基于超声影像与临床特征的儿童及青少年甲状腺乳头状癌侧颈部淋巴结转移预测模型：一项回顾性研究。

Prediction model for lateral lymph node metastasis of papillary thyroid carcinoma in children and adolescents based on ultrasound imaging and clinical features: a retrospective study.

机构信息

Department of ultrasound, The Sixth Affiliated Hospital, Sun Yat-sen University, Biomedical Innovation Center, 26 Yuancunerheng Street, Tianhe District, Guangzhou, China.

Department of ultrasound, The First People's Hospital of Foshan, Dafu Road, Chancheng District, Foshan, China.

出版信息

BMC Med Imaging. 2024 Aug 29;24(1):228. doi: 10.1186/s12880-024-01384-4.

DOI:10.1186/s12880-024-01384-4

PMID:39210250

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11361114/

Abstract

BACKGROUND

The presence of lateral lymph node metastases (LNM) in paediatric patients with papillary thyroid cancer (PTC) is an independent risk factor for recurrence. We aimed to identify risk factors and establish a prediction model for lateral LNM before surgery in children and adolescents with PTC.

METHODS

We developed a prediction model based on data obtained from 63 minors with PTC between January 2014 and June 2023. We collected and analysed clinical factors, ultrasound (US) features of the primary tumour, and pathology records of the patients. Multivariate logistic regression analysis was used to determine independent predictors and build a prediction model. We evaluated the predictive performance of risk factors and the prediction model using the area under the receiver operating characteristic (ROC) curve. We assessed the clinical usefulness of the predicting model using decision curve analysis.

RESULTS

Among the minors with PTC, 21 had lateral LNM (33.3%). Logistic regression revealed that independent risk factors for lateral LNM were multifocality, tumour size, sex, and age. The area under the ROC curve for multifocality, tumour size, sex, and age was 0.62 (p = 0.049), 0.61 (p = 0.023), 0.66 (p = 0.003), and 0.58 (p = 0.013), respectively. Compared to a single risk factor, the combined predictors had a significantly higher area under the ROC curve (0.842), with a sensitivity and specificity of 71.4% and 81.0%, respectively (cutoff value = 0.524). Decision curve analysis showed that the prediction model was clinically useful, with threshold probabilities between 2% and 99%.

CONCLUSIONS

The independent risk factors for lateral LNM in paediatric PTC patients were multifocality and tumour size on US imaging, as well as sex and age. Our model outperformed US imaging and clinical features alone in predicting the status of lateral LNM.

摘要

背景

儿童甲状腺乳头状癌（PTC）患者存在侧方淋巴结转移（LNM）是复发的独立危险因素。我们旨在确定儿童和青少年 PTC 患者术前发生侧方 LNM 的危险因素，并建立预测模型。

方法

我们基于 2014 年 1 月至 2023 年 6 月期间 63 例患有 PTC 的未成年人的数据开发了一个预测模型。我们收集并分析了患者的临床因素、原发肿瘤的超声（US）特征和病理记录。多变量逻辑回归分析用于确定独立预测因子并建立预测模型。我们使用受试者工作特征曲线（ROC）下面积评估危险因素和预测模型的预测性能。我们使用决策曲线分析评估预测模型的临床实用性。

结果

在患有 PTC 的未成年人中，有 21 例发生侧方 LNM（33.3%）。Logistic 回归显示，侧方 LNM 的独立危险因素为多灶性、肿瘤大小、性别和年龄。多灶性、肿瘤大小、性别和年龄的 ROC 曲线下面积分别为 0.62（p=0.049）、0.61（p=0.023）、0.66（p=0.003）和 0.58（p=0.013）。与单一危险因素相比，联合预测因素的 ROC 曲线下面积显著更高（0.842），其敏感性和特异性分别为 71.4%和 81.0%（临界值为 0.524）。决策曲线分析表明，预测模型具有临床实用性，阈值概率在 2%至 99%之间。