Preoperative Prediction of Occult Level V Lymph Node Metastasis in Papillary Thyroid Carcinoma: Development and Validation of a Radiomics-Driven Nomogram Model

Jia-Wei Feng; Feng Zheng; Shui-Qing Liu; Gao-Feng Qi; Xin Ye; Jing Ye; Yong Jiang

doi:10.1016/j.acra.2024.10.001

Preoperative Prediction of Occult Level V Lymph Node Metastasis in Papillary Thyroid Carcinoma: Development and Validation of a Radiomics-Driven Nomogram Model

Acad Radiol. 2024 Oct 22:S1076-6332(24)00760-8. doi: 10.1016/j.acra.2024.10.001. Online ahead of print.

Authors

Jia-Wei Feng¹, Feng Zheng², Shui-Qing Liu³, Gao-Feng Qi⁴, Xin Ye⁵, Jing Ye⁶, Yong Jiang⁷

Affiliations

¹ Department of thyroid surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China; Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
² Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
³ Department of Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
⁴ Department of Trauma Center, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
⁵ Department of General Surgery, Wujin Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, China.
⁶ Department of thyroid surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
⁷ Department of thyroid surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China. Electronic address: yjiang8888@hotmail.com.

PMID: 39443241
DOI: 10.1016/j.acra.2024.10.001

Abstract

Rationale and objectives: The study aimed to analyze the patterns and frequency of Level V lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC), identify its risk factors, and construct predictive models for assessment.

Methods: We conducted a retrospective analysis of 325 PTC patients who underwent thyroidectomy and therapeutic unilateral bilateral modified radical neck dissection from October 2020 to January 2023. Patients were randomly allocated into a training cohort (70%) and a validation cohort (30%). The radiomics signature model was developed using ultrasound images, applying the minimum Redundancy-Maximum Relevance and Least Absolute Shrinkage and Selection Operator regression to extract high-throughput quantitative features. Concurrently, the clinic signature model was formulated based on significant clinical factors associated with Level V LNM. Both models were independently translated into nomograms for ease of clinical use.

Results: The radiomics signature model, without the inclusion of clinical factors, showed high discriminative power with an area under the curve (AUC) of 0.933 in the training cohort and 0.912 in the validation cohort. Conversely, the clinic signature model, composed of tumor margin, simultaneous metastasis, and high-volume lateral LNM, achieved an AUC of 0.749 in the training cohort. The radiomics signature model exhibited superior performance in sensitivity, specificity, positive predictive value, negative predictive value across both cohorts. Decision curve analysis demonstrated the clinical utility of the radiomics signature model, indicating its potential to guide more precise treatment decisions.

Conclusion: The radiomics signature model outperformed the clinic signature model in predicting Level V LNM in PTC patients. The radiomics signature model, available as a nomogram, offers a promising tool for preoperative assessment, with the potential to refine clinical decision-making and individualize treatment strategies for PTC patients with potential Level V LNM.

Keywords: Lateral lymph node metastasis; Modified radical neck dissection; Papillary thyroid carcinoma; Radiomics; Ultrasound.