BackgroundParathyroid carcinoma (PC) is a rare and often misdiagnosed endocrine malignancy that can present with diverse clinical manifestations, complicating its detection and management.Case presentationThis case report presents a 59-year-old male diagnosed with parathyroid carcinoma (PC), initially misidentified as benign parathyroid hyperplasia and adenoma. Over the course of 4 years, the patient underwent three surgical interventions. Final surgery confirmed the definitive diagnosis of PC, which revealed vascular invasion. The patient exhibited unusual clinical manifestations, notably severe hypercalcemia leading to acute urinary retention (AUR), which posed a diagnostic challenge. Pathological evaluation indicated a Ki-67 proliferation index of 8%, raising concerns about malignancy. This case highlights the need for multidisciplinary collaboration in the diagnostic process, recognizing atypical symptoms and carefully interpreting histopathological markers in suspected PC cases.ConclusionPersistent hyperparathyroidism, elevated Ki-67 levels, and unexplained lower urinary tract symptoms (LUTS) should prompt re-evaluation for malignancy, highlighting the rarity yet clinical significance of hypercalcemia-induced AUR as a presenting symptom of underlying parathyroid pathology.

Background:Papillary thyroid microcarcinoma (PTMC) generally exhibits an excellent prognosis. However, a subset of patients develops high-volume (>5 nodes) central lymph node metastasis (CLNM), which is associated with increased recurrence risk and may influence surgical decision-making. Reliable preoperative risk stratification for high-volume CLNM in clinically node-negative (cN0) PTMC remains challenging. Therefore, this study aimed to develop and validate a nomogram for predicting high-volume CLNM in unilateral cN0 PTMC. Methods:In this retrospective study conducted at a single center, 1,500 patients with unilateral cN0 PTMC who received surgical treatment were included. Patients were randomly allocated to training cohort and validation cohort at a 7:3 ratio. Independent predictors of high-volume CLNM were identified using multivariate logistic regression analysis. A nomogram was constructed using the training cohort and subsequently validated. Results:Multivariate logistic analysis identified male sex, age ≤50 years, maximal tumor diameter >8 mm, and tumor multifocality as independent predictors for high-volume CLNM. The nomogram showed good discrimination performance, with a concordance index (C-index) exceeding 0.70 in both the training and validation cohorts. Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis indicated favorable clinical applicability. Conclusions:A practical nomogram was developed to predict high-volume CLNM in patients with unilateral cN0 PTMC. This model may facilitate individualized preoperative risk stratification and assist clinicians in optimizing surgical strategies, particularly in the context of increasingly conservative management of PTMC.

ABSTRACT Background The individual prognostic impacts of BRAFV600E and TERT promoter mutations in papillary thyroid carcinoma (PTC) are established, but the clinical significance of their co‐occurrence, especially when assessed preoperatively, requires further elucidation. Objective To evaluate the clinicopathological features and recurrence risk associated with the combined BRAFV600E/TERT mutation in PTC using preoperative specimens. Methods This retrospective study included 756 PTC patients. Mutations were detected from preoperative fine‐needle aspiration (FNA) samples. Patients were stratified into three groups: double wild‐type (BRAF−/TERT−, n = 121), BRAF‐mutant only (BRAF+/TERT−, n = 606), and both‐mutant (BRAF+/TERT+, n = 27). Clinicopathological comparisons used appropriate statistical tests. Risk factors for extrathyroidal extension (ETE) and high nodal burden (NLNM ≥ 5) were analyzed via univariate and multivariate logistic regression. Recurrence‐free survival (RFS) was assessed by Kaplan–Meier analysis and log‐rank test. Results The BRAF+/TERT+ group exhibited the most aggressive phenotype: older age (mean 55.2 vs. 41.9–42.7 years, p < 0.001), larger tumors (median 20.0 vs. 8.7–9.3 mm, p < 0.001), highest rates of ETE (85.2% vs. 10.7%–14.0%, p < 0.001), and heaviest nodal burden (NLNM ≥ 5: 63.0% vs. 25.4%–31.4%, p < 0.001). In multivariate analysis, the double‐mutant status was the strongest independent risk factor for both ETE (OR = 11.35; p < 0.001) and NLNM ≥ 5 (OR = 8.02; p = 0.044). With a median follow‐up of 27 months, Kaplan–Meier analysis revealed a significantly inferior RFS for the BRAF+/TERT+ group compared to the others (log‐rank p < 0.001). In contrast, the only BRAF‐mutant group exhibited fewer aggressive features, primarily associated with a higher body mass index (BMI) and lower prevalence of Hashimoto's thyroiditis. Conclusion BRAFV600E and TERT promoter co‐mutation, identifiable preoperatively, defines a distinct PTC subtype with a profoundly aggressive clinicopathological profile and a significantly elevated risk of recurrence. This combined molecular signature is a potent preoperative biomarker for stratifying patients into the highest‐risk category, potentially guiding more individualized initial therapeutic strategies.

