination of this nomogram in the training cohort [AUC, 0.837; 95% confidence interval (CI), 0.756–0.919] and the validation cohort (AUC, 0.824; 95% CI, 0.723–0.925)
The decision curve analysis showed that the radiomic nomogram has good clinical application value

Summary

Introduction

Papillary thyroid carcinoma (PTC) occurs in 90% of patients with thyroid carcinoma [1,2,3]. PTC surgery mainly involves either total/ subtotal thyroidectomy or resection of the affected thyroid lobe and isthmus, but both surgical procedures have no significant effect on postoperative distant metastasis and mortality. Surgical procedures targeting only one thyroid lobe or the isthmus do retain some functionality of the thyroid gland but protect parathyroid functions and prevent injuries of the contralateral laryngeal recurrent nerve. Total/subtotal thyroidectomy is usually suggested for PTC patients with ETE, whereas PTC patients without ETE are treated with resection of the affected thyroid lobe and isthmus. There is a need for a noninvasive method to evaluate ETE, thereby avoiding total/ subtotal thyroidectomy in patients without ETE

Methods

Results

Conclusion