Objective: The purposes of this study were to identify risk factors for cervical lymph node metastasis and to examine the association between BRAF^(V600E) status and clinical features in papillary thyroid microcarcino...Objective: The purposes of this study were to identify risk factors for cervical lymph node metastasis and to examine the association between BRAF^(V600E) status and clinical features in papillary thyroid microcarcinoma(PTMC).Methods: A total of 1,587 patients with PTMC, treated in Tianjin Medical University Cancer Institute and Hospital from January2011 to March 2013, underwent retrospective analysis. We reviewed and analyzed factors including clinical results, pathology records, ultrasound results, and BRAF^(V600E) status.Results: Multivariate logistic regression analyses demonstrated that gender(male) [odds ratio(OR) = 1.845, P = 0.000], age(< 45 years)(OR = 1.606, P = 0.000), tumor size(> 6 mm)(OR = 2.137, P = 0.000), bilateralism(OR = 2.011, P = 0.000) and extrathyroidal extension(OR = 1.555, P = 0.001) served as independent predictors of central lymph node metastasis(CLNM).Moreover, CLNM(OR = 29.354, P = 0.000) served as an independent predictor of lateral lymph node metastasis(LLNM). Among patients with a solitary primary tumor, those with tumor location in the lower third of the thyroid lobe or the isthmus were more likely to experience CLNM(P < 0.05). Univariate analyses indicated that CLNM, LLNM, extrathyroidal extension, and multifocality were not significantly associated with BRAF^(V600E) mutation.Conclusions: The present study suggested that prophylactic neck dissection of the central compartment should be considered in patients with PTMC, particularly in men with tumor size greater than 6 mm, age less than 45 years, extrathyroidal extension, and tumor bilaterality. Among patients with PTMC, BRAF^(V600E) mutation is not significantly associated with prognostic factors. For a better understanding of surgical management of PTMC and the risk factors, we recommend multicenter research and long-term follow-up.展开更多
Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultra...Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer.The localization of thyroid nodules is a recognized predictor of CLNM;however,quantifying this relationship is challenging due to variable measurements.in this study,we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules,thereby predicting CLNM.We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node(CLN)surgery and utilized these images to train our predictive model,ACE-Net.Furthermore,we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions.ACENet demonstrated superior performance in 6 external multicenter tests(AUC=0.826),surpassing the predictive accuracy of human experts(accuracy=0.561).The risk heatmap enabled the identification of high-risk areas for CLNM,likely correlating with lymphatic metastatic pathways.Additionally,it was observed that the likelihood of metastasis exceeded 80%when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm.ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%,without missing positive cases,thus offering a valuable tool for clinical decision-making.展开更多
基金supported by grants from the National Natural Science Foundation of China (Grant No. 81402392, 81472580, 81502322)Tianjin Municipal Science and technology project (Grant No. 15JCQNJC12800 and 17YFZCSY00690)
文摘Objective: The purposes of this study were to identify risk factors for cervical lymph node metastasis and to examine the association between BRAF^(V600E) status and clinical features in papillary thyroid microcarcinoma(PTMC).Methods: A total of 1,587 patients with PTMC, treated in Tianjin Medical University Cancer Institute and Hospital from January2011 to March 2013, underwent retrospective analysis. We reviewed and analyzed factors including clinical results, pathology records, ultrasound results, and BRAF^(V600E) status.Results: Multivariate logistic regression analyses demonstrated that gender(male) [odds ratio(OR) = 1.845, P = 0.000], age(< 45 years)(OR = 1.606, P = 0.000), tumor size(> 6 mm)(OR = 2.137, P = 0.000), bilateralism(OR = 2.011, P = 0.000) and extrathyroidal extension(OR = 1.555, P = 0.001) served as independent predictors of central lymph node metastasis(CLNM).Moreover, CLNM(OR = 29.354, P = 0.000) served as an independent predictor of lateral lymph node metastasis(LLNM). Among patients with a solitary primary tumor, those with tumor location in the lower third of the thyroid lobe or the isthmus were more likely to experience CLNM(P < 0.05). Univariate analyses indicated that CLNM, LLNM, extrathyroidal extension, and multifocality were not significantly associated with BRAF^(V600E) mutation.Conclusions: The present study suggested that prophylactic neck dissection of the central compartment should be considered in patients with PTMC, particularly in men with tumor size greater than 6 mm, age less than 45 years, extrathyroidal extension, and tumor bilaterality. Among patients with PTMC, BRAF^(V600E) mutation is not significantly associated with prognostic factors. For a better understanding of surgical management of PTMC and the risk factors, we recommend multicenter research and long-term follow-up.
基金supported by the SFYF at SJTU(24X010500175)the Interdisciplinary Program of Shanghai jiao Tong University(YG2024QNA02)+5 种基金Neil Shen's SJTU Medical Research Fund,SJTU Transmed Awards Research(STAR)Grant No.20210106 the Science and Technology Commission of Shanghai Municipality(STCSM)(grant no.23JS1400700)the Innovative Research Team of High-Level Local Universities in Shanghai(SHSMU-ZDCX20212200),NSFC81903417Scientific Project of Huangpu District(grant no.HKQ201810)Shanghai Huangpu District Health Commission(Grant No.2023XD02)Xuzhou Municipal Bureau of Science and Technology Key R&D Projects Social Development Projects(KC23178)Science and Technology Special Fundation of Jiangsu Province(BE2023657).
文摘Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer.The localization of thyroid nodules is a recognized predictor of CLNM;however,quantifying this relationship is challenging due to variable measurements.in this study,we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules,thereby predicting CLNM.We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node(CLN)surgery and utilized these images to train our predictive model,ACE-Net.Furthermore,we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions.ACENet demonstrated superior performance in 6 external multicenter tests(AUC=0.826),surpassing the predictive accuracy of human experts(accuracy=0.561).The risk heatmap enabled the identification of high-risk areas for CLNM,likely correlating with lymphatic metastatic pathways.Additionally,it was observed that the likelihood of metastasis exceeded 80%when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm.ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%,without missing positive cases,thus offering a valuable tool for clinical decision-making.
