Analysis of risk factors for lateral lymph node metastasis in papillary thyroid carcinoma: A retrospective cohort study

Predicting central lymph node metastasis in papillary thyroid carcinoma combined with Hashimoto's thyroiditis: a preoperative study

BACKGROUND

Current studies have reported a high association between the Hashimoto's thyroiditis (HT) and papillary thyroid cancer (PTC). However, studies on the characteristics of central lymph node metastasis (CLNM) in PTC patients with HT are scarce. Therefore, this study aims to evaluate the risk factors of CLNM in PTC and HT patients.

METHODS

We retrospectively collected clinical data from 933 PTC patients with HT who underwent thyroid surgery. Of these, 653 patients were categorized into a training cohort for constructing the nomogram, and 280 patients formed a validation cohort to verify the performance of the model. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were used to select risk factors. A nomogram model for predicting CLNM was developed and internally validated. We subsequently evaluated thyroid function within 3 years after surgery and estimated the prevalence and incidence of postoperative complications between the CLNM ( +) and CLNM (-) groups.

RESULTS

LASSO regression revealed that 19 nonzero variables were associated with CLNM. Multivariate logistic regression analysis revealed that younger, patients of low body mass index (BMI), drinking, intranodular hyperechoic (IH) status, diameter ≥ 1 cm, multifocality, extrathyroidal extension (ETE), enlarged central lymph nodes (ECLNs) and lateral lymph node metastasis (LLNM) were at higher risk of CLNM (P < 0.05). A nomogram to predict CLNM in PTC patients with HT was constructed and internally validated on the basis of risk factors. The areas under the ROC curve (AUCs) of nomogram were 0.768 (95% CI, 0.723-0.812) and 0.773 (95% CI, 0.705-0.841) in training and validation groups, respectively. Moreover, the nomogram data showed a good discrimination and calibration ability to training and validation groups. Postoperative follow-up revealed that TGAb levels and the incidence of hypothyroidism were significantly greater in CLNM ( +) group than CLNM (-) group, respectively.

CONCLUSIONS

Our nomogram schedule developed and validated with a comprehensive set of preoperative risk factors showed a high benefit in predicting CLNM in PTC patients with HT. Postoperative follow-up of thyroid function allow to clarify the trend, as well as prevalence and incidence of common thyroid complications.

Preoperative Prediction of Occult Level V Lymph Node Metastasis in Papillary Thyroid Carcinoma: Development and Validation of a Radiomics-Driven Nomogram Model

RATIONALE AND OBJECTIVES

The study aimed to analyze the patterns and frequency of Level V lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC), identify its risk factors, and construct predictive models for assessment.

METHODS

We conducted a retrospective analysis of 325 PTC patients who underwent thyroidectomy and therapeutic unilateral bilateral modified radical neck dissection from October 2020 to January 2023. Patients were randomly allocated into a training cohort (70%) and a validation cohort (30%). The radiomics signature model was developed using ultrasound images, applying the minimum Redundancy-Maximum Relevance and Least Absolute Shrinkage and Selection Operator regression to extract high-throughput quantitative features. Concurrently, the clinic signature model was formulated based on significant clinical factors associated with Level V LNM. Both models were independently translated into nomograms for ease of clinical use.

RESULTS

The radiomics signature model, without the inclusion of clinical factors, showed high discriminative power with an area under the curve (AUC) of 0.933 in the training cohort and 0.912 in the validation cohort. Conversely, the clinic signature model, composed of tumor margin, simultaneous metastasis, and high-volume lateral LNM, achieved an AUC of 0.749 in the training cohort. The radiomics signature model exhibited superior performance in sensitivity, specificity, positive predictive value, negative predictive value across both cohorts. Decision curve analysis demonstrated the clinical utility of the radiomics signature model, indicating its potential to guide more precise treatment decisions.

CONCLUSION

The radiomics signature model outperformed the clinic signature model in predicting Level V LNM in PTC patients. The radiomics signature model, available as a nomogram, offers a promising tool for preoperative assessment, with the potential to refine clinical decision-making and individualize treatment strategies for PTC patients with potential Level V LNM.

