Central Compartment Lymph Node Metastasis Research Articles

Prediction of central lymph node metastasis in patients with papillary thyroid microcarcinoma by gradient-boosting decision tree model based on ultrasound radiomics and clinical features.

In recent years, the study of radiomics in thyroid diseases has developed rapidly. This study aimed to establish a preoperative radiomics prediction model for central compartment lymph node metastases (CLNMs) in papillary thyroid microcarcinoma (PTMC) patients using gradient-boosting decision tree (GBDT) model and evaluate the performance of the model. A total of 274 patients with PTMC admitted for thyroid surgery at China-Japan Union Hospital of Jilin University from January 2020 to July 2022 were retrospectively analyzed. Patients were randomized into training and validation cohorts according to a ratio of 8:2. Radiomics features were extracted from the ultrasound (US) images of PTMC lesions. The open-source software Pyradiomics was used to extract radiomics features, and WEKA software was used to select CLNM-related radiomics features. Clinical risk factors for CLNM were screened by statistical methods. The GBDT model was constructed by combining radiomics features and clinical risk factors, and compared with the diagnostic efficacy of US-reported cervical lymph node status. Shapley Additive exPlanations (SHAP) was applied to visualize and analyze the GBDT model globally and locally. A total of seven radiomics features were significantly correlated with central lymph node status in the training and validation cohorts. The predictors in the GBDT model included the radiomics features, sex, age, and body mass index (BMI). The area under the curve (AUC) values of the GBDT model in the training and validation cohorts were 0.946 [95% confidence interval (CI): 0.920-0.972] and 0.845 (95% CI: 0.714-0.976), respectively, compared with 0.583 (95% CI: 0.508-0.659) and 0.582 (95% CI: 0.430-0.736) for US-reported lymph node status alone. The Delong test showed a significant difference between AUS in the training and validation cohorts (P<0.001, respectively). SHAP visual analysis showed the effect of each parameter on the GBDT model globally and locally. Decision curve analysis demonstrated the clinical utility of the GBDT model. The prediction of CLNM by the GBDT model, based on US radiomics features and clinical factors, can be better than that by using US alone in patients with PTMC. Furthermore, the GBDT model may serve a guidance of clinical decision for patient's treatment strategy.

Intraoperative frozen section for determining the extent of surgery in papillary thyroid carcinoma: comprehensive risk factor assessment.

There is much debate on the optimal treatment approach of papillary thyroid carcinoma (PTC). Different guidelines base recommendations on various risk factors. While diagnosing the various risk factors is difficult due to the technical limitations, intraoperative frozen section (IFS) may be a feasible method. We aim to real-time evaluate the multiple risk factors, including lymph node metastasis (LNM), extrathyroidal extension (ETE), multifocality using IFS, and then identify a more effective surgical plan, which may help avoid the need for a second surgery and improve prognosis of patients. We retrospectively reviewed the medical records of 364 patients from January 1, 2021 to December 31, 2021. All the patients were initially recommended to undergo a hemithyroidectomy (HT) with isthmusectomy and ipsilateral central compartment neck dissection (CCND). IFS would be executed immediately. Further total thyroidectomies (TTs) would be performed if: (I) results of IFS showed >5 LNM, or (II) there are 1≤ LNM ≤5 but with ETE and/or multifocal carcinoma. The patients were divided and investigated according to the extent of surgery. Based on the results of IFS, 72 patients underwent TT. The TT group displayed larger average tumor diameter, greater age, higher average body mass index (BMI), and elevated incidence of hypertension and hyperlipidemia compared to the HT group. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IFS were 77.61%, 100%, 100%, and 88.46%, respectively. IFS is a highly reliable procedure. Comprehensively evaluating central compartment LNM, ETE, and multifocal carcinoma through IFS helps identify a more reasonable surgical option under the current clinical consensus, which may thus help avoid the need for a second surgery.

