A multivariable model of BRAFV600E and ultrasonographic features for predicting the risk of central lymph node metastasis in cN0 papillary thyroid microcarcinoma
Received 30 December 2018
Accepted for publication 4 July 2019
Published 30 July 2019 Volume 2019:11 Pages 7211—7217
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Beicheng Sun
Bao-Ding Chen,1,* Zheng Zhang,1,* Ke-Ke Wang,1 Meng-Yuan Shang,1 Shuang-Shuang Zhao,1 Wen-Bo Ding,2 Rui Du,1 Zhuan Yu,1 Xi-Ming Xu3
1Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People’s Republic of China; 2Department of Medical Ultrasound, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing 210028, People’s Republic of China; 3Department of Pharmaceutics, School of Pharmacy and Center for Drug/Gene Delivery and Tissue Engineering, Jiangsu University, Zhenjiang, Jiangsu 212001, People’s Republic of China
*These authors contributed equally to this work
Background: Prophylactic central lymph node dissection (CLND) in papillary thyroid microcarcinoma (PTMC) patients without clinical evidence of central lymph node metastasis (CLNM) remains controversial. The purpose of our study is to identify preoperative predictive factors for finding CLNM in Chinese PTMC patients, which may allow tailored CLND.
Methods: We retrospectively reviewed 182 consecutive Chinese PMTC patients with negative central lymph nodes who underwent total thyroidectomy plus central neck dissection from October 2015 to December 2017. Chi-squared and multivariate analysis were performed to evaluate the association of CLNM with ultrasonographic and clinicopathologic characteristics. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the utility of markers in predicting CLNM.
Results: The CLNM was found in 39.0% (71 of 182) of cN0 PTMC patients. In multivariate analysis, tumor size>7 mm (OR: 3.636, 95% CI: 1.671–7.914), marked hypoechogenicity (OR: 2.686, 95% CI: 1.080–6.678), multifocality (OR: 4.184, 95% CI: 1.707–10.258) and BRAFV600E mutation (OR: 5.339, 95% CI: 2.529–11.272) were independent predictors of CLNM. In ROC analysis integrating these predictors, the sensitivity was 63.4% and specificity was 80.2%, and the area under the ROC (AUC) was 0.755.
Conclusion: In conclusion, we found tumor size>7 mm, marked hypoechogenicity, multifocality, and BRAFV600E mutation were risk factors for CLNM. In term of these preoperative risk factors for CLNM, prophylactic CLND should be cautiously performed in cN0 PTMC patients.
Keywords: central lymph node metastasis, prophylactic central lymph node dissection, papillary thyroid microcarcinoma, risk factor
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