Ultrasound Diagnosis Of Cervical Lymph Node Metastases From Medullary Thyroid Carcinoma And Construction Of A Clinical Prognosis Model

Objective:To investigate the value of ultrasonographic feature-based nomogram in predicting cervical LN(lymph node)metastasis in MTC(medullary thyroid carcinoma).Methods:Retrospective analysis of clinical and ultrasound imaging data of 139 MTC patients,including 93 patients with lymph node metastasis.Record the patiens' gender,age,and preoperative ultrasound examination.The ultrasound features of MTC primary lesion was analyzed,including size,echo,calcification,blood flow,capsule invasion,boundary of cortex and medulla in LN,and blood flow in LN.We used lasso and logistic regression analyses to select predictive factors,built the predictive model and developed the nomogram.We internally validated the model with Bootstrap resampling.Results:Multifocality,irregular shape,capsule involvement,and ultrasound-reported LN metastasis were identified as predictive factors of cervical LN metastasis.The C-index of the nomogram was 0.894(95%CI:0.845-0.943)and AUC was 0.894.The calibration curve and DCA showed great clinical value of the nomogram.Conclusions:The nomogram based on the ultrasound features of MTC can be applied as a simple,non-invasive quantitative tool to predict the risk of cervical LN metastasis.Purpose:To explore the prognostic impact of the log odds of positive lymph nodes(LODDS)on medullary thyroid cancer(MTC)and to develop a nomogram incorporating LODDS to predict the cancer-specific survival(CSS)of MTC.Methods:Data from 1110 MTC patients after total thyroidectomy were collected from the Surveillance,Epidemiology,and End Results(SEER)database and divided into training and validation cohorts.The prognostic efficiency of N status from the American Joint Committee on Cancer(AJCC)staging system,number of positive lymph nodes(PLNN)and LODDS were compared using the Harrell concordance index(C-index),Akaike information criterion(AIC),and area under the receiver operating characteristic(ROC)curve(AUC).We conducted multivariate Cox analysis to determine the independent prognostic factors and constructed a nomogram based on LODDS.The nomogram's performance was assessed with the C-index,AUC,calibration curves,and decision curve analysis(DCA).Results:Among the three lymph node(LN)staging systems,LODDS showed the highest accuracy in predicting CSS for MTC.In the training cohort,the C-index of the LODDS-based nomogram was 0.895.The AUCs were 0.949,0.917,0.925 and 0.901 for predicting 1-,3-,5-and 10-year CSS,respectively.The calibration plots and DCA showed superior clinical applicability of the nomogram.These results were verified in the validation cohort.Conclusions:LODDS is an independent prognostic factor for MTC with superior prognostic efficiency over N status and PLNN.This LODDS-based nomogram yielded better performance than the AJCC tumor-node-metastasis(TNM)staging system in predicting CSS after surgery for MTC.