Background Whether lymph node metastasis in different anatomical regions of papillary thyroid carcinoma affects recurrence-free survival is controversial. This long-term follow-up study aims to evaluate the impact of lymph node metastasis region on recurrence-free survival and identify independent recurrence factors.Materials and methods This cross-sectional study included 1,378 patients who underwent at least unilateral thyroid lobectomy plus central and lateral lymph node dissection. Propensity score matching, Cox proportional hazards regression, and time-dependent receiver operating characteristic curve analysis were performed to assess recurrence-free survival, recurrence predictors, and predictive accuracy.Results Among 1,378 patients, isolated central, lateral, and combined lymph node metastasis occurred in 361 (26.2%), 75 (5.4%), 584 (42.4%), respectively. With 91-month median follow-up, 43 (3.1%) developed recurrence. Prior to matching, patients with lateral lymph node metastasis demonstrated significantly poorer recurrence-free survival compared to those without lateral nodal involvement (p < 0.001). Propensity-matched comparisons revealed no significant recurrence-free survival differences between different anatomical regions. Male (HR = 2.317), clinically lymph node positive (HR = 3.811), and lymph node metastasis ratio > 26.3% (HR = 6.735) were independent recurrence factors in multivariate Cox analysis, with a concordance index of 0.789 (95% CI: 0.776 - 0.802).Conclusions The anatomical region of lymph node metastasis was not an independent risk factor for recurrence free survival in papillary thyroid carcinoma patients. Male, clinically lymph node positive, and lymph node metastasis ratio > 26.3% were independent recurrence risk factors. For patients with high-risk recurrence factors, close clinical surveillance should be considered.

OBJECTIVE:To identify independent risk factors for lymph node metastasis posterior to the right recurrent laryngeal nerve (RLN) in cN0 papillary thyroid carcinoma and develop a predictive model for preoperative risk stratification. METHODS:A retrospective analysis was conducted on 721 cN0 papillary thyroid carcinoma patients that underwent lymph node dissection posterior to the right RLN between 2016 and 2019. Univariable and multivariable logistic regression analyses were used to assess clinical and pathological characteristics, and a nomogram was constructed. The model was validated using receiver operating characteristic curves and calibration curves. RESULTS:The incidence of lymph nodes posterior to the right was 19.8%. Multivariable analysis revealed three independent predictors: the number of paratracheal lymph node metastases (OR = 1.360, p = 0.021), combined prelaryngeal and paratracheal lymph node metastases (1-2 involved nodes: OR = 3.433; ⩾ 3 involved nodes: OR = 4.402, p < 0.05), and extrathyroidal extension (OR = 0.580, p = 0.021). CONCLUSION:This model provides a quantitative tool for intraoperative risk assessment and guides the development of individualized surgical plans for high-risk patients with cN0 papillary thyroid carcinoma.

