Preoperative US Integrated Random Forest Model for Predicting Delphian Lymph Node Metastasis in Patients with Papillary Thyroid Cancer.

BACKGROUND: Delphian lymph node (DLN) has been considered to be a gate that predicts widespread lymph node involvement, higher recurrence and mortality rates of head and neck cancer. OBJECTIVE: This study aimed to establish a preoperative ultrasonography integrated machine learning prediction model to predict Delphian lymph node metastasis (DLNM) in patients with diagnosed papillary thyroid carcinoma (PTC). METHODS: Ultrasonographic and clinicopathologic variables of PTC patients from 2014 to 2021 were retrospectively analyzed. The risk factors associated with DLNM were identified and validated through a developed random forest (RF) algorithm model based on machine learning and a logistic regression (LR) model. RESULTS: A total of 316 patients with 402 thyroid lesions were enrolled for the training dataset and 280 patients with 341 lesions for the validation dataset, with 170 (28.52%) patients developed DLNM. The elastography score of ultrasonography, central lymph node metastasis, lateral lymph node metastasis, and serum calcitonin were predictive factors for DLNM in both models. The RF model has better predictive performance in the training dataset and validation dataset (AUC: 0.957 vs. 0.890) than that in the LR model (AUC: 0.908 vs. 0.833). CONCLUSION: The preoperative ultrasonography integrated RF model constructed in this study could accurately predict DLNM in PTC patients, which may provide clinicians with more personalized clinical decision-making recommendations preoperatively. Machine learning technology has the potential to improve the development of DLNM prediction models in PTC patients.

Meta-analysis of the effect and clinical significance of Delphian lymph node metastasis in papillary thyroid cancer.

Objective: To investigate the effect and clinical significance of Delphian lymph nodes (DLN) on the factors influencing papillary thyroid cancer (PTC) to provide individualized guidance for the surgical treatment of thyroid cancer. Methods: Relevant studies from PubMed, Web of Science, the Cochrane Library, Embase, and China National Knowledge Infrastructure databases were searched until February 13, 2023. Stringent selection parameters were used to obtain included data and homogeneous articles. Analyses were performed using Revman 5.4 and SPSS software. A P-value of < 0.05 was considered statistically significant. Results: Five studies were finally included in this study. The results revealed a higher risk of DLN metastasis (DLNM) in patients with tumor size >1cm, multifocality, and extrathyroidal extension (ETE) of the thyroid. The risk of central lymph node metastasis (CLNM) was 11.25 times higher in DLN-positive patients with PTC than in DLN-negative (OR = 11.25, 95% CI: 8.64-14.64, P < 0.05) patients. The risk of LLNM was 5.57 times higher in DLN-positive patients with PTC than in DLN-negative (OR = 5.57, 95% CI: 4.57-6.78, P < 0.001) patients. The risk of postoperative recurrence in DLN-positive patients with PTC was 3.49 times higher (OR = 3.49, 95% CI: 1.91-6.38, P < 0.001) than in DLN-negative patients with PTC. Conclusion: Patients with tumor size >1 cm in diameter, multifocality, and ETE have an increased risk for DLN development. DLN-positive patients with central and lateral cervical lymph node metastasis and postoperative recurrence are at higher risk than DLN-negative patients.

The incidence and features of Delphian lymph node involvement in patients with papillary thyroid carcinoma.

INTRODUCTION: In papillary thyroid cancer patients, the extent of dissection is still a matter of debate. Evaluating Delphian lymph nodes (DLNs) during the surgery has been speculated as a valuable tool to determine the extent of dissection. Herein, we aimed to evaluate the incidence and features of DLNs involvement in patients with papillary thyroid carcinoma. METHOD: We conducted this cross-sectional study among surgical cases of papillary thyroid cancer. Patients were divided based on their DLNs involvement status. Their age, gender, location of the mass, lymphatic involvement, tumor size, tumor characteristics, pathology report, and operation note features were compared between the two groups. Definitive pathology slides of the patients were evaluated regarding DLN features. RESULTS: Of the 61 patients (mean age: 38.2 ± 12.0), 45 (73.8%) were females. In 13 (21.3%) patients, DLNs involvement was reported. A statistically significant relationship was noted between DLNs involvement and other lymph nodes' involvement on the same side of the mass (P < 0.001), the opposite side (P = 0.041), and also central lymph nodes (P < 0.001). Vascular invasion was also significantly higher among patients with DLNs involvement (P = 0.012). CONCLUSION: Since DLNs involvement is significantly associated with extensive nodal involvement, intraoperative evaluation of DLNs is recommended to establish the extent to which dissection should be performed.

