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Clinicopathologic factors and preoperative ultrasonographic characteristics for predicting central lymph node metastasis in papillary thyroid microcarcinoma: a single center retrospective study / Fatores clínico-patológicos e características ultrassonográficas pré-operatórias na previsão de metástase em linfonodos centrais no microcarcinoma papilífero da tireoide: um estudo retrospectivo de centro único
Jiwang, Liang; Yahong, Luo; Kai, Liang; Bo, Huang; Yuejiao, Zhao; Haotian, Wang; Tao, Yu.
  • Jiwang, Liang; Cancer Hospital of China Medical University. Liaoning Cancer Hospital & Institute. Department of Head and Neck Surgery. Shenyang. CN
  • Yahong, Luo; Cancer Hospital of China Medical University. Liaoning Cancer Hospital & Institute. Department of Medical Imaging. Shenyang. CN
  • Kai, Liang; Cancer Hospital of China Medical University. Liaoning Cancer Hospital & Institute. Department of Medical Imaging. Shenyang. CN
  • Bo, Huang; Cancer Hospital of China Medical University. Liaoning Cancer Hospital & Institute. Department of Pathology. Shenyang. CN
  • Yuejiao, Zhao; Cancer Hospital of China Medical University. Liaoning Cancer Hospital & Institute. Department of Head and Neck Surgery. Shenyang. CN
  • Haotian, Wang; Dalian Medical University. The First Clinical College. Grade 2016 Clinical Medicine Class 5. Shenyang. CN
  • Tao, Yu; Cancer Hospital of China Medical University. Liaoning Cancer Hospital & Institute. Department of Medical Imaging. Shenyang. CN
Braz. j. otorhinolaryngol. (Impr.) ; 88(1): 36-45, Jan.-Feb. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364585
ABSTRACT
Abstract Introduction The treatment of papillary thyroid microcarcinoma remains controversial. Central lymph node metastasis is common in papillary thyroid microcarcinoma and it is an important consideration in treatment strategy selection. Objective The aim of this study was to investigate clinicopathologic risk factors and thyroid nodule sonographic characteristics for central lymph node metastasis in papillary thyroid microcarcinoma. Methods We retrospectively reviewed the data of 599 papillary thyroid microcarcinoma patients who underwent surgery from 2005 to 2017 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic factors and preoperative sonographic features of central lymph node metastasis. A receiver-operating characteristic, ROC curve analysis, was performed to identify the efficacy of ultrasonographic features in predicting central lymph node metastasis. A nomogram based on the risk factors was established to predict central lymph node metastasis. Results The incidence of central lymph node metastasis was 22.4%. The univariate and multivariate analyses suggested that gender, age, multifocality, extrathyroidal invasion, and lateral lymph node metastasis were independent risk factors for central lymph node metastasis. The univariate and multivariate analyses revealed that nodular shape, margin, and calcification were independently associated with central lymph node metastasis. The ROC curve analysis revealed that the combination of shape, margin and calcification had excellent accuracy in predicting central lymph node metastasis. The nomogram was developed based on the identified risk factors for predicting central lymph node metastasis, and the calibration plot analysis indicated the good performance and clinical utility of the nomogram. Conclusions Central lymph node metastasis is associated with male gender, younger age (<5 years), extrathyroidal invasion, multifocality and lateral lymph node metastasis in papillary thyroid microcarcinoma patients. The ultrasongraphic features, such as irregular shape, ill-defined margin and calcification, may improve the efficacy of predicting central lymph node metastasis. Surgeons and radiologists should pay close attention to the patients who have these risk factors. The nomogram may help guide surgical decision making in papillary thyroid microcarcinoma.
RESUMO
Resumo Introdução O tratamento do microcarcinoma papilífero de tireoide permanece controverso. A metástase em linfonodos centrais é comum e é uma consideração importante na seleção da estratégia de tratamento. Objetivo Investigar os fatores de risco clínico-patológicos e as características ultrassonográficas de nódulos tireoidianos para metástase em linfonodos centrais em microcarcinoma papilífero de tireoide. Método Foram analisados retrospectivamente os dados de 599 pacientes com microcarcinoma papilífero de tireoide submetidos à cirurgia de 2005 a 2017 em uma única instituição. Análises univariadas e multivariadas foram usadas para identificar os fatores clínico-patológicos e as características ultrassonográficas pré-operatórias das metástases em linfonodos centrais. Uma análise de curva ROC (receiver-operating characteristic) foi feita para identificar a eficácia das características ultrassonográficas na previsão dessas metástases. Um nomograma baseado nos fatores de risco foi estabelecido para prever a metástase em linfonodos centrais. Resultados A incidência de metástase em linfonodos centrais foi de 22,4%. As análises univariadas e multivariadas sugeriram que sexo, idade, multifocalidade, invasão extratireoidiana e metástase em linfonodos laterais eram fatores de risco independentes para a metástase em linfonodos centrais. As análises univariadas e multivariadas revelaram que o formato nodular, a margem e a calcificação estavam independentemente associadas à metástase em linfonodos centrais. A análise da curva ROC mostrou que a combinação do formato, margem e calcificação apresentou excelente precisão na previsão dessas metástases. O nomograma foi desenvolvido com base nos fatores de risco identificados para predizer a metástase em linfonodos centrais e a análise do gráfico de calibração indicou o bom desempenho e a utilidade clínica do nomograma. Conclusões Em pacientes com microcarcinoma papilífero de tireoide, metástase em linfonodos centrais está associado ao sexo masculino, menor idade ( < 45 anos), invasão extratireoidiana, multifocalidade e presença de metástase em linfonodos laterais. As características ultrassonográficas, como formato irregular, margem mal definida e calcificação, podem melhorar a eficácia da previsão de metástase em linfonodos centrais. Cirurgiões e radiologistas devem ficar mais atentos aos pacientes que apresentam esses fatores de risco. O nomograma pode ajudar a orientar a tomada de decisão cirúrgica para o microcarcinoma papilífero de tireoide.


Full text: Available Index: LILACS (Americas) Type of study: Observational study / Prognostic study / Risk factors Language: English Journal: Braz. j. otorhinolaryngol. (Impr.) Journal subject: Otolaryngology Year: 2022 Type: Article Affiliation country: China Institution/Affiliation country: Cancer Hospital of China Medical University/CN / Dalian Medical University/CN

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Full text: Available Index: LILACS (Americas) Type of study: Observational study / Prognostic study / Risk factors Language: English Journal: Braz. j. otorhinolaryngol. (Impr.) Journal subject: Otolaryngology Year: 2022 Type: Article Affiliation country: China Institution/Affiliation country: Cancer Hospital of China Medical University/CN / Dalian Medical University/CN