Clinicopathological features and surgical treatment of thyroid papillary carcinoma in Hashimoto thyroiditis

Background and Aim: Papillary thyroid carcinoma (PTC) is the most prevalent types of thyroid cancer. The present study aimed to investigate the clinicopathological features and surgical treatment of thyroid papillary carcinoma in Hashimoto thyroiditis. Patients and Methods: A cross-sectional study was carried out on 486 papillary thyroid carcinoma patients in the surgical department of Mardan Medical Complex, Mardan Pakistan from March 2020 to March 2023. All the patients were categorized into two groups: Group-I (papillary thyroid carcinoma with Hashimoto thyroiditis) and Group-II (papillary thyroid carcinoma without Hashimoto thyroiditis). Serum thyroid-stimulating hormone (TSH), age, central compartment lymph node metastasis (CLNM), gender, nodular size, and invasive status were different clinicopathological factors recorded. SPSS version 27 was used for data analysis. Results: The overall mean age was 42.84±10.8 years. Out of 486 patients, Group-I had 76 (15.6%) patients whereas Group-II had 410 (84.4%) patients. There were 52 (10.7%) male and 434 (89.3%) females. The incidence of final diagnosis of benign thyroid nodule and PTC was 53.9% (n=262) and 46.1% (n=224) respectively. The prevalence of PT in Group-I was significantly higher 56.8% 57.9% (n=44) than in Group-II 43.4% (n=178).

FREQUENCY OF HASHIMOTO THYROIDITIS IN PAPILLARY THYROID CANCER PATIENTS AND ITS IMPACT ON THEIR OUTCOME

Introduction: There is conicting information on Hashimoto thyroiditis (HT) and the risk of cancer. The purpose of this study was to look at the coexistence of papillary thyroid carcinoma (PTC) and HT. Aims: To aims of the study hashimoto thyroiditis in patients with papillary thyroid cancer: frequency and effect on their outcome. Material and methods: It is a retrospective review of patients who got admitted with the diagnosis of papillary thyroid cancer from Jan 2021 to December 2022 at MGIMS Sewagram, Maharashtra. Results: In the entire presently analyzed material, the presence of central compartment lymph node metastases was signicantly higher in patients with cancer and Hashimoto thyroiditis (PTC- HT081 (30.4 %) vs. non-HT-PTC0121 (12.8 %)). According to numerous reports, metastatic foci in cervical lymph nodes accompany both “clear” cancer forms and tumors presenting with symptoms of chronic lymphocytic thyroiditis. Conclusion: Analyzing this aspect, we may say that primary total thyroidectomy also limits the number of permanent complications, which in a signicant percentage of cases pose a considerable threat in the course of reoperation. In our opinion, the above-described rationale provides a foundation for considering radical surgical treatment in cases of nodular lesions being present in immunologically altered thyroid gland

Application of decision tree algorithms to predict central lymph node metastasis in well-differentiated papillary thyroid carcinoma based on multimodal ultrasound parameters: a retrospective study.

Prophylactic central neck dissection (pCND) in patients with well-differentiated primary papillary thyroid carcinoma (PTC) has become controversial. Several attempts have been made to predict central compartment lymph node metastasis (CLNM) based on clinical and conventional ultrasonic parameters. This study aimed to develop a decision tree (DT) model for predicting the risk of CLNM in patients with PTC based on clinical and preoperative multimodal ultrasound (US) characteristics. A total of 148 PTC nodules confirmed by surgical pathology at Beijing Tiantan Hospital were retrospectively analyzed. All nodules underwent multimodal US examinations preoperatively from January 2020 to September 2021. Correlation analysis of CLNM with clinical characteristics as well as multimodal US parameters of PTC lesions based on gray-scale US, color Doppler flow imaging (CDFI), superb microvascular imaging (SMI), contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE) technology was carried out. Finally, the chi-squared automatic interaction detector (CHAID) with a 10-fold cross-validation was used to establish DTs for CLNM prediction. The area under the curve was calculated to compare the predictive performance. Univariate analysis indicated that CLNM was positively correlated with thyroglobulin level, maximum size, taller-than-wide, the number of microcalcifications greater than or equal to 5, contact capsule, abnormal cervical lymph node on conventional US, noncentripetal perfusion, delayed clearance, the average shear wave velocity (SWV mean), and the SWV ratio (P<0.05). The multimodal US DT based on taller-than-wide, contact capsule, abnormal cervical lymph node on conventional US, and centripetal enhancement as independent variables showed good discrimination: the sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were 80.0%, 76.7%, 78.4%, and 0.837 [95% confidence interval (CI): 0.771-0.902]. There was a significant difference between the multimodal and conventional US DTs (P=0.009). Our results indicated that the DT based on the preoperative multimodal US characteristics of PTCs has a reasonable predictive ability for CLNM and can be conveniently used for clinical decision-making of individualized treatment in patients with well-differentiated PTC.

