Risk factors of central neck lymph node metastasis following solitary papillary thyroid carcinoma

Abstract

Objective To evaluate the risk factors in terms of clinical characteristics, serological indicators and sonographic features regarding thyroid papillary carcinoma (PTC) for the central neck lymph node metastasis. Methods One thousand one hundred and seventy-four patients accepted thyroid cancer surgery at Fudan University Shanghai Cancer Center from January to September 2016 were enrolled. All patients were confirmed to be solitary PTC in paraffin wax pathology after thyroidectomy.Meanwhile, the status of central neck lymph node metastasis was determined referring to postoperative pathology. All features of the PTC lesion in terms of clinical, serological and sonographic features were evaluated for the association with central neck lymph node metastasis using univariate and multivariate logistic regression analysis. Meanwhile, a nomogram model was established for the determined risk factors. Results Out of 1 174 patients, 469 patients (39.9%) presented central neck lymph node metastasis, univariate analysis showed that age, gender, preoperative thyroglobulin(Tg) and thyroid peroxidase antibody(TPOAb), maximum diameter, location, close to the thyroid capsule, AP/TR, echo, acoustic halo, and presence of microcalcification were related with CLNM (P<0.05). Multivariate logistic regression analysis demonstrated that less than 55 years-old, male, Tg higher than 20 μg/L, TPOAb less than 1 kU/L, maximum diameter larger than 10 mm, and presence of microcalcification were independent risk factors for CLNM. The nomogram was established based on independent risk factors determined by the logistic regression with the AUC 0.714, specificity 73.1%, and sensitivity 59.7%. Conclusions For patients with single focal PTC lesion, younger age, male, higher Tg, lower TPOAb, and larger lesions containing microcalcificatin on ultrasound are associated with central neck lymph node metastasis. Key words: Ultrasonography; Papillary thyroid carcinoma; Lymph node metastasis; Nomogram