Abstract

BackgroundThe preoperative distinguishment of lymph nodes with reactive hyperplasia or tumor metastasis plays a pivotal role in guiding the surgical extension for papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT), especially in terms of the central lymph node (CLN) dissection. We aim to identify the preparative risk factors for CLN metastasis in PTC patients concurrent with HT.Materials and MethodsWe retrospectively reviewed and analyzed the data including the basic information, preoperative sonographic characteristics, and thyroid function of consecutive PTC patients with HT in our medical center between Jan 2019 and Apr 2021. The Chi-square and Fisher’s exact tests were used for comparison of qualitative variables among patients with or without CLN metastasis. Univariate and multivariate logistic regression analyses were used to determine the risk factors for CLN metastasis. The nomogram was constructed and further evaluated by two cohorts produced by 1,000 resampling bootstrap analysis.ResultsA total of 98 in 214 (45.8%) PTC patients were identified with CLN metastasis. In multivariate analysis, four variables including high serum thyroglobulin antibody (TgAb) level (>1,150 IU/ml), lower tumor location, irregular margin of CLN, and micro-calcification in the CLN were determined to be significantly associated with the CLN metastasis in PTC patients with HT. An individualized nomogram was consequently established with a favorable C-index of 0.815 and verified via two internal validation cohorts.ConclusionsOur results indicated that preoperatively sonographic characteristics of the tumor and lymph node condition combined with serum TgAb level can significantly predict the CLN in PTC patients with HT and the novel nomogram may further help surgeons to manage the CLN in this subpopulation.

Highlights

  • Over the past few years, the standardized clinical management for papillary thyroid carcinoma (PTC) has aroused wide concern in global researchers [1,2,3], due to the significant increasing prevalence and overdiagnosis of thyroid cancer [4,5,6]

  • According to the latest management guidelines derived from the American Thyroid Association (ATA), lobectomy without central lymph node dissection (CLND) was evaluated to be a sufficient surgical extension for clinically lymph node negative patients with differentiated thyroid carcinoma (DTC) [3]

  • One recent study identified that the number of examined lymph nodes during the CLND was increased in PTC patients with Hashimoto’s thyroiditis (HT)

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Summary

Introduction

Over the past few years, the standardized clinical management for papillary thyroid carcinoma (PTC) has aroused wide concern in global researchers [1,2,3], due to the significant increasing prevalence and overdiagnosis of thyroid cancer [4,5,6]. According to the latest management guidelines derived from the American Thyroid Association (ATA), lobectomy without central lymph node dissection (CLND) was evaluated to be a sufficient surgical extension for clinically lymph node negative (cN0) patients with differentiated thyroid carcinoma (DTC) [3]. One recent study identified that the number of examined lymph nodes during the CLND was increased in PTC patients with HT. It did not increase the detection rate of positive lymph nodes [11]. The preoperative distinguishment of lymph nodes with reactive hyperplasia or tumor metastasis plays a pivotal role in guiding the surgical extension for papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT), especially in terms of the central lymph node (CLN) dissection.

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