Central Compartment Involvement in T3 &amp; T4 Papillary Thyroid Carcinoma

Background: Lymphatic metastasis in papillary thyroid cancer (PTC) is common; however, the extent of central compartment lymph nodes dissection (CCD) is controversial and requires the knowledge of pattern for central compartment (level VI) lymph nodes metastasis (CCM).&#x0D; Objective: To determine the frequency of central compartment (level VI) lymph node metastasis in T3 &amp; T4 papillary thyroid carcinoma.&#x0D; Methods: This study was conducted in the Department of Otolaryngology-Head &amp;Neck Surgery, BSMMU, Dhaka, from January 2019 to June 2020. A total of 31 cases of T3 &amp; T4 PTC were selected after obtaining clearance and approval from the IRB of BSMMU; the subjects were included based on the inclusion and exclusion criteria. After taking informed written consent detailed history and examination was done. Ultrasound neck and fine-needle aspiration cytology was taken from all thyroid swelling. All patients had underwent total thyroidectomy with central compartment dissection. The data were analyzed by computer-based statistical software SPSS version 26. Results were expressed as frequency and percentage. Z proportion test was done as applicable.&#x0D; Results: In this study, mean (±SD) tumor size was 3.66 (±1.34) cm. 20 (64.52%) had T3 and 11 (35.48%) T4 PTC. 11 (35.48%) had N0, 20 (64.52%) N1a and 8 (25.81%) N1b. 20 (64.52%) had overall central compartment lymph nodes metastasis. Among T3 papillary thyroid carcinoma, 12 (60%) had overall central compartment lymph nodes metastasis, and inT4 papillary thyroid carcinoma, 8 (72.7%) had overall central compartment lymph nodes metastasis. This difference was not statistically significant.&#x0D; Conclusion: The frequency of central compartment (level VI) lymph node metastasis (CCM) is high (64.52%) in T3 &amp; T4 papillary thyroid carcinoma. So central compartment (level VI) should be dissected in advanced (T3 &amp; T4) papillary thyroid carcinoma.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(2): 149-156

En bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach in papillary thyroid carcinoma.

The current study presents a preliminary exploration of en bloc resection via a gasless transoral approach in papillary thyroid carcinoma. This study aimed to summarize and explore the efficacy and safety of en bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach in patients with papillary thyroid carcinoma. This study was conducted between January 2021 and December 2021. It involved 30 patients with bilateral papillary thyroid carcinoma who had undergone en bloc resection of the total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach using a three-trocar and four-instrument technique at The First Affiliated Hospital of the University of Science and Technology of China. The key steps and difficulties of the operation were summarized, and the clinicopathological characteristics and surgical complications of patients were analyzed. All operations were successful without conversion to open surgery. The pathological diagnosis was bilateral papillary thyroid carcinoma. The mean maximum tumor diameter was 0.85 ± 0.51cm (range 0.3-2.5 cm). There was no case of gross capsular invasion. The mean number of harvested central compartment lymph nodes was 11.36 ± 5.36. Central compartment lymph node metastases were found in 16 patients (53.3%) with a mean of 1.53 ± 2.39. On the other hand, lymphocytic thyroiditis was observed in 12 cases (40%), and microscopic capsular invasion was observed in five cases (16.6%). All patients had normal parathyroid hormone levels after the operation. However, one patient developed hoarseness after the operation due to injury of the recurrent laryngeal nerve branch, but there was no numbness of the mandible and lower lip or infection of the oral incision. The study revealed that the three-trocar and four-instrument technique can be used in the en bloc resection of total thyroid and bilateral central compartment lymph nodes via a gasless transoral approach without disconnecting the thyroid isthmus. As a result, the operation is considered effective and safe. Therefore, this technique may be a better surgical method for patients with bilateral thyroid cancer and cosmetic needs.

