Li Ning, He Ju-Hua, Song Chao, Yang Li-Chun, Zhang Hong-Jiang, Li Zhi-Hai
Department of Ultrasound, Yunnan Kungang Hospital, Kunming, Yunnan Province, People's Republic of China.
Department of Function Examination, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, Yunnan Province, People's Republic of China.
Cancer Manag Res. 2020 Oct 29;12:10789-10797. doi: 10.2147/CMAR.S278382. eCollection 2020.
It is controversial whether contralateral prophylactic central neck dissection (PCND) should be performed for patients with solitary and clinical lymph node negative (cN) papillary thyroid carcinoma (PTC) although routine ipsilateral PCND is required.
The aim of this study was to develop an improved nomogram including clinical features, ultrasound, and acoustic radiation force impulse (ARFI) elastography for the prediction of contralateral central lymph node metastasis (CLNM) in patients with solitary and cN PTC in the preoperative period.
A total of 340 patients were retrospectively included as the training cohort and 170 patients as the external validation cohort. Patients were grouped according to the pathological results of contralateral CLNM. The association between the clinical characteristics, ultrasound, and ARFI elastography and the risk for contralateral CLNM were analyzed. A nomogram was established based on the result of multivariable logistic analysis to predict the risk of contralateral CLNM, which was assessed by internal and external validation.
CLNM was found in 213 patients (41.8%), among whom 142 (27.8%) had ipsilateral CLNM and 95 (18.6%) had contralateral CLNM (including 68 (13.3%) with bilateral CLNM). Multivariable analysis revealed that patients with younger age, male gender, larger tumor size, closer distance from the capsule, microcalcification, and larger SWV were independent predictors associated with the contralateral CLNM ( < 0.05), which was served as the basis of the nomogram. It showed good discrimination (C-index: 0.856) and calibration ( = 9.028, = 0.340, Hosmer-Lemeshow test) in the training cohort, and good discrimination was maintained in the external validation cohort (C-index: 0.792).
The nomogram utilizing the features of ultrasound combined with ARFI elastography in preoperatively predicting the risk of contralateral CLNM in patients with solitary and cN PTC was established, which showed superior performance both in internal and external validation.
对于孤立性且临床淋巴结阴性（cN）的乳头状甲状腺癌（PTC）患者，尽管常规需要进行同侧预防性中央区颈部清扫术（PCND），但对侧预防性中央区颈部清扫术（PCND）是否应实施仍存在争议。
本研究的目的是开发一种改进的列线图，纳入临床特征、超声和声学辐射力脉冲（ARFI）弹性成像，用于术前预测孤立性且cN的PTC患者的对侧中央区淋巴结转移（CLNM）。
共纳入340例患者作为训练队列，170例患者作为外部验证队列。根据对侧CLNM的病理结果对患者进行分组。分析临床特征、超声和ARFI弹性成像与对侧CLNM风险之间的关联。基于多变量逻辑分析结果建立列线图以预测对侧CLNM风险，并通过内部和外部验证进行评估。
213例患者（41.8%）发现有CLNM，其中142例（27.8%）有同侧CLNM，95例（18.6%）有对侧CLNM（包括68例（13.3%）双侧CLNM）。多变量分析显示，年龄较小、男性、肿瘤较大、距包膜较近、微钙化和较大的剪切波速度（SWV）的患者是与对侧CLNM相关的独立预测因素（<0.05），这作为列线图的基础。其在训练队列中显示出良好的区分度（C指数：0.856）和校准度（=9.028，=0.340，Hosmer-Lemeshow检验），在外部验证队列中也保持了良好的区分度（C指数：0.792）。
建立了利用超声特征结合ARFI弹性成像术前预测孤立性且cN的PTC患者对侧CLNM风险的列线图，其在内部和外部验证中均表现出优异性能。