Pretreatment level of circulating tumor cells is associated with lymph node metastasis in papillary thyroid carcinoma patients with ≤ 55 years old

OBJECTIVE

To investigate the relationship of pretreatment of circulating tumor cells (CTCs) and cervical lymph node metastasis (LNM) (central LNM (CLNM) and lateral LNM (LLNM)) in papillary thyroid carcinoma (PTC) patients with ≤ 55 years old.

METHODS

Clinicopathological data (CTCs level, Hashimoto's thyroiditis, thyroid function, multifocal, tumor size, invaded capsule, clinical stage, and LNM) of 588 PTC patients with ≤ 55 years old were retrospectively collected. The relationship of CLNM, LLNM and the clinical features of patients was analyzed. Univariate and multivariate logistic regression analyses were used to evaluate the relationship between the CTCs and CLNM, LLNM.

RESULTS

There were 273(46.4%) and 89(15.1%) patients with CLNM and LLNM, respectively. Patients with CLNM had higher proportions of multifocality, tumor size > 1 cm, invaded capsule, and positive CTCs level than those without (all p < 0.05). Patients with LLNM had higher proportions of multifocality, tumor size > 1 cm, and invaded capsule than those without (all p < 0.05). Logistic regression analysis showed that multifocality (odds ratio (OR): 1.821, 95% confidence interval (CI): 1.230-2.698, p = 0.003), tumor size > 1 cm (OR: 3.444, 95% CI: 2.296-5.167, p < 0.001), invaded capsule (OR: 1.699, 95% CI: 1.167-2.473, p = 0.006), and positive CTCs level (OR: 1.469, 95% CI: 1.019-2.118, p = 0.040) were independently associated with CLNM; and multifocality (OR: 2.373, 95% CI: 1.389-4.052, p = 0.002), tumor size > 1 cm (OR: 5.344, 95% CI: 3.037-9.402, p < 0.001), and invaded capsule (OR: 2.591, 95% CI: 1.436-4.674, p = 0.002) were independently associated with LLNM.

CONCLUSIONS

Preoperative CTCs positive was associated with CLNM in PTC patients with ≤ 55 years old, but not LLNM.

Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study

Background

The occurrence of cervical lymph node metastasis in T1 stage papillary thyroid carcinoma (PTC) is frequently observed. Notably, lateral lymph node metastasis (LLNM) emerges as a critical risk factor adversely affecting prognostic outcomes in PTC. The primary aim of this investigation was to delineate the risk factors associated with LLNM in the initial stages of PTC.

Methods

This retrospective analysis encompassed 3,332 patients diagnosed with T1 stage PTC without evident LLNM at the time of diagnosis. These individuals underwent primary surgical intervention at West China Hospital, Sichuan University between June 2017 and February 2023. The cohort was divided into two groups: patients manifesting LLNM and those without metastasis at the time of surgery. Additionally, T1 stage PTC patients were subdivided into T1a and T1b categories. Factors influencing LLNM were scrutinized through both univariate and multivariate analyses.

Results

The incidence of LLNM was observed in 6.2% of the cohort (206 out of 3,332 patients). Univariate analysis revealed significant correlations between LLNM and male gender (P<0.001), tumor localization in the upper lobe (P<0.001), maximal volume of the primary tumor (P<0.001), largest tumor diameter (P<0.001), multifocality (P<0.001), and bilaterality (P<0.001), with the exception of age (P=0.788) and duration of active surveillance (AS) (P=0.978). Multivariate logistic regression analysis identified male gender (P<0.001), upper lobe tumor location (P<0.001), maximal primary tumor volume (P<0.001), and multifocality (P<0.001) as independent predictors of LLNM. However, age categories (≤55, >55 years), maximum tumor diameter, bilaterality, and surveillance duration did not exhibit a significant impact. Comparative analyses between T1a and T1b subgroups showed congruent univariate results but revealed differences in multivariate outcomes. In the T1a subgroup, gender, tumor location, and multifocality (all P<0.05) were associated with elevated LLNM risk. Conversely, in the T1b subgroup, tumor location, dimensions, and multifocality (all P<0.05) were significant predictors of LLNM risk, whereas gender (P=0.097) exerted a marginal influence.

Conclusions

The investigation highlights several key risk factors for LLNM in T1 stage PTC patients, including gender, upper lobe tumor location, larger tumor size, and multifocality. Conversely, prolonged AS and younger age did not significantly elevate LLNM risk, suggesting the viability of AS as a strategic option in selected cases.

Prediction of bilateral thyroid carcinoma and lateral cervical lymph node metastasis in PTC patients with suspicious thyroid nodules

PURPOSE

This study aimed to evaluate the factors associated with bilateral papillary thyroid carcinoma (PTC) and lateral cervical lymph node metastasis (LLNM) in patients with suspicious unilateral PTC.

METHODS

This study analyzed patients with suspicious unilateral PTC who were enrolled in a university hospital between 2016 and 2019 in Zhejiang, China. Using logistic regression, the study examined the factors associated with bilateral PTC and LLNM in demographic data, anthropometric measurements, lifestyle factors, medical history, preoperative diagnostic tests, and histopathological factors.

RESULTS

A total of 256 patients, with a mean age of 49 years, were enrolled. Bilateral PTC was associated with multifocality (aOR: 5.069, 95% CI: 2.440-10.529, P < 0.001), and contralateral nodule in the upper (aOR: 9.073, 95% CI: 2.111-38.985, P = 0.003) and middle (aOR: 9.926, 95% CI: 2.683-36.717, P < 0.001). LLNM was positively associated with bilateral PTC (aOR, 4.283, 95% CI: 1.378-13.308, p = 0.012), male (aOR, 3.377, 95% CI: 1.205-9.461, P = 0.021), upper location of carcinoma (aOR, 3.311, 95% CI: 1.091-10.053, p = 0.035), and punctate echogenic foci (aOR, 3.309, 95% CI: 1.165-9.394, P = 0.025). Contralateral maximal nodule in the upper (aOR: 0.098, 95% CI: 0.015-0.628, p = 0.014), middle (aOR: 0.114, 95% CI: 0.033-0.522, p < 0.001), and lower (aOR, 0.028, 95% CI: 0.003-0.276, P = 0.002) location were inversely associated with LLNM.

CONCLUSION

Upper and middle location of contralateral nodule and tumor multifocality predicted the risk bilateral PTC. Bilateral PTC, male, upper tumor location, punctate echogenic foci and contralateral nodule location in the entire lobes were independent predictors for LLNM.

Detection of thyroglobulin for diagnosis of metastatic lateral cervical lymph nodes in papillary thyroid carcinoma: accuracy and application in clinical practice

Background

Accurate assessment of lateral cervical lymph node metastasis (LLNM) involvement is important for treating papillary thyroid carcinoma (PTC). Thyroglobulin is associated with LLNM, but there may be differences in the diagnostic value of serum thyroglobulin (sTg) and fine needle aspiration washout fluid thyroglobulin (FNA-Tg). Herein, we investigated the optimal cutoff value (OCV) of sTg and FNA-Tg and their diagnostic performance.

Methods

We enrolled 116 PTC patients who underwent radical resection of thyroid carcinoma with lateral cervical lymph node dissection at the Affiliated Hospital of Zunyi Medical University from June 2018 to July 2022. We used the receiver operating characteristic (ROC) curve analysis to determine the OCV for sTg and FNA-Tg to diagnose LLNM in PTC patients. We also evaluated the performance of FNA-Tg, sTg, fine needle aspiration cytology (FNAC), and their combinations for diagnosis. Pathological results were the gold standard.

Results

We performed 125 lymph node dissections, 106 had metastasis, and 19 did not. The OCV for sTg was 17.31 ng/mL [area under the curve (AUC) =0.760, sensitivity =78.30%, specificity =73.68%, and accuracy =77.60%]. Meanwhile, the OCV for FNA-Tg was 4.565 ng/mL (AUC =0.948, sensitivity =89.62%, specificity =100%, and accuracy =91.20%). The combination of FNAC and FNA-Tg presented the greatest diagnostic performance for LLNM detection in PTC patients. Moreover, serum antithyroglobulin antibody (TgAb) was not correlated with sTg or FNA-Tg levels.

Conclusions

The cutoff value for the diagnosis of LLNM in PTC are sTg >17.31 ng/mL or FNA-Tg >4.565 ng/mL. The combination method of FNA-Tg and FNAC is the most optimal choice for the diagnosis of LLNM and is highly recommended for further clinical application.

Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.