Contrast-enhanced ultrasonography with intra-glandular contrast injection can improve the diagnostic accuracy of central compartment lymph node metastasis of thyroid cancer

To investigate the value of lymphatic contrast-enhanced ultrasound (LCEUS) with intra-glandular injection of contrast agent for diagnosis of central compartment lymph node metastasis of thyroid cancer. From November, 2020 to May, 2022, the patients suspected of having thyroid cancer and scheduled for biopsy at our center received both conventional ultrasound and LCEUS examinations of the central compartment lymph nodes before surgery. All the patients underwent surgical dissection of the lymph nodes. The perfusion features in LCEUS were classified as homogeneous enhancement, heterogeneous enhancement, regular/irregular ring, and non-enhancement. With pathological results as the gold standard, we compared the diagnostic ability of conventional ultrasound and LCEUS for identifying metastasis in the central compartment lymph nodes. Forty-nine patients with 60 lymph nodes were included in the final analysis. Pathological examination reported metastasis in 34 of the lymph nodes, and 26 were benign lymph nodes. With ultrasound findings of heterogeneous enhancement, irregular ring and non-enhancement as the criteria for malignant lesions, LCEUS had a diagnostic sensitivity, specificity and accuracy of 97.06%, 92.31% and 95% for diagnosing metastatic lymph nodes, respectively, demonstrating its better performance than conventional ultrasound (P < 0.001). Receiver-operating characteristic curve analysis showed that LCEUS had a significantly greater area under the curve than conventional ultrasound for diagnosing metastatic lymph nodes (94.7% [0.856-0.988] vs 78.2% [0.656-0.878], P=0.003). LCEUS can enhance the display and improve the diagnostic accuracy of the central compartment lymph nodes to provide important clinical evidence for making clinical decisions on treatment of thyroid cancer.

Efficacy, safety, and controversy of ultrasound-guided radiofrequency ablation in the treatment of T1N0M0 papillary thyroid carcinoma.

To evaluate the safety effect, and controversy on the treatment outcomes of radiofrequency ablation (RFA) for T1N0M0 papillary thyroid carcinoma (PTC). This study is assessed the medical records of 142 patients with primary T1N0M0 PTC tumors after RFA between 2014 and 2022. 4 patients underwent delayed surgery (DS) after RFA and 411 T1N0M0 patients underwent DS were recorded. Outcomes were compared between RFA and DS groups after propensity score matching (PSM). The maximal diameter (MD) and volume (V) increased in months 1 (P < 0.01) and reduced after the 6-month follow-up (all P < 0.01). The disappearance and disease progression rates were 53.5% and 2.1%, respectively. The complication and disease progression rates had no significant difference between RFA and DS (P>0.05). In some cases, the tumors were not fully inactivated after RFA, and the central compartment lymph node (CCLN) were metastasis. The CCLN metastasis rate was 13.4%. MD, V and clustered calcifications were independent risk factors for CCLN metastasis by univariate analysis. RFA is an effective and safe treatment option in selected patients with solitary T1N0M0 PTC. There are the risks of tumor incompletely ablated and CCLN metastasis.

Risk factor score for the prediction of central compartment lymph node metastasis in papillary thyroid carcinoma and its clinical significance.