Clinicopathological characteristics of papillary thyroid cancer located in the isthmus with Delphian lymph node metastasis.

Papillary thyroid carcinomas (PTC) arising from the isthmus have aggressive clinical and pathological features, especially regarding the Delphian lymph node (DLN), which are associated with poor overall and disease-specific survival of patients with head and neck cancer. In the present study, we evaluated clinicopathological characteristics in 195 DLN-positive isthmus PTCs (14.9%) and their lymph node metastatic pattern in 1305 isthmus PTC patients in our hospital between January 2016 and July 2019. Furthermore, a multivariate analysis was conducted to investigate independent risk factors for isthmus PTC with a positive DLN. The results showed that a positive DLN was significantly related to tumour size, extrathyroid extension, median number of DLN, and metastasis to the central, bilateral central, lateral, and pretracheal lymph nodes. Meanwhile, patients with DLN-positive PTC had a significantly increased incidence of suspected preoperative lymph node status than patients with DLN-negative PTC. Multivariate logistic regression of DLN metastasis in PTC located in the isthmus showed that tumour size, extrathyroid extension, and metastasis to the central, bilateral central, lateral, and pretracheal lymph nodes, were independent risk factors.

Role of Neck Dissection in Organ-Preservation for Glottic Squamous Cell Carcinoma.

The surgical approach to the neck in laryngeal cancer depends on the tumor site and stage. Clinical practice guidelines recommend elective neck dissection in ≥ T2 N0 and all supraglottic cancers; however, there is no evidence supporting these recommendations. The objective is to evaluate the results of bilateral elective neck dissection in patients with glottic cancer who underwent supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). Thirty-five patients diagnosed with ≥ T2 N0 laryngeal squamous cell carcinoma (LSCC) in a single-center retrospective study. Right-sided neck dissections yielded 900 lymph nodes, none of which were positive for metastatic disease. Left-sided neck dissections yielded 949 lymph nodes, one of which was positive for malignancy. Prelaryngeal (Delphian) neck dissection was performed in all patients. Out of 50 lymph nodes removed; one was positive for malignancy. Median overall survival was 172 months, and the 60-month overall survival was 87.3%. The 60-month disease-specific survival was 97.1%. Bilateral neck dissection and Delphian node dissection showed a low rate of metastasis (2.8%). Radical neck dissection may thus represent overtreatment; however, this surgical procedure could be justified to prevent regional recurrences.

Diagnostic Model Incorporating Clinicopathological Characteristics of Delphian Lymph Node Metastasis Risk Profiles in Papillary Thyroid Cancer.

The Delphian lymph node (DLN), also known as the prelaryngeal node, is one component of the central lymph node. The DLN has been well studied in laryngeal cancer, although its significance in papillary thyroid cancer (PTC) remains unclear. We retrospectively analyzed 936 patients with PTC who underwent thyroidectomy by a single surgeon in Tianjin Cancer Hospital from 2017 to 2019. Moreover, 250 PTC patients who underwent thyroidectomy by another surgeon in Tianjin Cancer Hospital from January 2019 to April 2019 were used as a validation cohort. Among the 936 patients with PTC, 581 patients (62.1%) had DLNs, of which 177 samples with metastasis (177/581, 30.5%) were verified. DLN metastasis was significantly correlated with sex, age, tumor size, bilateral cancer, multifocality, extrathyroidal extension, lymphovascular invasion and central and lateral neck lymph node metastasis. Multivariate analysis revealed that independent risk factors for DLN metastasis included age, gender, tumor size, extrathyroid extension, lymphovascular invasion and central lymph node metastasis, which determined the nomogram. In particular, tumor size was proven to be one of the most predominant single predictors. The diagnostic model had an area under the curve (AUC) of 0.829 (95% confidence interval, 0.804-0.854). The internal and external validations of the nomogram were 0.819 and 0.745, respectively. Our results demonstrate that DLN metastasis appears to be a critical parameter for predicting metastatic disease of the central compartments. Furthermore, this study provides a precise criterion for assessing DLN metastasis and has great clinical significance for treating PTC.

