实用医学杂志2026，Vol.42Issue(9)：1570-1578,9.DOI:10.3969/j.issn.1006-5725.2026.09.011
基于瘤内及瘤周超声特征预测甲状腺微小乳头状癌中央区淋巴结转移模型构建及验证
Construction and verification of prediction model of lymph node metastasis in central area of thyroid mi-cropapillary carcinoma based on intra-tumor and peritumoral ultrasound characteristics
摘要
Abstract
Objective To develop a nomogram model based on clinical characteristics,intratumoral ultra-sound features,and peritumoral ultrasound features for preoperative prediction of the risk of central lymph node metastasis(CLNM)in papillary thyroid microcarcinoma(PTMC),and to evaluate its predictive performance and clinical applicability.Methods A total of 534 papillary thyroid microcarcinoma(PTMC)cases that underwent surgical treatment at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from February 2022 to April 2023 were retrospectively included.The cases were randomly allocated in a 7:3 ratio to a training co-hort(n=373)and a validation cohort(n=161)using computer-generated random numbers.The participants were categorized into central lymph node metastasis(CLNM)-positive and CLNM-negative groups according to post-operative pathological findings.Clinical data and ultrasound imaging features were gathered.Independent risk fac-tors for CLNM were determined using multivariable logistic regression analysis,and a predictive nomogram was de-veloped based on these variables.The performance of the model was evaluated in terms of discrimination,calibra-tion,and clinical utility using receiver operating characteristic(ROC)curves,area under the curve(AUC),cali-bration plots,and decision curve analysis(DCA).Results Multivariate analysis demonstrated that male sex,age less than 46.5 years,tumor heterogeneity,tumor contact with the thyroid capsule equal to or greater than 50％,and peritumoral hyperechoic changes were independent predictors of central lymph node metastasis(CLNM)(P＜0.05).The nomogram model attained an area under the curve(AUC)of 0.857(95％CI:0.820-0.894)in the training cohort,with a sensitivity of 79.0％and a specificity of 80.0％.In the validation cohort,the AUC was 0.840(95％CI:0.778-0.902),with a sensitivity of 94.1％and a specificity of 66.7％.Calibration plots showed good agreement between predicted and observed probabilities,and decision curve analysis(DCA)indicated a favorable net clinical benefit across a range of threshold probabilities.Conclusions The proposed nomogram,which inte-grates gender,age,and key ultrasonographic features,can effectively predict the risk of central lymph node metas-tasis(CLNM)in patients with papillary thyroid microcarcinoma(PTMC)pre-operatively.It demonstrates strong discriminative ability and calibration.This model may serve as a valuable tool for guiding individualized surgical decision-making.关键词
超声特征/甲状腺微小乳头状癌/中央区淋巴结转移Key words
ultrasound features/papillary thyroid microcarcinoma/central lymph node metastasis分类
医药卫生引用本文复制引用
彭雄强,汤盼,黄炜贤,张建兴..基于瘤内及瘤周超声特征预测甲状腺微小乳头状癌中央区淋巴结转移模型构建及验证[J].实用医学杂志,2026,42(9):1570-1578,9.基金项目
广东省医学科研基金项目(编号:A2024609) （编号:A2024609）
西藏自治区自然科学基金组团式援藏医学资助项目(编号:XZ2024ZR-ZY081(Z)) （编号:XZ2024ZR-ZY081(Z）