To establish the criteria for a risk factor score (RFS) for predicting the probability of central compartment lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) and to explore the clinical significance of the RFS. The data of 412 patients with PTC who underwent surgical resection between May 2013 and July 2016 were retrospectively analysed and divided into two groups: a central LNM group and a non-central LNM group. In each group, the frequency of six risk factors was documented: sex, age, tumour size, extracapsular spread (ECS), tumour multifocality, and tumour location. The maximum likelihood method of discriminant analysis was adopted to calculate patient scores for the six risk indicators. In addition, the data of 104 patients with PTC admitted between July 2016 and December 2016 were prospectively analysed using this method and these six risk factors. A higher score represented one certain possibility that was the more appropriate for one patient. In the retrospective group, the result was as follows: 129 patients with positive (+) lymph nodes in the central compartment and 168 patients with negative (-) lymph nodes in the central compartment, which was in line with the actual results. In the prospective group, there were 28 patients with positive lymph nodes in the central compartment and 48 patients with negative lymph nodes in the central compartment. The coincidence rates using the RFS were 71.9% for the retrospective group and 73.1% for the prospective group. By simple and quantitative analyses of the presence of central LNM, the RFS is of great significance when choosing surgical approaches and postoperative individual-based treatment plans, as well as when determining the prognosis of central compartment LNM in patients with PTC.

Analysis of clinicopathological features of papillary thyroid carcinoma in solid organ transplant recipients: a retrospective study.

BackgroundWith the advances in organ transplantation technology and the increased number of organ recipients, more organ transplant recipients are living longer. However, many newly-onset thyroid cancer cases have been found among this population. The question remains in the uncertainty in whether the post-transplant thyroid cancer is more pathologically aggressive than the thyroid cancer in non-organ-transplant recipients. We compared the clinicopathological features of papillary thyroid carcinoma (PTC) between solid organ transplant recipients (SOTR) and the general population, in an attempt to improve the detection rate of post-transplant PTC in SOTR and overall survival prognosis of those patients.MethodsThe clinical data of 408 PTC patients in the First Affiliated Hospital of Zhejiang University School of Medicine from July 2013 to April 2019 were retrospectively analyzed. The clinicopathological features were compared between non-organ-transplant recipients with PTC (group A, n=380) and SOTR with newly-onset PTC (group B, n=31) using Chi-square test, Fisher’s exact test, Student’s t-test, and logistic regression.ResultsThere were significant differences between these two groups in central compartment lymph node metastasis (P=0.005), multifocality (P=0.003), and maximum tumor diameter (P=0.007). Compared with group A, group B had a higher rate of tumor multifocality, higher rate of lymph node metastasis, and smaller tumor size. In addition, PTC in group B was more aggressive in biological behaviors such as tumor multifocality and lymph node metastasis.ConclusionsCompared with the general population, PTC after SORT demonstrate a more malignant pathological feature. The examination rate of thyroid cancer in SORT should be increased to improve the overall prognosis after solid organ transplant.

The utility of sentinel Lymph node biopsy in the lateral neck in papillary thyroid carcinoma.

BackgroundRegional lymph node metastases (LNMs) are very common in papillary thyroid carcinoma (PTC) and associate with locoregional recurrence. The appropriate management of cervical lymph nodes is very important. Therefore, this study evaluated the application of sentinel lymph node biopsy (SLNB) in the lateral neck in PTC patients.MethodsThis prospective study was conducted from 1 November 2015 to 31 December 2017 and recruited 78 PTC patients treated with SLNB in the lateral neck and prophylactic lateral neck dissection (compartments II–IV) followed by thyroidectomy or lobectomy and central neck dissection.ResultsThere were 78 PTC patients enrolled and sentinel lymph nodes (SLNs) were detected among 77 patients. A total of 30 patients were diagnosed with SLN metastases (SLNMs). The remaining 47 patients were pathologically negative of SLN, whereas 4 patients were found with metastases in the non-SLN samples. The detection rate, sensitivity, specificity, and accuracy rate of SLNB in the lateral neck were 98.7%, 87.1%, 98.7%, and 93.6%, respectively. However, the values varied greatly in each specific compartment of the lateral neck, and all of them were no more than 80%. These 34 PTC patients diagnosed with lateral compartment LNM (LLNM) were more likely to be younger (41.38 vs. 48.95 years old, p = 0.002) and exhibit extrathyroidal extension (56.8% vs. 31.7%, p = 0.026) and central compartment LNM (66.7% vs. 12.1%, p < 0.001). Tumors located in the upper third of the thyroid lobe also had a significantly higher probability of LLNM compared with those in middle or inferior location (66.7% vs. 35.3% vs. 34.8%, p = 0.044). At last, age (OR=0.912, p = 0.026), tumor location (upper vs inferior, OR=17.478, p = 0.011), and central compartment LNM (OR=25.364, p < 0.001) were independently predictive of LLNM.ConclusionsSLNB can help surgeons to identify some PTC patients who may benefit from therapeutic lateral neck dissection and protect some patients from prophylactic lateral neck dissection. However, it cannot accurately indicate specific lateral compartment-oriented neck dissection. Meanwhile, LLNM is more likely to occur in PTC patients with younger age or upper pole tumors or central compartment LNM.