Predictive value of the Delphian lymph node in cervical lymph node metastasis of papillary thyroid carcinoma.

INTRODUCTION: Delphian lymph node metastasis (DLNM) has proven to be a risk factor for a poor prognosis in head and neck malignancies. This study aimed to reveal the clinical features and evaluate the predictive value of the Delphian lymph node (DLN) in papillary thyroid carcinoma (PTC) to guide the extent of surgery. METHODS: Tianjin Medical University Cancer Institute and Hospital pathology database was reviewed from 2017 to 2020, and 516 PTC patients with DLN detection were enrolled. Retrospective analysis was performed, while multivariate analysis was performed to identify the risk factors for DLNM. RESULTS: Among the 516 PTC patients with DLN detection, the DLN metastasis rate was 25.39% (131/516). Tumor size >1 cm, location in the upper 1/3, central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and lymphovascular invasion were independent risk factors for DLNM. Patients with DLNM had a higher incidence of ipsilateral CLNM, contralateral CLNM (CCLNM) and LLNM, and larger numbers and size of metastatic CLNs than those without DLNM. The incidence of CLNM among cN0 patients with DLNM was higher than that among those without DLNM. The incidence of CCLNM among unilateral cN + patients with DLNM was similarly higher than that among patients without DLNM. CONCLUSIONS: DLNM indicates a high likelihood and large number of cervical lymph nodes metastases in PTC patients. Surgeons are strongly recommended to detect DLN status during operation by means of frozen pathology, so as to evaluate the possibility of cervical nodal metastasis and decide the appropriate extent of surgery.

Clinical Study on Prelaryngeal Lymph Node Metastasis in Papillary Thyroid Carcinoma.

OBJECTIVE: This study aims to investigate the risk factors of prelaryngeal lymph node metastasis in papillary thyroid carcinoma and its clinical application value. METHODS: The clinical pathological features and metastatic risks were statistically analyzed by reviewing 254 patients with papillary thyroid carcinoma, who received their first operation and prelaryngeal lymph node dissection in our department. RESULTS: The detection of prelaryngeal lymph nodes, tumor size and any paratracheal lymph node metastasis were correlated with the number of paratracheal lymph node metastasis (P<0.05), but these were not correlated with age, gender, multiple foci, tumor size, any paratracheal lymph node metastasis, metastatic location, or foci location (P>0.05). CONCLUSION: Paratracheal lymph node metastasis indicates a high possibility of prelaryngeal lymph node metastasis. Paratracheal lymph node dissection combined with prelaryngeal lymph node dissection should be simultaneously considered in operations for thyroid papilla carcinoma.

Clinical implications of Delphian lymph node metastasis in papillary thyroid carcinoma: a single-institution study, systemic review and meta-analysis.

BACKGROUND: To evaluate the possible predictive value and clinicopathological characteristics of Delphian lymph node metastasis in papillary thyroid carcinoma. METHODS: A retrospective analysis of papillary thyroid carcinoma patients with Delphian lymph node metastasis in a single institution and meta-analysis of literature reports were performed. RESULTS: In own series, Delphian lymph node metastasis was detected in 19 (9.9%) of 192 papillary thyroid carcinoma patients and was significantly associated with tumor size≥1 cm (P = 0.003), multifocality (P = 0.006) and extrathyroid extension (P < 0.001) in the multivariate analysis. Female was a protective factor for Delphian lymph node metastasis (P = 0.001). Delphian lymph node metastasis was highly predictive of further central lymph node metastasis (positive predictive value = 89.5%, negative predictive value = 67.6%) and moderately predictive of lateral lymph node metastasis (positive predictive value = 26.3%, negative predictive value = 95.4%). In this meta-analysis, there was a strong correlation between Delphian lymph node metastasis and aggressive clinicopathologic characteristics with regards to multifocality (P = 0.0008), bilaterality (P = 0.04), extrathyroid extension (P < 0.00001), lymphovascular invasion (P < 0.00001), further central lymph node metastasis (P < 0.00001) and lateral lymph node metastasis (P < 0.00001). CONCLUSIONS: This single-institution observational study and meta-analysis identified that Delphian lymph node metastasis was significantly associated with unfavorable clinicopathological characteristics and had a strong predictive power for further disease in the central compartment. TRIAL REGISTRATION: The clinical study was retrospectively registered to UMIN clinical trials registry (the registry number: UMIN000033835 ).

Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancer patients with Delphian lymph node metastasis.

Although the roles of Delphian lymph node (DLN) metastasis in papillary thyroid cancer (PTC) have been previously reported, there are still limited data on correlations of clinicopathologic factors with DLN metastasis and unique patterns of cervical node subsite metastasis in PTC patients with DLN metastasis. We retrospectively reviewed medical records of 320 patients with a diagnosis of PTC who underwent primary surgery. Clinicopathologic features and DLN metastasis patterns were analyzed for predicting extensive cervical lymph node metastasis. Both univariate and multivariate Cox regression analyses were used to identify independent factors for cervical lymph node metastasis. DLN metastasis was significantly associated with multifocality, tumor size > 1 cm, extrathyroid extension, BRAFV600E mutation, central neck node metastasis (CNNM), and lateral neck nodes metastases. Patients with DLN metastasis had more lymph node metastases in the central compartment. CNNM number and tumor size > 1 cm were independent risk factors for DLN metastasis. DLN metastasis was highly predictive of lateral lymph node metastasis with moderate sensitivity and high specificity. DLN metastasis is associated with several poor prognostic factors, including extensive cervical lymph node metastasis, and can serve as a predictor of advanced PTC. The presence of DLN metastasis should prompt surgeons to perform an aggressive surgery approach.

The significance of Delphian lymph node in papillary thyroid cancer.

AIM: To investigate the clinical significance of the DLN metastasis in papillary thyroid cancer (PTC). METHODS: A total of 231 PTC patients who underwent first surgical treatment in the Department of Hand and Neck Surgery of Zhejiang Cancer Hospital from January 2013 to June 2014 were enrolled. The relationship between Delphian lymph node (DLN) metastasis and patient age, gender, tumor size, tumor number, unilateral or bilateral, capsular invasion, pretracheal and paratracheal node metastasis, and lateral node metastasis was analyzed. RESULTS: Within 231 cases, 69 showed DLN, but only 19 (8.23%) were found with metastasis. In the univariate analysis, DLN metastasis was significantly associated with tumor size (P = 0.023), capsular invasion (P = 0.001), pretracheal or paratracheal node metastasis (P = 0.003) and lateral node metastasis (P = 0.001), while there were no significant correlation between DLN metastasis and gender (P = 0.976), age (P = 0.976), tumor number (P = 0.234) and unilateral or bilateral (P = 0.724). In the multivariate analysis, capsular invasion was an independent risk factor of DLN metastasis (P < 0.05, odds ratio = 10.15). CONCLUSION: Capsular invasion is an independent risk factor of DLN metastasis and DLN metastasis could be used as a predictor of lateral node metastasis. The dissection of DLN in PTC patients is recommended and lateral lymph node should be evaluated for patients with DLN positive.

