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Papillary thyroid carcinoma: an ultrasound-based nomogram improves the prediction of lymph node metastases in the central compartment

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To develop a nomogram based on postoperative clinical and ultrasound findings to quantify the probability of central compartment lymph node metastases (CLNM).

Methods

A total of 952 patients with histologically confirmed papillary thyroid carcinoma (PTC) were included in this retrospective study and assigned to three groups based on sex and age. The strongest predictors for CLNM were selected according to ultrasound imaging features, and an ultrasound (US) signature was constructed. By incorporating clinical characteristics, a predictive model presented as a nomogram was developed, and its performance was assessed with respect to calibration, discrimination and clinical usefulness.

Results

Predictors contained in the nomogram included US signature, US-reported LN status and age. The US signature was constructed with tumour size and microcalcification. The nomogram showed excellent calibration in the training dataset, with an AUC of 0.826 (95% CI, 0.765–0.887) for male patients, 0.818 (95% CI, 0.746–0.890) for young females and 0.808 (95% CI, 0.757–0.859) for elder females. For male and young female patients, application of the nomogram to the validation cohort revealed good discrimination, with AUCs of 0.813 (95% CI, 0.722–0.904) and 0.814 (95% CI, 0.712–0.915), respectively. Conversely, for elderly female patients, the nomogram failed to show good performance with an AUC of 0.742 (95% CI, 0.661–0.823).

Conclusion

This ultrasound-based nomogram may serve as a useful clinical tool to provide valuable information for treatment decisions, especially for male and younger female patients.

Key Points

• Age, gender, US-reported LN status and US signature were the strongest predictors of CLNM in PTC patients and informed the development of a predictive nomogram.

• Microcalcification was the strongest predictor in the US signature, as CLMN was identified in approximately 92% of patients characterised by diffuse microcalcification.

• Stratified by sex and age, this nomogram achieved good performance in predicting CLNM, especially in male and young female patients. This prediction tool may be useful as an imaging marker for identifying CLNM preoperatively in PTC patients and as a guide for personalised treatment.

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Abbreviations

ATA:

American Thyroid Association

CI:

Confidence interval

CLND:

Central compartment lymph node dissection

CLNM:

Central compartment lymph node metastases

LASSO:

Least absolute shrinkage and selection operator

LN:

Lymph node

PTC:

Papillary thyroid carcinoma

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Acknowledgements

The National Natural Science Foundation of China (NSFC), the Natural Science Foundation of Beijing, China (BJNSF) and the Innovation Cultivation Fund Project of the Seventh Medical Center of the PLA General Hospital are gratefully acknowledged. Yukun Luo, Qing Song, Ling Ren, Ying Zhang, Fang Xie, Yan Zhang, Jie Tang, Yaqiong Zhu and Zhuang Jin are gratefully acknowledged.

Funding

This study received funding from the National Natural Science Foundation of China (81771834 and 81901746); the Natural Science Foundation of Beijing, China (7194318); and the Innovation Cultivation Fund Project of the Seventh Medical Center of the PLA General Hospital (2015-LC-05).

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Authors and Affiliations

  1. Medical College of Nankai University, No.94, Weijin Road, Nankai District, Tianjin, 300071, People’s Republic of China

    Xiaoqi Tian, Ying Zhang, Yaqiong Zhu & Yukun Luo

  2. Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of China

    Xiaoqi Tian, Qing Song, Fang Xie, Ling Ren, Ying Zhang, Jie Tang, Yan Zhang, Zhuang Jin, Yaqiong Zhu, Mingbo Zhang & Yukun Luo

  3. Department of Ultrasound, Seventh Medical Center of the PLA General Hospital, Beijing, People’s Republic of China

    Qing Song

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  1. Xiaoqi Tian
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Correspondence to Yukun Luo.

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The scientific guarantor of this publication is Yukun Luo.

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Tian, X., Song, Q., Xie, F. et al. Papillary thyroid carcinoma: an ultrasound-based nomogram improves the prediction of lymph node metastases in the central compartment. Eur Radiol 30, 5881–5893 (2020). https://doi.org/10.1007/s00330-020-06906-6

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  • DOI: https://doi.org/10.1007/s00330-020-06906-6

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