Chronic stress may contribute to endocrine dysregulation. The allostatic load (AL), an indicator of cumulative physiological burden across multiple systems, has unclear associations with thyroid function. We analyzed 5525 adults (2678 men and 2847 women) from NHANES 2007-2010. The participants were categorized into allostatic load score (ALS) quartiles: Q1 (n = 2582), Q2 (n = 1394), Q3 (n = 1003), and Q4 (n = 546). The ALS was constructed from eight cardiovascular, metabolic, and inflammatory biomarkers. Thyroid function was assessed (TSH, FT3, FT4, TgAb, and TPOAb) and categorized as thyroid dysfunction. Survey-weighted multivariable linear and logistic models estimated associations; trend tests and restricted cubic splines (RCS) assessed linearity. Subgroup and interaction analyses examined effect modification, and sensitivity analyses evaluated robustness. ALS was positively associated with higher TSH (β = 0.038, 95% CI: 0.019-0.057, p = 0.001) and FT3 (β = 0.005, 95% CI: 0.003-0.008, p < 0.001). No significant associations were observed for FT4, TPOAb, or TgAb. TSH increased linearly across ALS quartiles (p-trend < 0.001). Restricted cubic splines indicated no overall departure from linearity; in sex-stratified analyses, the association was linear in women and nonlinear in men. Significant interactions with age and race (p < 0.05) indicate that the ALS-TSH association differs by demographics. The results were consistent across the subgroup and sensitivity analyses. Our study suggested a significant positive association between AL and TSH levels. Further research is needed to clarify the mechanisms linking stress and thyroid function.

BackgroundOwing to the limited characterization of lymph nodes around the entrance point of the recurrent laryngeal nerve (LN-epRLN) in clinical lymph node negative (cN0) papillary thyroid carcinoma (PTC), this study sought to develop machine learning (ML) models to predict LN-epRLN metastasis, identify the optimal model, and improve interpretability using explainable artificial intelligence techniques.MethodsWe retrospectively reviewed 1,800 patients with cN0-PTC who underwent central lymph node dissection (CLND) with systematic LN-epRLN sampling. Histopathological evaluation confirmed metastatic status. Patients were randomly divided into training and testing sets at a 7:3 ratio. Nine ML models were constructed and optimized through 10-fold cross-validation and grid search. Performance was assessed using 11 metrics, including AUC, accuracy, sensitivity, and specificity. The best-performing model was compared against traditional nomograms via probability-based ranking analysis (PMRA).ResultsLN-epRLNs were identified in 149 out of 1800 PTC patients, with a metastasis rate of 19.46%. The Random Forest (RF) model outperformed others, achieving training/testing scores of 0.914/0.911 accuracy, 0.956/0.919 AUC, 0.993/0.974 specificity, and 0.609/0.500 sensitivity. A simplified model incorporating seven key predictors—total central lymph node metastasis number and ratio, pretracheal lymph node metastasis number and ratio, tumor size, age, and paratracheal lymph node metastasis number—retained high predictive performance. SHAPley Additive exPlanations (SHAP) analysis highlighted central compartment metastasis burden (number and ratio) as the most influential predictors.ConclusionThe interpretable ML model developed in this study, leveraging the RF, provides a reliable tool for preoperative and intraoperative prediction of LN-epRLN metastasis in cN0 PTC patients. This approach has the potential to guide individualized surgical planning, optimizing the balance between oncological resection completeness and functional preservation.

