Abstract
BackgroundMost patients with papillary thyroid carcinoma (PTC) have an excellent prognosis. Although central lymph node invasion is frequent, management via central lymph node dissection (CLND) remains controversial. The present study retrospectively investigated independent predictors of pathologic central lymph node negativity (pCLN-) and established a prediction model for pCLN- in clinical lymph node negativity (cN0) PTC.MethodsA total of 2,687 patients underwent thyroid surgery for cN0 PTC from 2013 to 2018 at the First Affiliated Hospital of Chongqing Medical University, and lobectomy plus ipsilateral CLND was the basic surgical extent. Clinicopathological characteristics were reviewed and analyzed. Univariate and multivariate analyses were performed to identify factors related to pCLN-. A prediction model was established based on the results of multivariate analyses.ResultsThe pCLN- rate was 51.5% (1,383/2,687). Multivariate analysis revealed that sex, age, thyroid stimulating hormone (TSH), size, location, laterality, unifocality and extrathyroidal extension negativity (ETE-) were independent predictors of pCLN-. The nomogram showed good discriminative ability (C-index: 0.784 and 0.787 in derivation and validation groups, respectively) and was well calibrated. We quantified the clinical usefulness of the nomogram by decision curve analysis. The median length of follow-up was 30 (range 12– 83) months, and 190 cases were lost, with a follow-up rate of 92.9% (2,497/2,687). Of the 2,687 patients included, 21 (0.8%) experienced recurrence.ConclusionThis nomogram, which integrates available preoperative clinicopathological features and intraoperative frozen biopsy outcomes, is a reliable tool with high accuracy to predict pCLN- in cN0 PTC.
Highlights
Thyroid cancer is the most common endocrine malignancy, and papillary thyroid carcinoma (PTC) accounts for more than 90% of cases
Multivariate analysis revealed that sex, age, thyroid stimulating hormone (TSH), size, location, laterality, unifocality and extrathyroidal extension negativity (ETE-) were independent predictors of pCLN
The 2015 American Thyroid Association (ATA) and 2021 National Comprehensive Cancer Network (NCCN) guidelines recommend that T1 and T2 clinical lymph node negativity (cN0) PTC should not be treated using prophylactic central lymph node dissection (CLND)
Summary
Thyroid cancer is the most common endocrine malignancy, and papillary thyroid carcinoma (PTC) accounts for more than 90% of cases. The ultrasonic signs of typical lymph node metastasis primarily include a round shape, disappearance of the lymphatic hilum, mass hyperechoic regions, calcification foci (primarily microcalcification; coarse calcification is rare), cystic changes, and peripheral or mixed blood flow distribution signals. None of these features alone is sufficient to diagnose all metastatic lymph nodes, and the accuracy of the evaluation is limited based on considering the experience of clinicians, the function of instruments and heterogeneity among patients, the accuracy of the evaluation is limited [8,9,10]. The present study retrospectively investigated independent predictors of pathologic central lymph node negativity (pCLN-) and established a prediction model for pCLN- in clinical lymph node negativity (cN0) PTC
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