Zhang Xiaochen, Zhu Jianing, Ai Xin, Dang Meizheng, Huang Pintong
Department of Ultrasound in Medicine, Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou.
Department of Ultrasound in Medicine, Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzho.
Med Ultrason. 2024 Dec 19;26(4):369-375. doi: 10.11152/mu-4411. Epub 2024 Jul 29.
Performing prophylactic central lymph node dissection for papillary thyroid microcarcinoma (PTMC) patients with clinically negative lymph node metastasis remains controversial - not all patients with PTMC are suitable for active surveillance. Therefore, we aimed to establish a nomogram based on ultrasound features for predicting CLNM in PTMC.
This retrospective study included 636 patients with PTMC, in which the CLNM status was pathologically confirmed. Univariate and multivariate regression analyses were conducted to screen for risk factors associated with CLNM. Then, a CLNM prediction model was established, receiver operating characteristic, calibration, and decision curve analyses were used to assess the model's performance.
Five variables, including age, sex, combined CLNM status, tumor size, and capsule invasion, were included in the nomogram. The values of the area under the receiver operating characteristic curve in the training and validation datasets were 0.720 (95% confidence interval [CI], 0.649-0.791) and 0.704 (95% CI, 0.622-0.786), respectively.
An ultrasound-based nomogram was successfully established, of which the predictive model shows excellent predictive performance and can be used to evaluate the status of CLNM in PTMC. Thus, patients with high nomogram scores should be considered for prophylactic central neck dissection.
对于临床淋巴结转移阴性的甲状腺微小乳头状癌（PTMC）患者行预防性中央区淋巴结清扫仍存在争议——并非所有PTMC患者都适合主动监测。因此，我们旨在建立一种基于超声特征的列线图，用于预测PTMC患者的中央区淋巴结转移（CLNM）。
这项回顾性研究纳入了636例PTMC患者，其CLNM状态经病理证实。进行单因素和多因素回归分析以筛选与CLNM相关的危险因素。然后，建立CLNM预测模型，采用受试者工作特征曲线、校准曲线和决策曲线分析来评估模型的性能。
列线图纳入了五个变量，包括年龄、性别、合并CLNM状态、肿瘤大小和包膜侵犯。训练数据集和验证数据集中受试者工作特征曲线下面积的值分别为0.720（95%置信区间[CI]，0.649 - 0.791）和0.704（95%CI，0.622 - 0.786）。
成功建立了一种基于超声的列线图，其预测模型显示出优异的预测性能，可用于评估PTMC患者的CLNM状态。因此，列线图评分高的患者应考虑行预防性中央区颈清扫术。