Background: Occult lymph node metastasis (LNM) occurs in 30-80% of patients with clinically node-negative papillary thyroid carcinoma (cN0-PTC), partly owing to the limited sensitivity of current preoperative nodal assessment, and may contribute to postoperative recurrence. Conventional sentinel lymph node (SLN) biopsy, typically performed with a single tracer, has limited reliability for detecting occult metastatic nodes, which can result in either overtreatment or undertreatment with lymph node dissection. We aimed to develop a highly accurate multimodal prediction framework to accurately identify second-echelon lymph node metastasis (SeLNM) and non-sentinel lymph node metastasis (NsLNM). Methods: We prospectively enrolled 301 patients with cN0-PTC between April and October 2024, of whom 131 met the inclusion criteria. Intraoperatively, a dual-tracer technique combining carbon nanoparticles and indocyanine green was applied, and near-infrared imaging was used to record the entire SLN visualization process in real time. For each case, a 3 min video clip (150 frames) was captured. Two senior surgeons delineated regions of interest to generate 19,650 mask images. A total of 2048 spatial features and 20 temporal features were extracted, combined with 32 clinical variables, including demographics, ultrasound characteristics, and gene mutation status. Nine deep learning models were developed and evaluated using 10-fold cross-validation. Model performance was quantified using receiver operating characteristic curves, decision curve analysis curves, calibration curves, precision-recall curves, learning curves, and 12 metrics. Statistical comparisons were performed using the DeLong test, and models were further evaluated using a probability-based ranking approach. Shapley Additive Explanations (SHAP) analysis was applied to interpret key predictive features. The primary outcomes were SeLNM and NsLNM, defined based on postoperative histopathology. Results: The Long Short-Term Memory (LSTM) + Transformer model showed the best performance for both prediction tasks, with stable AUCs across training and testing (SeLNM: 0.980/0.982; NsLNM: 0.986/0.983). In the testing set, the model reached the same accuracy for both outcomes (94.7%) and showed strong sensitivity/specificity for SeLNM (94.7%/94.6%) and NsLNM (96.4%/91.5%). SHAP analysis indicated that time-series fluorescence flow features were the most influential predictors, followed by spatial structural features and SLN status. Conclusions: Dual-tracer SLN mapping with deep learning demonstrated encouraging intraoperative prediction of lymph node metastasis with interpretable features in this single-center cohort. Independent multicenter validation and prospective outcome studies are needed before considering clinical adoption.

ObjectiveProphylactic dissection of lymph nodes posterior to the recurrent laryngeal nerve (LN-prRLN) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial due to the inability to preoperatively assess LN-prRLN metastasis.Materials and methodsThis study aims to construct and validate an interpretable predictive model for LN-prRLN metastasis in cN0 PTC using machine learning (ML) method. Data were collected from hospital A and divided into training and testing sets (7:3). Additional data from the hospital B were used as validation set. Nine ML models, including XGBoost, were developed. Predictive performance was evaluated using ROC curves, decision curve analysis (DCA), calibration curves, and precision-recall curves. The best model was compared to a traditional logistic regression-based nomogram using learning curves and the method of Probability-based Ranking Model Approach (PMRA). SHapley Additive exPlanations (SHAP) were used to interpret the top ten predictive features and create a web-based calculator.ResultsA total of 2033 patients were included. XGBoost outperformed other models with AUCs of 0.859, and 0.885 for the testing, and validation sets, respectively, compared to the nomogram (0.814, 0.836). SHAP-based visualizations identified the top ten predictive features: ipsilateral paratracheal lymph node metastasis rate, number of total central lymph node metastases, total central lymph node metastasis rate, number of ipsilateral paratracheal lymph node metastases, pretracheal lymph node metastasis rate, ipsilateral paratracheal lymph node metastasis, unclear tumor border, size, and age ≤39 years. These features were used to develop a web-based calculator.ConclusionML is a reliable tool for predicting LN-prRLN metastasis in cN0 PTC patients. The SHAP method provides insights into the XGBoost model, and the resultant web-based calculator is a clinically useful tool to assist in the surgical planning for LN-prRLN dissection.

INTRODUCTION:Although autologous fat grafting has been widely adopted globally to improve poor cosmetic outcomes following breast cancer surgery, oncologic concerns persist regarding the potential risk of cancer recurrence associated with fat transfer performed near the tumor bed. We sought to prospectively evaluate the oncologic safety and clinical benefits for breast cancer women undergoing breast-conserving surgery (BCS) with immediate autologous fat grafting (IAFG). METHODS:This multicenter, prospective, randomized controlled clinical trial enrolled 360 women diagnosed with breast cancer between 3 March 2017 and 31 May 2021. Participants were randomly assigned in a 1:1 ratio to either the BCS with IAFG (IAFG group) or the BCS without IAFG (control group). The primary outcomes were the cumulative incidence rates of locoregional and systemic recurrence. The secondary outcomes included adverse events, patient's satisfaction, and psychosocial well-being. RESULTS:The average volume resected and volume grafted were 45.5 g and 66.5 mL, respectively, in the IAFG group. At a median follow-up period of 62.8 months (range: 4.3-86 months), the proportions of local relapse were 0.6% and 2.4% in the IAFG group and the control group, respectively (P = 0.65). There was no increased risk of distant recurrence (3.6% vs. 3.5%) or breast cancer-specific mortality (0.6% vs. 0.6%) in the IAFG group. Among the secondary outcomes, the occurrence rates of complications were similar; however, the IAFG group showed significantly higher scores of satisfaction with breast appearance, psychosocial well-being, and sexual well-being than the controls (78 vs. 65, P < 0.001; 83 vs. 71, P < 0.001; 74 vs. 66, P < 0.001, respectively). CONCLUSION:Our results provide clear evidence that IAFG is a safe and effective surgical technique that does not increase the risk of local or distant recurrence in breast cancer patients and yields higher satisfaction with postoperative breast appearance and psychosocial outcomes.

