The value of cervical midline lymph nodes subdivison in predicting the contralateral central lymph nodes metastasis in papillary thyroid carcinoma
Objective To analyze the factors associated with contralateral central lymph nodes(Cont-CLNs)metastasis in patients with papillary thyroid carcinoma(PTC),and to evaluate the clinical value of midline cervical lymph nodes(Mid-CLNs)segmentation in the identification of Cont-CLNs metastasis.Methods A total of 125 patients with PTC who underwent total thyroidectomy and bilateral central neck dissection(CND)in The First People's Hospital of Foshan City,Guangdong Province from January 2021 to June 2023 were selected.The main fac-tors evaluated by histopathological examination included:maximum diameter of primary tumor,multifocality,cap-sule invasion,extrathyroidal invasion,Hashimoto's thyroiditis,and lymph node metastasis level.One-way analysis of variance was used to compare the data between groups.Multivariate Logistic regression analysis was used to ana-lyze the risk factors of Cont-CLNs metastasis,and the area under the receiver operating characteristic(ROC)curve was calculated to analyze the predictive efficacy of contralateral Mid-CLNs metastasis for Cont-CLNs metastasis.Re-sults Among 125 patients with PTC,107(85.60％)patients had Mid-CLNs metastasis,57.60％(72/125)pa-tients had ipsilateral Mid-CLNs metastasis,and 28.80％(36/125)patients had contralateral Mid-CLNs metastasis.In univariate analysis,multiple lesions(P=0.004),capsule invasion(P=0.002),extrathyroidal invasion(P=0.048),contralateral Mid-CLNs metastasis(P＜0.01)and iDIS-CLNs metastasis(P=0.043)were significantly corre-lated with Cont-CLNs metastasis.There was no correlation between Mid-CLNs metastasis(P=0.422),Mid-CLNs me-tastasis(P=0.856)on the affected side and Cont-CLNs metastasis.Multivariate Logistic regression analysis showed that the more iDIS-CLNs metastasis(P=0.013,OR=2.065)and contralateral Mid-CLNs metastasis(P=0.008,OR=2.072),the greater the probability of Cont-CLNs metastasis.The AUC of contralateral Mid-CLNs metastasis in pre-dicting Cont-CLNs metastasis was 0.664(95％CI=0.554-0.774,P=0.006),the sensitivity was 76.19％,and the specificity was 56.60％.Conclusion Contralateral Mid-CLNs metastasis is an independent risk factor for metastasis of Cont-CLNs,and it has a good diagnostic value for predicting metastasis of Cont-CLNs.
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