Ultrasound-based radiomics analysis for preoperative prediction of central and lateral cervical lymph node metastasis in papillary thyroid carcinoma: a multi-institutional study

BackgroundAn accurate preoperative assessment of cervical lymph node metastasis (LNM) is important for choosing an optimal therapeutic strategy for papillary thyroid carcinoma (PTC) patients. This study aimed to develop and validate two ultrasound (US) nomograms for the individual prediction of central and lateral compartment LNM in patients with PTC.MethodsA total of 720 PTC patients from 3 institutions were enrolled in this study. They were categorized into a primary cohort, an internal validation, and two external validation cohorts. Radiomics features were extracted from conventional US images. LASSO regression was used to select optimized features to construct the radiomics signature. Two nomograms integrating independent clinical variables and radiomics signature were established with multivariate logistic regression. The performance of the nomograms was assessed with regard to discrimination, calibration, and clinical usefulness.ResultsThe radiomics scores were significantly higher in patients with central/lateral LNM. A radiomics nomogram indicated good discrimination for central compartment LNM, with an area under the curve (AUC) of 0.875 in the training set, the corresponding value in the validation sets were 0.856, 0.870 and 0.870, respectively. Another nomogram for predicting lateral LNM also demonstrated good performance with an AUC of 0.938 and 0.905 in the training and internal validation cohorts, respectively. The AUC for the two external validation cohorts were 0.881 and 0.903, respectively. The clinical utility of the nomograms was confirmed by the decision curve analysis.ConclusionThe nomograms proposed here have favorable performance for preoperatively predicting cervical LNM, hold promise for optimizing the personalized treatment, and might greatly facilitate the decision-making in clinical practice.

Fortuitously detected Paget’s bone disease in a patient with TENIS syndrome on FDG PET/CT

A 74-year-old lady presented with a complaint of progressive neck swelling for two years. FNAC from the swelling was suggestive of papillary carcinoma thyroid (PCT). She underwent total thyroidectomy with central compartment lymph node dissection. Histopathology revealed multifocal PCT with central compartment lymph node metastases. Her baseline stimulated sTg was 5.3 ng/ml after levothyroxine withdrawal. WBS showed uptake in the operative bed (not shown). She was treated with 100 mCi of I-131 and was kept on a suppressive dose of thyroxin hormone. Her sTg gradually increased (77.5 ng/ml) in follow-up after three years. WBS was negative for metastatic disease. She underwent FDG PET/CT, that revealed cervical and upper mediastinal lymph nodes. Apart from that, multiple pagetic lesions were also noted. The patient had a history of mild localized pain and tenderness over these. Her Serum Alkaline phosphatase level was elevated (269 U/L). The patient refused resurgery for cervical lymph nodes. She is on Zolendronic acid infusion and remains asymptomatic. She is in regular follow-up, and her suppressedsTg remains stable even after two years.

