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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleHead and Neck Imaging

Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer

N.U. Patel, K.E. Lind, K. McKinney, T.J. Clark, S.S. Pokharel, J.M. Meier, E.R. Stamm, K. Garg and B. Haugen
American Journal of Neuroradiology April 2018, 39 (4) 756-761; DOI: https://doi.org/10.3174/ajnr.A5554
N.U. Patel
aFrom the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
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  • ORCID record for N.U. Patel
K.E. Lind
aFrom the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
cDepartment of Health Systems, Management and Policy (K.E.L.), Colorado School of Public Health, Aurora, Colorado.
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  • ORCID record for K.E. Lind
K. McKinney
aFrom the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
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T.J. Clark
aFrom the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
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  • ORCID record for T.J. Clark
S.S. Pokharel
aFrom the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
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J.M. Meier
aFrom the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
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E.R. Stamm
aFrom the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
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K. Garg
aFrom the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)
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B. Haugen
bDivision of Endocrinology (B.H.), University of Colorado School of Medicine, Aurora, Colorado
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Article Figures & Data

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  • FIGURE.
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    FIGURE.

    Diagram depicting the overall study design.

Tables

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    Table 1:

    Lymph node evaluation by the sonographic predictive model (features of a predicted abnormal LN)a

    Nonhomogeneous Echo PatternMicrocalcificationsVolume (mm3)
    PresentPresentAny
    Absent or indeterminatePresent≥853
    PresentAbsent or indeterminate≥690
    Absent or indeterminateAbsent or indeterminate≥2538
    • ↵a LN FNAB recommendation was based on the combination of features at a given volume threshold.

    • View popup
    Table 2:

    Patient characteristics (N = 103)

    VariableMean (SD)MedianMin, Max
    Age (yr)51.17 (13.49)51.023, 78
    Time since PTC diagnosis (yr)6.07 (5.35)4.50.23, 30.48
    • Note:—Min indicates minimum; Max, maximum.

    • View popup
    Table 3:

    Patient characteristics (N = 103)

    Frequency (%)
    Women76 (73.79%)
    Biopsy or operation performed39 (37.86%)
    Positive for LN metastasis21 (53.85%)
    No. of LNs evaluated on US
        130 (29.13%)
        236 (34.95%)
        321 (20.39%)
        411 (10.68%)
        54 (3.88%)
        81 (0.97%)
    • View popup
    Table 4:

    Frequencies of patient level (N = 103 participants) and lymph node level (N = 237 LNs) M and R method resultsa

    Biopsy Positive for MetastasisBiopsy Negative for MetastasisNot BiopsiedTotal
    Person level
        Total participants211864103
        M
            Positive1761336
            Negative4125167
        R
            Positive19131749
            Negative254754
    Lymph node level
        Total lymph lodes3340164237
        M
            Positive2191747
            Negative1231147190
        R
            Positive24263787
            Negative914127150
    • ↵a For person level results, biopsy positive for metastasis indicates that the patient had at least 1 LN positive for metastasis, and positive M or R method indicates that the patient had at least 1 LN called positive by the respective method.

    • View popup
    Table 5:

    LN pathology results by R and M method

    ResultsMethod
    +R Method−R Method
    Positive for metastasis (33 LNs)
        +M method174
        −M method75
    Negative for metastasis (40 LNs)
        +M method63
        −M method2011
    • View popup
    Table 6:

    Relative true-positive and relative false-positive rates for the M method compared with the R method (n = 54 LNs with pathology results in which at least 1 method, R or M, had positive findings)

    Estimate (SE)95% CIP Value
    rTPF M method1.46 (0.20)1.12–1.91.01
    rFPF M method0.58 (0.14)0.36–0.92.02
    • Note:—SE, indicates standard error.

    • View popup
    Table 7:

    M and R method results compared with follow-up neck ultrasound examination for interval change in lymph nodes without pathology results (n = 105)

    M and R MethodsSuspiciousNot SuspiciousStableP Valuea
    +M method055.66
    −M method43358
    +R method21118.74
    −R method22745
    • ↵a Fisher exact test.

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American Journal of Neuroradiology: 39 (4)
American Journal of Neuroradiology
Vol. 39, Issue 4
1 Apr 2018
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Cite this article
N.U. Patel, K.E. Lind, K. McKinney, T.J. Clark, S.S. Pokharel, J.M. Meier, E.R. Stamm, K. Garg, B. Haugen
Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer
American Journal of Neuroradiology Apr 2018, 39 (4) 756-761; DOI: 10.3174/ajnr.A5554

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Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer
N.U. Patel, K.E. Lind, K. McKinney, T.J. Clark, S.S. Pokharel, J.M. Meier, E.R. Stamm, K. Garg, B. Haugen
American Journal of Neuroradiology Apr 2018, 39 (4) 756-761; DOI: 10.3174/ajnr.A5554
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