Background:Extrathyroidal extension (ETE) and lymph node metastasis (LNM) are significant factors influencing the prognosis of papillary thyroid carcinoma (PTC). However, their relationship remains controversial. This study explores the connection between ETE and LNM by using propensity score matching (PSM) to guide individualized treatment. Methods:A retrospective analysis was conducted on 1,045 PTC patients who underwent surgery between January 2023 and June 2024. PSM at a 1:1 ratio was used to balance confounding factors based on univariate and multivariate analyses to investigate the relationship between ETE and LNM. Results:Among the 1,045 patients, 55.8% had LNM, and 16.1% had ETE. Univariate analysis showed that male sex, age <45 years, tumor size ≥8 mm, ETE, and multifocal were associated with LNM (P<0.05). Multivariate analyses identified male sex, age <45 years, tumor size ≥8 mm, and multifocal as independent risk factors for LNM (P<0.05). After PSM in the present data set, the difference in LNM rates between ETE and non-ETE groups did not reach statistical significance (P>0.05). Similarly, the relationship between LNM and ETE was analyzed. Univariate analysis showed that age <45 years, tumor location, tumor diameter ≥8 mm, multifocal and LNM were risk factors for ETE (P<0.05). Multivariate analysis indicated that age <45 years, tumor located at the isthmus, tumor diameter ≥8 mm and LNM were independent risk factors for ETE (P<0.05). After PSM, no significant difference in ETE was found between patients with and without LNM (P>0.05). Conclusions:In this single-center, retrospective PSM cohort, we did not observe a significant association between the extent of ETE and LNM in patients with PTC. ETE does not appear to be a reliable indicator for guiding the extent of lymph node dissection. For patients with concurrent ETE, the lymph node dissection range should be personalized.

BACKGROUND:The necessity of prophylactic lateral neck dissection for cN0 papillary thyroid carcinoma (PTC) remains debated. This study aimed to compare traditional nomograms with machine learning (ML) models for predicting ipsilateral lateral and level II, III, and IV lymph node metastasis (LNM). METHODS:Data from 1616 PTC patients diagnosed via fine-needle aspiration biopsy from hospital A were split into training and testing sets (7:3). Two hundred forty-three patients from hospital B served as a validation set. Four dependent variables-ipsilateral lateral and level II, III, and IV LNM-were analyzed. Eight ML models [logistic regression, decision tree, random forest (RF), gradient boosting, support vector machine, K-nearest neighbor, Gaussian naive Bayes, neural networks] were developed and validated using 10-fold cross-validation and grid search hyperparameter tuning. Models were assessed using 11 metrics including accuracy, area under the curve (AUC), specificity, and sensitivity. The best was compared with nomograms using the probability-based ranking model approach (PMRA). RESULTS:RF outperformed other approaches achieving accuracy, AUC, specificity, and sensitivity of 0.773/0.728, 0.858/0.799, 0.984/0.935, 0.757/0.807 in the testing/validation sets, respectively, for ipsilateral LLNM. A streamlined model based on the top 10 contributing features that includes ipsilateral central lymph node metastasis rate, extrathyroidal extension, and ipsilateral central lymph node metastasis number retained strong performance and clearly surpassed a traditional nomogram approach based on multiple metrics and PMRA analysis. Similar results were obtained for the other dependent variables, with the RF models relying on distinct but overlapping sets of features. Clinical tool implementation is facilitated via a web-based calculator for each of the 4 dependent variables. CONCLUSION:ML, especially RF, reliably predicts lateral LNM in cN0 PTC patients, outperforming traditional nomograms.

