A risk stratification model based on ultrasound radiologic features for cervical metastatic lymph nodes in papillary thyroid cancer.

Background: Accurate preoperative evaluation for metastatic lesions is significant for PTC patients. However, the stratification systems revealed inconsistencies in the ultrasound (US) features of cervical metastatic lymph nodes (LNs). This study aimed to investigate and develop a risk stratification model based on US radiologic features for cervical metastatic lesions in PTC patients.

Methods: This study retrospectively enrolled 1806 LNs from 1665 PTC patients who underwent US-guided fine-needle aspiration biopsy for cervical LNs from January 2010 to December 2022. Univariable and multivariable logistic regression analyses determined and developed the independent risk US features and a risk stratification model for cervical metastatic LNs. The performance of the risk stratification model was assessed and validated by the Korean Society of Thyroid Radiology and the European Thyroid Association.

Results: Among the 1806 LNs, 1411 LNs were pathologically diagnosed with malignant. Multivariate analysis indicated that the absence of fatty hilum, cystic components, round shape (SD/LD ≥ 0.5), abundant vascularity, hyperechogenicity (including hyper and hypo-echogenicity, and hyper-echogenicity), and calcifications (include microcalcification, and macrocalcification) were independent risk US features associated with malignant LNs. A risk stratification model for cervical metastatic LNs was developed based on these suspicious US features and showed well-predicted performance (C-index 0.840; 95% CI: 0.840-0.923).

Conclusion: Our study proposed a new risk stratification system based on US radiologic features to predict cervical metastatic lymph nodes in PTC patients. We identified several risk factors for lymph node (LN) metastasis from PTC including the absence of fatty hilum, cystic components, round shape (SD/LD ≥ 0.5), abnormal vascularity, hyper-echogenicity, hyper- and hypo-echogenicity, microcalcification, and macrocalcification. These features could serve as valuable indicators for surgeons to accurately assess the status of cervical LNs.