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Ultrasound-based Nomogram for Predicting the Pathological Nodal Negativity of Unilateral Clinical N1a Papillary Thyroid Carcinoma in Adolescents and Young Adults

  • Author Footnotes
    a These authors contributed equally to this work.
    Yi Wei
    Footnotes
    a These authors contributed equally to this work.
    Affiliations
    Department of Ultrasound, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai 200032, China
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  • Author Footnotes
    a These authors contributed equally to this work.
    Peixuan Sun
    Footnotes
    a These authors contributed equally to this work.
    Affiliations
    Diagnostic Imaging Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
    Search for articles by this author
  • Cai Chang
    Affiliations
    Department of Ultrasound, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai 200032, China
    Search for articles by this author
  • Yuyang Tong
    Correspondence
    Address correspondence to: Y.T.
    Affiliations
    Department of Ultrasound, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai 200032, China
    Search for articles by this author
  • Author Footnotes
    a These authors contributed equally to this work.
Published:January 04, 2023DOI:https://doi.org/10.1016/j.acra.2022.11.025

      Rationale and Objectives

      To develop and validate a nomogram incorporating clinical and ultrasound (US) characteristics for predicting the pathological nodal negativity of unilateral clinically N1a (cN1a) papillary thyroid carcinoma (PTC) among adolescents and young adults.

      Materials and Methods

      From December 2016 to August 2021, 278 patients aged ≤ 30 years from two medical centers were enrolled and randomly assigned to the training and validation cohorts at a ratio of 2:1. After performing univariate and multivariate analyses, a nomogram combining all independent predictive factors was constructed and applied to the validation cohort. The performance of the nomogram was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis .

      Results

      Multivariate logistic regression analysis showed that unilateral cN1a PTC in young patients with Hashimoto's thyroiditis, T1 stage, no intra-tumoral microcalcification, and tumors located in the upper third of the thyroid gland was more likely to be free of central lymph node metastases. The nomogram revealed good calibration and discrimination in both cohorts, with areas under the receiver operating characteristic curve of 0.764 (95% confidence interval [CI]: 0.684–0.843) and 0.728 (95% CI: 0.602–0.853) in the training and validation cohorts, respectively. The clinical application of the nomogram was further confirmed using decision curve analysis.

      Conclusion

      This US-based nomogram may assist the assessment of central cervical lymph nodes in young patients with unilateral cN1a PTC, enabling improved risk stratification and optimal treatment management in clinical practice.

      Key Words

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