A Thyroid Ultrasound Image-based Artificial Intelligence Model for Diagnosis of Central Compartment Lymph Node Metastasis in Papillary Thyroid Carcinoma

Objective To establish an artificial intelligence model based on B-mode thyroid ultrasound images to predict central compartment lymph node metastasis(CLNM)in patients with papillary thyroid carcinoma(PTC). Methods We retrieved the clinical manifestations and ultrasound images of the tumors in 309 patients with surgical histologically confirmed PTC and treated in the First Medical Center of PLA General Hospital from January to December in 2018.The datasets were split into the training set and the test set.We established a deep learning-based computer-aided model for the diagnosis of CLNM in patients with PTC and then evaluated the diagnosis performance of this model with the test set. Result The accuracy,sensitivity,specificity,and area under receiver operating characteristic curve of our model for predicting CLNM were 80%,76%,83%,and 0.794,respectively. Conclusion Deep learning-based radiomics can be applied in predicting CLNM in patients with PTC and provide a basis for therapeutic regimen selection in clinical practice.

Prevalence of Central Compartment Lymph Node Metastases in Papillary Thyroid Micro-Carcinoma: A Retrospective Evaluation of Predictive Preoperative Features.

Simple SummaryThe present study focused on patients affected by stage pT1a papillary thyroid micro-carcinomas that were treated with surgery and central lymph node dissection. In this study, male sex, low age, and sub-capsular carcinoma localization resulted as independent predictive factors for central lymph node metastases.Papillary thyroid micro-carcinomas are considered relatively indolent carcinomas, often occult and incidental, with good prognosis and favorable outcomes. Despite these findings, central lymph node metastases are common, and are related to a poor prognosis for the patient. We performed a retrospective analysis on patients treated with surgery for stage pT1a papillary thyroid micro-carcinomas. One hundred ninety-five patients were included in the analyses. The presence of central lymph node metastases was identified and studied. A multivariate analysis employing binary logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals of possible central lymph node metastases risk factors. In the performed multivariate analysis, male gender, younger age, and histopathological characteristics, such as a tumor sub-capsular localization, were significantly associated with central lymph node metastases in pT1a patients. Central compartment lymph node metastases are present in a non-negligible number of cases in patients with papillary thyroid micro-carcinoma undergoing surgical resection. Studying these factors could be an effective tool for predicting patients’ central lymph node metastases in papillary thyroid micro-carcinomas, defining a tailored surgical treatment in the future.

Utility and significance of clinical risk factor scoring model in predicting central compartment lymph node metastasis (CLNM) in patients with papillary thyroid cancer (PTC)

ABSTRACTObjectives:To establish and discuss the significance of a clinical risk factor scoring model in predicting central compartment lymph node metastasis (CLNM) (level VI) in patients with papillary thyroid cancer (PTC).Methods:A retrospective analysis was performed on 412 patients who underwent surgical treatment for PTC who were admitted to the Second Hospital of Hebei Medical University between July 2016 and May 2017, with the patients being divided into a CLNM group and a non-metastasis (NM) group. Risk factors such as sex, age, tumor diameter, capsular invasion, multifocality, and tumor location were recorded for scoring via maximum likelihood estimation (MLE)-based discriminant analysis. The scoring model was used for prospective analysis of CLNM in another 104 patients. Besides, the discriminant function that was developed using the risk factors based on the retrospective data derived from the 412 patients was evaluated by plugging the retrospective data in for specified variables, with a higher score indicating a greater risk of developing CLNM. Clinical diagnosis of CLNM was based on postoperative paraffin section pathology, which was adopted as the criterion to assess discriminative accuracy in the prospective and retrospective groups.Results:The discriminative accuracy of the scoring model was 71.8% in the retrospective group and 72.2% in the prospective group.Conclusions:The scoring model enables simplified, quantitative analysis of CLNM in PTC patients. The scoring model has clinical significance in that it provides a basis for the choice of operation, personalized postoperative treatment, and prognosis of PTC.

The Impact of Coexistent Hashimoto's Thyroiditis on Central Compartment Lymph Node Metastasis in Papillary Thyroid Carcinoma.

