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. 2023 Jun 20:14:1186381.
doi: 10.3389/fendo.2023.1186381. eCollection 2023.

Development and validation of a dynamic nomogram based on conventional ultrasound and contrast-enhanced ultrasound for stratifying the risk of central lymph node metastasis in papillary thyroid carcinoma preoperatively

Qiyang Chen  1 , Yujiang Liu  1 , Jinping Liu  1 , Yuan Su  1 , Linxue Qian  1 , Xiangdong Hu  1
Affiliations

Development and validation of a dynamic nomogram based on conventional ultrasound and contrast-enhanced ultrasound for stratifying the risk of central lymph node metastasis in papillary thyroid carcinoma preoperatively

Qiyang Chen et al. Front Endocrinol (Lausanne). .

Abstract

Purpose: The aim of this study was to develop and validate a dynamic nomogram by combining conventional ultrasound (US) and contrast-enhanced US (CEUS) to preoperatively evaluate the probability of central lymph node metastases (CLNMs) for patients with papillary thyroid carcinoma (PTC).

Methods: A total of 216 patients with PTC confirmed pathologically were included in this retrospective and prospective study, and they were divided into the training and validation cohorts, respectively. Each cohort was divided into the CLNM (+) and CLNM (-) groups. The least absolute shrinkage and selection operator (LASSO) regression method was applied to select the most useful predictive features for CLNM in the training cohort, and these features were incorporated into a multivariate logistic regression analysis to develop the nomogram. The nomogram's discrimination, calibration, and clinical usefulness were assessed in the training and validation cohorts.

Results: In the training and validation cohorts, the dynamic nomogram (https://clnmpredictionmodel.shinyapps.io/PTCCLNM/) had an area under the receiver operator characteristic curve (AUC) of 0.844 (95% CI, 0.755-0.905) and 0.827 (95% CI, 0.747-0.906), respectively. The Hosmer-Lemeshow test and calibration curve showed that the nomogram had good calibration (p = 0.385, p = 0.285). Decision curve analysis (DCA) showed that the nomogram has more predictive value of CLNM than US or CEUS features alone in a wide range of high-risk threshold. A Nomo-score of 0.428 as the cutoff value had a good performance to stratify high-risk and low-risk groups.

Conclusion: A dynamic nomogram combining US and CEUS features can be applied to risk stratification of CLNM in patients with PTC in clinical practice.

Keywords: central lymph node metastasis; contrast-enhanced ultrasound (CEUS); dynamic nomogram; papillary thyroid carcinoma; risk assessment.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient enrollment in the study.
Figure 2
Figure 2
Parameters of prediction model selection using the LASSO logistic regression model in the training cohort. (A) The area under the receiver operating characteristic curve was plotted versus log (λ). (B) The features were profiled by the LASSO coefficient.
Figure 3
Figure 3
Nomogram of the prediction model to assess the risk of CLNM in patients with PTC.
Figure 4
Figure 4
ROC curves of the prediction model and the single US and CEUS features for predicting CLNM (A) in the training cohort and (B) in the validation cohort.
Figure 5
Figure 5
Calibration curves of the nomogram in the training (A) and validation (B) cohorts.
Figure 6
Figure 6
Decision curves of the prediction model and the single US and CEUS features in predicting CLNM for papillary thyroid carcinoma.
Figure 7
Figure 7
Performance of the cutoff value for predicting CLNM in patients with PTC. In (A, B), the cutoff value of the Nomo-score performed well in the differential diagnosis of pN1 from pN0 in the training and validation cohorts, respectively. (C) The risk classification performance of the cutoff value is shown.
See this image and copyright information in PMC

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