Background This study aims to determine the optimal age cutoff for T1 papillary thyroid cancer (PTC), with a particular focus on the T1a and T1b subgroups. Methods A retrospective review of electronic medical records was conducted to identify patients who underwent thyroidectomy at our institution from January 2013 to December 2018. Results The study cohort consisted of 2,862 patients, including 765 men (26.7 %) and 2,097 women (73.3 %). Survival analysis demonstrated significantly poorer recurrence-free survival (RFS) in patients aged ≥55 years (p < 0.001). Patients were stratified into T1 (tumor size ≤2 cm, n = 2,328) and non-T1 (tumor size >2 cm, n = 534) subgroups. Among the non-T1 subgroup, older patients exhibited significantly inferior RFS, consistent with the overall cohort (p < 0.001). However, this difference was not observed in the T1 subgroup (p = 0.079). Within the T1 PTC subgroup, significant differences were identified between T1a and T1b patients concerning gender distribution, tumor size, clinical lymph node-positive status (cN1), total thyroidectomy, bilaterality, presence of Hashimoto’s thyroiditis, central lymph node metastasis, lateral lymph node metastasis, and radioiodine treatment (all p < 0.05). Further analysis indicated that when stratified by an age cutoff of 65 years, the prognosis for T1b patients was statistically significant (p = 0.018), whereas the prognosis for T1a patients was not statistically significant (p = 0.64). Conclusion The clinicopathologic characteristics of T1b patients differ significantly from those of T1a patients. Age may not be a critical factor in the prognostic staging system for T1a PTC patients, whereas 65 years appears to be a more appropriate age cutoff for T1b patients.

Rationale: This case analysis and literature review aim to identify the causes of bilateral chylothorax following thyroid cancer surgery, a rare yet serious complication. Patient concerns: We report 2 East Asian women who developed bilateral chylothorax after undergoing total thyroidectomy with neck lymph node dissection. Both patients presented with dyspnea and significant pleural effusion postoperatively. Diagnoses: Both patients were diagnosed with bilateral chylothorax based on clinical examination and imaging studies, including chest ultrasonography and X-rays. Interventions: In both cases, conservative management was initially implemented, involving chest tube drainage, total parenteral nutrition, and octreotide therapy. Surgical intervention was considered if conservative measures failed to control the chylous output. Outcomes: Both patients showed gradual improvement with conservative treatment, ultimately resulting in successful resolution of pleural effusion and discharge from the hospital without complications. Lessons: For patients with bilateral chylothorax, conservative treatment should be the initial approach for small effusions. For moderate to large effusions, placement of a chest drainage tube is recommended, and surgical intervention should be considered if chyle volume exceeds 10 mL/(kg/d) for 48 to 72 hours or persists for more than 11 days following conservative treatment.

A minority of papillary thyroid carcinoma (PTC) is highly aggressive, with rapid progression and a poor prognosis. This study investigated the clinical implications of preoperative multi-genic assay in identifying aggressive PTC and initial surgical management. The demographic data, clinicopathological data and preoperative multi-genic assay results of 251 patients with PTC after the initial surgery admitted to the First Affiliated Hospital of Chongqing Medical University from June 2022 to October 2023 were retrospectively analyzed. The results of preoperative multi-genic assay were categorized into three Molecular Risk Groups (MRGs) : MRG-Low, MRG-Intermediate, and MRG-High. 6.7% of patients belonged to MRG-High in this cohort study. Compared with MRG-Low and MRG-Intermediate, there was a significant increase in tumor size, capsular invasion, extrathyroidal extension (ETE), TNM stage, total thyroidectomy (TT) and radioiodine ablation in MRG-High. The multivariate analyses showed MRG-High was an independent predictor for high prevalence of ETE [OR = 83.343(10.074-689.477), P < 0.001]. However, MRG-High was not associated with lymph node metastases(LNM). Conversely, MRG-Low had lower rates of LNM [OR = 0.11 (0.02–0.6), p = 0.011]. Additionally, preoperative multi-genic assay could avoid 20.9% of complete total thyroidectomy in the MRG-Intermediate. This study found that preoperative multi-genic assay is useful to identify the aggressiveness of PTC, which is helpful to the choice of initial surgical management.

