Abstract
Objective Exploring the predictive value of preoperative BRAFv600E mutation combined with ultra-sound features for the risk of cervical lymph node metastasis(LNM)in patients with clinical node negative(cN0)papillary thyroid carcinoma(PTC),in order to accurately identify pathological node positive(PN+)to perform preventive lymph node dissection before surgery,while identifying pathological node negative(PN0)pa-tients to reduce unnecessary procedures,providing a basis for individualized surgical decision-making.Methods A retrospective analysis was conducted on patients diagnosed with cN0 PTC undergoing concurrent thyroid cancer surgery at Tongren People's Hospital from September 2023 to September 2025.Based on postoperative pathologi-cal lymph node results,the patients were divided into PN0 and PN+groups,and their clinical basic data,pre-operative ultrasound characteristics,and BRAFV600E mutation results were statistically analyzed.Univariate logistic regression was used to screen variables with P＜0.05,and then forward stepwise multivariate logistic regression was applied to identify the independent risk factors for postoperative PN+status,and a prediction model was constructed.The predictive performance was evaluated by ROC curve,and conduct internal validation of the model using Bootstrap self-sampling method.Results A total of 200 cN0 PTC patients were included,including the PN0(131 cases,65.5％)and the PN+(69 cases,34.5％).Univariate logistic regression analysis showed that there were statistically significant differences between the two groups in terms of gender,age,height,weight,location left lobe,hypoechogenicity,mixed echogenicity,maximum tumor diameter,microcalci-fications,blurred edges,and BRAFV600E mutation(P＜0.05).The forward stepwise multivariate logistic regres-sion showed that age(OR=0.938 6,95％CI:0.896 3-0.982 9,P=0.007 1),maximum tumor diameter(OR=1.470 8,95％CI:1.000 1-2.163 2,P=0.05),microcalcification(OR=5.939 3,95％CI:2.349 9-15.011 3,P=0.000 2),blurred edges(OR=2.623 5,95％CI:1.061 1-6.486 2,P=0.036 8),and BRAFV600E mutation(OR=2.342 5,95％CI:1.016 0-5.401 1,P=0.045 8)were all independent predictive factors for LNM in cN0 PTC patients.The area under the ROC curve of the training set is 0.851(95％CI:0.797-0.904),and the area under the ROC curve of the validation set was 0.835(95％CI:0.715-0.948),and the average absolute error of its calibration curve was 0.013,indicating that the model has a good fit.The DCA curve results show that in this nomogram model,when the threshold probability of individuals is in the range of 0-0.88,the model provides more net benefits than the strategies of"everyone intervenes"or"no one intervenes".Conclusion The BRAFV600E mutation combined with ultrasound features can effectively identify PN+and PN0 patients in cN0 PTC patients,providing more basis for the treatment plan and prognosis of PTC,optimi-zing surgical strategies,and reducing the risk of overtreatment.关键词
甲状腺乳头状癌/淋巴结转移/超声特征/BRAFV600E突变/临床淋巴结阴性/预测价值Key words
papillary thyroid carcinoma/lymph node metastasis/ultrasonic features/BRAFV600E mutation/clinical lymph node negativity/predictive value分类
医药卫生