BackgroundHashimoto’s thyroiditis (HT) is the most prevalent inflammatory disorder of the thyroid gland. Current studies have reported the coexistence rate between HT and papillary thyroid carcinoma (PTC) is quite high. The objective of this study was to evaluate the impact of HT on the predictive factors of central compartment lymph node metastasis (CLNM) in PTC.MethodsA retrospective investigation was performed on PTC patients. They were subclassified into HT and non-HT groups. The results of preoperative neck ultrasound (US) examinations were reviewed. The clinical characteristics and the predictive value for CLNM were explored and compared between the two groups.ResultsA total of 756 patients were included in this study. There were more female patients (86.1%) in the PTC coexistent with the HT group than non-HT group. The patients with HT group had higher preoperative serum level of TSH. There was statistically significant difference between the HT patients and non-HT patients in nodular vascularization. Univariate and multivariate analyses showed that male, age ≤45 years old, tumor diameter >1 cm, and presence of suspicious central compartment lymph node on US, irregular nodular shape, multifocal carcinoma were independent predictive factors of CLNM in PTC patients. It was showed that male, age ≤45 years old, tumor diameter >1 cm, multifocality, and presence of suspicious central lymph node on US were risk factors for CLNM in non-HT patients. Only tumor diameter >1 cm and presence of suspicious central lymph node on US were independently correlated with CLNM in HT patients. The sensitivity of the multivariate model was 63.5%, and specificity was 88.9% for prediction CLNM in HT patients. For non-HT patients, the AUC was 80.6%, the sensitivity of the multivariate model was 64.5%, and specificity was 85.2%ConclusionPTC combined with HT is more common in women, and TSH level in HT group is higher than that in patients with PTC alone. Regardless of that HT is not a related risk factor of CLNM in PTC, our result suggested that different predictive systems should be used for HT and non-HT patients respectively to have a more accurate evaluation of CLNM in clinic.

Serum Calcitonin-Negative Medullary Thyroid Carcinoma: A Case Series of 19 Patients in a Single Center.

IntroductionMedullary thyroid carcinoma (MTC) is a rare cancer that accounts for 5% of thyroid cancers. Serum calcitonin is a good biomarker for MTC, which is used for diagnosis, prognosis, and monitoring of recurrence. Calcitonin-negative MTC (CNMTC) is rare but confounds diagnostic and prognostic directions. This study introduces 19 cases of CNMTC in a single center.MethodFrom 2002 March to 2020 July, more than 76,500 patients had undergone thyroid surgery due to thyroid cancer at the Severance Hospital, and a total of 320 patients were diagnosed with MTC (0.4%). Serum calcitonin levels were obtained from every patient who was suspected with MTC. These patients had undergone either bilateral total thyroidectomy or unilateral thyroidectomy with central compartment lymph node dissection, and additional modified radical lymph node dissection if lateral lymph node metastasis was positive. Postoperative monitoring and out-patient clinic follow-up were performed with obtaining the serum calcitonin levels.ResultNineteen patients tested negative for calcitonin preoperatively (6%). The mean preoperative calcitonin level was 5.1pg/mL if undetectable level is regarded as 0pg/mL. Only two patients were males, and the female bias was significant (p = 0.017). No one except two patients with modified radical neck dissection showed central compartment lymph node metastasis. Every patient’s postoperative calcitonin level remained low. The median follow-up period was 71 months. There was no recurrence and only one fatality, and the overall survival rate was 95%.ConclusionSince incidence of CNMTC is not negligible, MTC should not be ruled out in the diagnostic phase even if serum calcitonin is negative in preoperative examination. We presented 19 cases of CNMTC whose prognosis in general were favorable. Markers of serum and immunohistochemical samples other than calcitonin should be actively examined.

Image Segmentation of Thyroid Nodule and Capsule for Diagnosing Central Compartment Lymph Node Metastasis.

Thyroid ultrasound (US) image segmentation is of great significance for both doctors and patients. However, it is a challenging task because of the low image quality, low contrast and complex background in each US image. In recent years, some researchers have done thyroid nodule segmentation tasks, but the results achieved are not particularly satisfactory. In this paper, we have broadened the targets of interest and included both thyroid nodules and capsules into our research scope. We propose a method that implements a C-MMDetection to detect and extract the region of interest (ROI), and a modified salient object detection network U2-RNet to segment nodules and capsules respectively. Experiments show that our method segments nodules and capsules in US images more effectively than other networks, which is very helpful for doctors to diagnose central compartment lymph node metastasis (CLNM).