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A Risk Model for Predicting Central Lymph Node Metastasis of Papillary Thyroid Microcarcinoma Including Conventional Ultrasound and Acoustic Radiation Force Impulse Elastography

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this prospective study was to propose a new rating system using a risk model including conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography for predicting central lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC).

A total of 252 patients with PTMCs were enrolled, who were preoperatively evaluated by US and ARFI elastography including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ). Risk factors of independent variables for central LNM were analyzed by univariate and multivariate analyses. A multivariate analysis was performed to create a predicting model and rating system.

Of the 252 patients, 72 (28.6%) had central LNMs. Multivariate analysis revealed that rare internal flow (odds ratio [OR]: 4.454), multiple suspicious foci on US (OR: 5.136), capsule involvement (OR: 20.632), and VTI area ratio (VAR) > 1 (OR: 5.621) were independent risk factors for central LNM. The final predicting model was obtained and the risk score (RS) was defined as 1.5 × (if rare internal flow) + 1.6 × (if multiple suspicious foci on US) + 1.7 × (if VAR > 1) + 3.0 × (if capsule involvement). The rating system was divided into 5 stages. Stage I, <1.5; Stage II, 1.5 to 3.0; Stage III, 3.1 to 4.7; Stage IV, 4.8 to 6.3; and Stage V, 6.4 to 7.8. The risk rates of central LNM were 3.4% (2/59) in Stage I, 13.3% (13/98) in Stage II, 54.2% (39/72) in Stage III, 72.2% (13/18) in Stage IV, and 100% (5/5) in Stage V (P < 0.001).

The results indicated that rare internal flow, multiple suspicious foci, capsule involvement on US, and VAR > 1 on ARFI elastography are the risk factors for predicting central LNM. The risk model developed in the study clearly predicts the risk of central LNM in patients with PTMC and thus has a potential to avoid unnecessary central compartment node dissection.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic (ROC) curve. The equation for prediction of central lymph node metastasis (LNM) was accurate and discriminating, with an area under the ROC curve of 0.888. The point of cutoff value for predicting central LNM in the equation was defined as 0.22. The sensitivity and specificity was 88.9% and 74.4%, respectively.
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Figure 2: Receiver operating characteristic (ROC) curve. The equation for prediction of central lymph node metastasis (LNM) was accurate and discriminating, with an area under the ROC curve of 0.888. The point of cutoff value for predicting central LNM in the equation was defined as 0.22. The sensitivity and specificity was 88.9% and 74.4%, respectively.

Mentions: A multivariate logistic regression equation was then created with the significant predictive variables and the ROC curve was plotted. The equation was established as following: P = 1/1 + ExpΣ [−0.09 + 0.06 × age (years) −1.636 × (if multiple suspicious foci on US) −1.494 × (if rare internal flow) + 1.158 × (if taller than wide shape) −3.027 × (if capsule involvement) −1.727 × (if VAR > 1)]. The diagnostic value of predictive equation for the population was accurate and discriminative with an area under the ROC curve of 0.888 (CIs, 0.844–0.932) (Figure 2). The sensitivity and specificity were 88.9% and 74.4%, respectively. The cut-off value for predicting central LNM in the equation was 0.22.


A Risk Model for Predicting Central Lymph Node Metastasis of Papillary Thyroid Microcarcinoma Including Conventional Ultrasound and Acoustic Radiation Force Impulse Elastography
Receiver operating characteristic (ROC) curve. The equation for prediction of central lymph node metastasis (LNM) was accurate and discriminating, with an area under the ROC curve of 0.888. The point of cutoff value for predicting central LNM in the equation was defined as 0.22. The sensitivity and specificity was 88.9% and 74.4%, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998281&req=5

Figure 2: Receiver operating characteristic (ROC) curve. The equation for prediction of central lymph node metastasis (LNM) was accurate and discriminating, with an area under the ROC curve of 0.888. The point of cutoff value for predicting central LNM in the equation was defined as 0.22. The sensitivity and specificity was 88.9% and 74.4%, respectively.
Mentions: A multivariate logistic regression equation was then created with the significant predictive variables and the ROC curve was plotted. The equation was established as following: P = 1/1 + ExpΣ [−0.09 + 0.06 × age (years) −1.636 × (if multiple suspicious foci on US) −1.494 × (if rare internal flow) + 1.158 × (if taller than wide shape) −3.027 × (if capsule involvement) −1.727 × (if VAR > 1)]. The diagnostic value of predictive equation for the population was accurate and discriminative with an area under the ROC curve of 0.888 (CIs, 0.844–0.932) (Figure 2). The sensitivity and specificity were 88.9% and 74.4%, respectively. The cut-off value for predicting central LNM in the equation was 0.22.

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this prospective study was to propose a new rating system using a risk model including conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography for predicting central lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC).

A total of 252 patients with PTMCs were enrolled, who were preoperatively evaluated by US and ARFI elastography including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ). Risk factors of independent variables for central LNM were analyzed by univariate and multivariate analyses. A multivariate analysis was performed to create a predicting model and rating system.

Of the 252 patients, 72 (28.6%) had central LNMs. Multivariate analysis revealed that rare internal flow (odds ratio [OR]: 4.454), multiple suspicious foci on US (OR: 5.136), capsule involvement (OR: 20.632), and VTI area ratio (VAR) > 1 (OR: 5.621) were independent risk factors for central LNM. The final predicting model was obtained and the risk score (RS) was defined as 1.5 × (if rare internal flow) + 1.6 × (if multiple suspicious foci on US) + 1.7 × (if VAR > 1) + 3.0 × (if capsule involvement). The rating system was divided into 5 stages. Stage I, <1.5; Stage II, 1.5 to 3.0; Stage III, 3.1 to 4.7; Stage IV, 4.8 to 6.3; and Stage V, 6.4 to 7.8. The risk rates of central LNM were 3.4% (2/59) in Stage I, 13.3% (13/98) in Stage II, 54.2% (39/72) in Stage III, 72.2% (13/18) in Stage IV, and 100% (5/5) in Stage V (P < 0.001).

The results indicated that rare internal flow, multiple suspicious foci, capsule involvement on US, and VAR > 1 on ARFI elastography are the risk factors for predicting central LNM. The risk model developed in the study clearly predicts the risk of central LNM in patients with PTMC and thus has a potential to avoid unnecessary central compartment node dissection.

No MeSH data available.


Related in: MedlinePlus