Abstract
Purpose: This study aimed to establish and validate an ultrasound radiomics nomogram for the preoperative prediction of central lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC).Patients and Methods: The prediction model was developed in 609 patients with clinicopathologically confirmed unifocal PTC who received ultrasonography between Jan 2018 and June 2018. Radiomic features were extracted after the ultrasonography of PTC. Lasso regression model was used for data dimensionality reduction, feature selection, and radiomics signature building. The predicting model was established based on the multivariable logistic regression analysis in which the radiomics signature, ultrasonography-reported LN status, and independent clinicopathologic risk factors were incorporated, and finally a radiomics nomogram was established. The performance of the nomogram was assessed with respect to the discrimination and consistence. An independent validation was performed in 326 consecutive patients from July 2018 to Sep 2018.Results: The radiomics signature consisted of 23 selected features and was significantly associated with LN status in both primary and validation cohorts. The independent predictors in the radiomics nomogram included the radiomics signature, age, TG level, TPOAB level, and ultrasonography-reported LN status. The model showed good discrimination and consistence in both cohorts: C-index of 0.816 (95% CI, 0.808–0.824) in the primary cohort and 0.858 (95% CI, 0.849–0.867) in the validation cohort. The area under receiver operating curve was 0.858. In the validation cohort, the accuracy, sensitivity, specificity and AUC of this model were 0.812, 0.816, 0.810, and 0.858 (95% CI, 0.785–0.930), respectively. Decision curve analysis indicated the radiomics nomogram was clinically useful.Conclusion: This study presents a convenient, clinically useful ultrasound radiomics nomogram that can be used for the pre-operative individualized prediction of central LN metastasis in patients with PTC.
Highlights
The incidence of thyroid cancer has increased significantly in last two decades [1, 2], and the papillary thyroid carcinoma (PTC) accounts for the majority of thyroid cancers [3, 4]
Significant differences in some other clinical characteristics were not observed in both the LNpositive group (P = 0.894 for age, 0.972 for gender, 0.258 for thyroid stimulating hormone (TSH), 0.831 for TG, 0.297 for thyroglobulin antibodies (TGAB), 0.068 for thyroid peroxidase antibody (TPOAB), 0.602 for Bethesda category, 0.227 for TR score, and 0.349 for USreport lymph node (LN) status) and the LN-negative group
Some studies have been conducted to establish the clinical model for the prediction of central cervical LN metastasis in PTC patients [41,42,43,44], and their Area Under the Curve (AUC) range from 61.5 to 76.4%, which is similar to the diagnosis with combination of US and computer tomography (CT) [17, 18]
Summary
The incidence of thyroid cancer has increased significantly in last two decades [1, 2], and the papillary thyroid carcinoma (PTC) accounts for the majority of thyroid cancers [3, 4]. In the newly diagnosed thyroid cancers, the proportion of papillary thyroid microcarcinoma (PTMC), defined as PTC tumor ≤1 cm in diameter, increases dramatically [5,6,7]. High frequency ultrasound (US) can be employed to diagnose lateral cervical LN metastasis accurately and guide the biopsy [12,13,14]. The accuracy of US is relatively low in the diagnosis of central cervical LN metastasis due to the overlying thyroid gland [15, 16]. The accuracy is only about 70%, even combined with computer tomography (CT) [17, 18]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
