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Use of New Nomogram in Predicting Lymph Node Metastasis in Papillary Thyroid Cancer

By: Hillary Ojeda
Posted: Wednesday, April 10, 2019

Yunjun Wang, MD, of the Fudan University Shanghai Cancer Center, Shanghai, and colleagues have developed a novel nomogram to risk stratify patients with papillary thyroid carcinoma who have clinically suspected lateral lymph node metastasis. Their study results, which were published in the Journal of Cancer, suggest there may be a relative lower incidence of level V lymph node metastasis in this patient population. As a result, it may be possible to reduce the morbidity of routine level V dissection and assess the need for a more extensive lateral neck dissection on an individual basis.

“This finding might help to reduce the morbidity induced by routine level V dissection,” the scientists concluded. “Level V [lymph node dissection] and strictly postoperative evaluation may be indicated when the patient has a high nomogram score.”

A total of 1,037 patients from Sudan University Shanghai Cancer Center were included in this retrospective cohort study. The patients, all of whom had clinically suspected lateral lymph node metastases, underwent total thyroidectomy with central lateral neck dissection and unilateral lateral neck dissection from 2011 to 2015. Using univariate and multivariate analyses, the scientists determined what factors were linked to level V metastasis. In addition, their nomogram was used to predict level V metastasis.

The nomogram found extranodal extension to be the major contributing factor, before lymph node size, unilateral central lymph node metastases, and level IV/III/II metastasis. The final rate of level V metastasis totaled 21.3%. Independent predictive factors for level V metastasis included lymph node size, extranodal extension, level II/III/IV metastasis, and unilateral central lymph node metastases (P < .05).

Disclosure: The study authors reported no conflicts of interest.

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