BACKGROUND:Occult lymph node metastasis of papillary thyroid carcinoma is common. However, whether undergoing prophylactic lateral lymph node dissections is still controversial. This cross-sectional study with large cohort of patients aims to investigate the clinical value of Delphian and pre-tracheal lymph node in predicting lateral lymph node metastasis of papillary thyroid carcinoma. MATERIALS AND METHODS:A retrospective analysis was conducted on 865 papillary thyroid carcinoma patients with Delphian and pre-tracheal lymph node data who underwent thyroidectomy plus central and lateral lymph node dissection. Data on clinicopathological characteristics were collected. Subsequently, a predictive model was established based on the results of the univariate and multivariate analyses. RESULTS:The rates of Delphian and pre-tracheal lymph node metastasis and lateral lymph node metastasis were 54.7% and 39.1%, respectively. Having ≥ 3 or 1-2 Delphian and pre-tracheal lymph node metastasis dramatically increased the risk of lateral lymph node metastasis (OR = 8.5, 95% CI 5.3-13.4 and OR = 3.9, 95% CI 2.7-5.7, respectively). The upper tumour had a 3.7 times higher risk of lateral lymph node metastasis than other locations. Patients ≤ 42 years or tumour size >8 mm had a higher risk of lateral lymph node metastasis. CONCLUSIONS:Delphian and pre-tracheal lymph node metastasis was associated positively with the risk of lateral lymph node metastasis. For patients without clinical lateral lymph node metastasis, the Delphian and pre-tracheal lymph node could be considered to harvest as the first step in a thyroidectomy to facilitate further conduct of the operation.

Prophylactic dissection of paratracheal lymph nodes in clinically lymph node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial. This study aims to integrate preoperative and intraoperative variables to compare traditional nomograms and machine learning (ML) models, developing and validating an interpretable predictive model for paratracheal lymph node metastasis (PLNM) in cN0 PTC patients. We retrospectively selected 3213 PTC patients treated at the First Affiliated Hospital of Chongqing Medical University from 2016 to 2020. They were randomly divided into the training and test datasets with a 7:3 ratio. The 533 PTC patients treated at the Guangyuan Central Hospital from 2019 to 2022 were used as an external test sets. We developed and validated nine ML models using 10-fold cross-validation and grid search for hyperparameter tuning. The predictive performance was evaluated using ROC curves, decision curve analysis (DCA), calibration curves, and precision-recall curves. The best model was compared to a traditional logistic regression-based nomogram. The XGBoost model achieved AUC values of 0.935, 0.857, and 0.775 in the training, validation, and test sets, respectively, significantly outperforming the traditional nomogram model with AUCs of 0.85, 0.844, and 0.769, respectively. SHapley Additive exPlanations (SHAP)-based visualization identified the top 10 predictive features of the XGBoost model, and a web-based calculator was created based on these features. ML is a reliable tool for predicting PLNM in cN0 PTC patients. The SHAP method provides valuable insights into the XGBoost model, and the resultant web-based calculator is a clinically useful tool to assist in the surgical planning for paratracheal lymph node dissection.