Clinical value of Delphian lymph node in papillary thyroid carcinoma / 国际外科学杂志

Objective To study the correlations between DLN and clinical pathological factors and provide clinical data for assessing the operation scopes and prognostic evaluations aims at further clarify its clinical values.Methods The research aimed at the 69 cases who undertook first-time surgery and confirmed thyroid papillary carcinoma by intraoperative frozen pathology from 2013 to 2014 in Wannan Medical college affiliated Yijishan Hospital.The groups was divided by whether the DLN had been detected and metastasized.And we made chi-square test or t test by using SPSS 22.0 to analysis between the clinical and pathological factors.Results The groups was divided by whether DLN had been metastasized from the detected cases and the results shown that there was no relationship with gender,age,tumor size,Hashimoto's thyroiditis and the number of COLN (which not including DLN).For multifocal cases (21.05％ vs 57.14％,P =0.047);for vascular infiltration,the positive cases of (10.53％ vs 71.43％,P＜0.001);for the metastasized rate of COLN,the positive cases of (65.79％ vs 14.29％,P =0.011);for the metastasized number of COLN,[(0.84 ± 1.48) vs (3.86 ± 3.08),P ＜ 0.001].All the data above illustrated that the two groups are statistically correlative in mulifocality,vascular infiltration,the metastasized rate of COLN and for the metastasized number of COLN.17.39％ of PTC cases can be detected by CD34 and D2-40.According to the presence of vascular infiltration,it can be divided into two groups,We contrast analyzed of the number of TCLN (include DLN),metastasized number of TCLN and the metastasized rate of TCLN.The results shown that the number of TCLN had no statistical differences,but significant in metastasized number of TCLN [(0.74 ± 1.83) vs (4.50 ± 2.20),P ＜ 0.001) and the metastasized rate of TCLN (29.82％ vs 100.00％,P ＜ 0.01)].Conclusions The DLN positive patients are more likely to have distant lymph node metastasized.If DLN positive,total thyroidectomy and bilateral central compartment neck dissection (CCND) has been necessary.Lateral selective neck node dissection (LSND) can be underwent after evaluating carefully combining with the history and preoperative images.CD34 and D2-40 could be the detection indexes of vascular infiltration for PTC.For the cases with vascular infiltration,it has a higher proportion to have the metastasized number and metastasized rate of TCLN and higher possibility of distant metastasis.So we should expand the scope of operation moderately and strengthen postoperative follow-up according to the history and preoperative images so as to reduce postoperative recurrence,distant metastasis rate and improve the living quality of patients.

The research progress in clinical relations between the Delphian node and papillary thyroid carcinoma / 实用肿瘤学杂志

Delphian lymph node is a part of Ⅵlymph node.According to the latest research ,the metasta-sis rate in papillary thyroid carcinoma ( PTC) is up to nearly 20%.Meanwhile ,the Ⅵlymph node is usually con-sidered as the sentinel lymph node of PTC metastasis .Most scholars believe that .Delphian lymph nodes may have certain clinical significance in the development process of PTC .This article aims to summarize the research pro-gress in clinical relations between the Delphian node and papillary thyroid carcinoma .

The Significance of Delphian Lymph Node in Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: The Delphian lymph node (DLN) has long beenregarded as a predictor of thyroid malignancy and indicator of advanced disease; however, there are a few published data in relation to the thyroid. Therefore we are to determine the significance of DLN involvement in differentiated papillary carcinoma. METHODS: We prospectively assessed the discovering rate of DLN and the frequency of DLN metastasis in the consecutive patients undergoing total thyroidectomy with central neck node dissection at Endocrine Surgery Department of our hospital. And we assessed whether DLN involvement may predict extensive cervical lymph node disease and other unfavorable prognostic factors. RESULTS: The DLN was separately removed and identified as such in 42 of 164 patients (25.6%), and 9 of 42 patients (21.4%) had DLN metastases. DLN involvement was not associated with larger tumor size (1.8 vs. 1.1 cm), age (41 vs. 46 years), perithyroidal tissue invasion (66.6 vs. 72.7%) and lymphovascular invasion. DLN involvement was highly predictive of central compartment metastasis (sensitivity 100%, specificity 41%), high proportion of metastatic nodes, and moderately suggestive of further disease in the lateral compartment (sensitivity 44%, specificity 92%). CONCLUSION: Although the clinical appearance of the DLN is not an accurate indicator of the presence of thyroid cancer, metastatic involvement of the DLN is an adverse prognostic marker in papillary thyroid cancer. The presence of DLN metastasis in patients with thyroid cancer should alert the surgeon to the high probability of advanced disease and need for paying greater attention to the central and lateral compartment lymph nodes.