A preoperative nomogram for the prediction of ipsilateral central compartment lymph node metastases in papillary thyroid cancer

Thompson, AM; Turner, RM; Hayen, A; Aniss, A; Jalaty, S; Learoyd, DL; Sidhu, S; Delbridge, L; Yeh, MW; Clifton-Bligh, R; Sywak, M

A preoperative nomogram for the prediction of ipsilateral central compartment lymph node metastases in papillary thyroid cancer

Thompson, AM Turner, RM Hayen, A

Aniss, A Jalaty, S Learoyd, DL Sidhu, S Delbridge, L Yeh, MW Clifton-Bligh, R Sywak, M

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Publication Type:: Journal Article
Citation:: Thyroid, 2014, 24 (4), pp. 675 - 682
Issue Date:: 2014-04-01

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Field	Value	Language
dc.contributor.author	Thompson, AM	en_US
dc.contributor.author	Turner, RM	en_US
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030	en_US
dc.contributor.author	Aniss, A	en_US
dc.contributor.author	Jalaty, S	en_US
dc.contributor.author	Learoyd, DL	en_US
dc.contributor.author	Sidhu, S	en_US
dc.contributor.author	Delbridge, L	en_US
dc.contributor.author	Yeh, MW	en_US
dc.contributor.author	Clifton-Bligh, R	en_US
dc.contributor.author	Sywak, M	en_US
dc.date.issued	2014-04-01	en_US
dc.identifier.citation	Thyroid, 2014, 24 (4), pp. 675 - 682	en_US
dc.identifier.issn	1050-7256	en_US
dc.identifier.uri	http://hdl.handle.net/10453/118628
dc.description.abstract	Background: Central compartment lymph node metastases in papillary thyroid carcinoma (PTC) are difficult to detect preoperatively, and the role of routine or prophylactic central compartment lymph node dissection (CLND) in managing PTC remains controversial. The aim of this project was to create a nomogram able to predict the occurrence of central compartment lymph node metastasis using readily available preoperative clinical characteristics. Methods: Records from patients undergoing total thyroidectomy and lymph node dissection for PTC in the period 1968-2012 were analyzed. Nodal status was based on results of serial hematoxylin and eosin (H&E) examination. Age, sex, tumor size, tumor site, and multifocality were included in a multivariable logistic regression model to predict lymph node metastasis. A coefficient-based nomogram was developed and validated using an external patient cohort. Results: The study population included 914 patients (80% females) with an average central compartment nodal yield of eight per patient. Central compartment lymph node metastases were present in 390 patients (42.7%). The variables with the strongest predictive value were age (p<0.001), male sex (p<0.001), increasing tumor size (p<0.001), and tumor multifocality (p<0.05). The nomogram had good discrimination with a concordance index of 76.4% [95% confidence interval 73.3-79.4], supported by an external validation point estimate of 61.5% [95% confidence interval 49.5-73.6]. An online calculator and smartphone application were developed for point of care use. Conclusions: A validated nomogram utilizing readily available preoperative variables has been developed to give a predicted probability of central lymph node metastases in patients presenting with PTC. This nomogram may help guide surgical decision making in PTC. © 2014, Mary Ann Liebert, Inc. 2014.	en_US
dc.relation.ispartof	Thyroid	en_US
dc.relation.isbasedon	10.1089/thy.2013.0224	en_US
dc.subject.classification	Endocrinology & Metabolism	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Carcinoma, Papillary	en_US
dc.subject.mesh	Thyroid Neoplasms	en_US
dc.subject.mesh	Lymphatic Metastasis	en_US
dc.subject.mesh	Lymph Node Excision	en_US
dc.subject.mesh	Nomograms	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Point-of-Care Systems	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Preoperative Period	en_US
dc.subject.mesh	Mobile Applications	en_US
dc.title	A preoperative nomogram for the prediction of ipsilateral central compartment lymph node metastases in papillary thyroid cancer	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	24	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	24	en_US

Abstract:

Background: Central compartment lymph node metastases in papillary thyroid carcinoma (PTC) are difficult to detect preoperatively, and the role of routine or prophylactic central compartment lymph node dissection (CLND) in managing PTC remains controversial. The aim of this project was to create a nomogram able to predict the occurrence of central compartment lymph node metastasis using readily available preoperative clinical characteristics. Methods: Records from patients undergoing total thyroidectomy and lymph node dissection for PTC in the period 1968-2012 were analyzed. Nodal status was based on results of serial hematoxylin and eosin (H&E) examination. Age, sex, tumor size, tumor site, and multifocality were included in a multivariable logistic regression model to predict lymph node metastasis. A coefficient-based nomogram was developed and validated using an external patient cohort. Results: The study population included 914 patients (80% females) with an average central compartment nodal yield of eight per patient. Central compartment lymph node metastases were present in 390 patients (42.7%). The variables with the strongest predictive value were age (p<0.001), male sex (p<0.001), increasing tumor size (p<0.001), and tumor multifocality (p<0.05). The nomogram had good discrimination with a concordance index of 76.4% [95% confidence interval 73.3-79.4], supported by an external validation point estimate of 61.5% [95% confidence interval 49.5-73.6]. An online calculator and smartphone application were developed for point of care use. Conclusions: A validated nomogram utilizing readily available preoperative variables has been developed to give a predicted probability of central lymph node metastases in patients presenting with PTC. This nomogram may help guide surgical decision making in PTC. © 2014, Mary Ann Liebert, Inc. 2014.

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http://hdl.handle.net/10453/118628