Objectives: The scope of lateral neck lymph node dissection (LND) in papillary thyroid carcinoma (PTC) remains controversial. Our research aimed to explore the value of central lymph node metastasis (CLNM) in frozen sections for predicting neck lateral lymph node metastasis (NLLNM) and to guide clinical surgeons in performing surgical lymph node dissection.Patients: A total of 275 patients with PTC with suspected 'Cervical lymph node metastasis (LNM, including CLNM and NLLNM)' underwent unilateral or bilateral thyroidectomy and an intraoperative frozen diagnosis of central lymph nodes (LNs), as well as central and neck lateral LND. Validity indices and consistency of central LNs in frozen sections were calculated. In total, 216 patients then met the inclusion criteria and were enrolled in the follow-up study. The clinical and pathological data of the patients were retrospectively analyzed. The relationship between the number, metastatic diameter, and the ratio of CLNM to NLLNM was investigated.Results: CLNM in frozen and paraffin-embedded sections was associated with NLLNM. Univariate and multivariate analyses revealed the following risk factors for NLLNM metastasis: maximum diameter, total number, and ratio of metastatic LNs. A significant result was obtained when a cut-off value of 2.050 mm for the maximum metastatic diameter, 5.5 in the total number, and 0.5342 for the CLNM ratio level was used. Interaction term analyses showed that the association between the number of CLNM and NLLNM differed according to maximum diameter.Conclusion: Central LNs in frozen sections accurately predicted NLLNM. In patients with PTC with >5 CLNMs, >= 2 and <= 5 CLNMs and maximum metastatic diameter > 2 mm, neck lateral LND should be considered. Our findings will facilitate the identification of patients who are likely to benefit from extended lateral neck LND.

Background:Central lymph node metastases (CLNM) in papillary thyroid microcarcinoma (PTMC) are common, but management through prophylactic central lymph node dissection (pCLND) remains controversial. In this study, the independent predictors of CLNM in PTMC were retrospectively studied based on ultrasound and pathological data, and we aim to establish the prediction model to predict CLNM in PTMC. Methods:This study included a total of 1,506 patients who underwent thyroid surgery for PTMC at the First Affiliated Hospital of Chongqing Medical University from 2015 to 2018. Ultrasound and clinicopathological features were summarized and analyzed. Univariate and multivariate analyses were performed to determine the risk factors associated with CLNM. The prediction model is established and verified according to the multivariate analysis results. The Kaplan-Meier curve was used to evaluate the effect of CLNM on survival. Results:The CLNM rate was 44.5% (670/1,506). Multivariate analysis showed that men, younger age, smaller diameter, ETE, microcalcification, without Hashimoto's thyroiditis, and multifocal were independent risk predictors of CLNM. Nomogram has a good discriminative ability (C-index: 0.755 in the validation group), and the calibration effect is good. In the DCA curve, the CLNM prediction model performed better net benefit given any high-risk thresholds. The median follow-up time was 30 months (12-59 months), 116 cases were lost, and the follow-up rate was 92.8% (1,506/1,622). Of the 1,506 patients included, 12 (0.8%) experienced recurrence. Conclusion:The likelihood of CLNM can be objectively quantified before surgery by using this reliable and accurate nomogram that combines preoperative ultrasound with clinicopathological features. Clinicians can use this nomogram to assess central lymph node status in patients with PTMC and consider prophylactic CND in patients with high scores.

Background: A minority of papillary thyroid carcinoma (PTC) is highly aggressive, with rapid progression and a poor prognosis. This study investigated the ability of multi-genic assay to identify patients with aggressive PTC. Patients and methods: A total of 117 PTC patients treated at The First Affiliated Hospital of Chongqing Medical University with clinicopathological data and multi-genic assay results and 389 patients with complete data from The Cancer Genome Atlas (TCGA) database were included. The chi-square test was used to analyze the relationship between the multi-genic assay results and clinicopathological characteristics. Univariate and multivariate regression analyses were used to analyze the impact of various factors on prognosis. Results: The median follow-up times of the local and TCGA cohorts were 30 months and 34 months, respectively. The results showed that central lymph node metastasis (P = 0.036), lateral lymph node metastasis (P = 0.003) and mutations in genes other than BRAF(V600E) (P = 0.002) were significantly associated with disease-free survival (DFS) in the local cohort, while the analysis of TCGA data showed that mutations in genes other than BRAF(V600E) were significantly related to poor prognosis (P = 0.029). According to univariate and multivariate analyses, mutations in genes other than BRAF(V600E) (P = 0.021) and lateral lymph node metastasis (P = 0.022) were independent factors for postoperative recurrence, as well as, mutations in genes other than BRAF(V600E) were an independent factor of survival (P = 0.047). Conclusions: The multi-genic assay was able to identify aggressive PTC, providing an effective biological basis for surgical management and postoperative treatment.