The International Journal of Romanian Society of Endocrinology / Registered in 1938

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July - September 2022, Volume 18, Issue 3
Endocrine Care

Zhang S, Xu C, Yang B, Yan D

Nomogram Combining Preoperative Ultrasonography with Clinical Features for Predicting Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve Metastasis in Patients with Papillary Thyroid Cancer

Acta Endo (Buc) 2022, 18 (3): 333-342
doi: 10.4183/aeb.2022.333

Aim. To establish a nomogram combining preoperative ultrasonic and clinical features for predicting lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC) patients. Methods. Preoperative ultrasonic and clinical variables of patients with PTC from 2014 to 2021 were retrospectively analyzed. The risk factors associated with LN-prRLN metastasis were identified and validated through a developed nomogram model based on univariate and multivariate logistic regression analysis. Results. A total of 615 patients (690 lesions) were enrolled for the training dataset and 207 patients (226 lesions) for the validation dataset with 54 (6.57%) patients developing LN-prRLN metastasis. Multivariate logistic regression analysis demonstrated that the preoperative ultrasound measurement of larger tumors (≥20 mm), higher TI-RADS category (category 5), and higher thyroglobulin level (9.86 ng/mL) in patients with PTC were predictive factors for LN-prRLN metastasis. The nomogram model was established and verified yielding a relatively good predictive performance in the training and validation dataset (AUC: 0.868 vs. 0.851). Conclusions. The nomogram combining preoperative ultrasonography with clinical features in this study is highly predictive of LN-prRLN metastasis in patients with PTC, which may provide more personalized recommendations for clinicians in preoperative decisionmaking for complete dissection of LN-prRLN.

Keywords: Nomogram, Lymph nodes posterior to the right recurrent laryngeal nerve, Ultrasonography, Papillary thyroid carcinoma.

Correspondence: Yan Ding MS, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Department of Medical Ultrasound, Wuxi, P.R. China. E-mail: