The Value of Ultrasonographic Scoring Method and Nomogram in Assessing Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma 

The Value of Ultrasonographic Scoring Method and Nomogram in Assessing Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Value of Ultrasonographic Scoring Method and Nomogram in Assessing Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma LiPing Chen, Yan Chen, Zhengming Hu, Huali Cai, Xiaona Lin, Jieyu Zhong, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5555235/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Jul, 2025 Read the published version in Thyroid Research → Version 1 posted 6 You are reading this latest preprint version Abstract Background The preoperative cervical lymph node metastasis (CLNM) status in patients with papillary thyroid carcinoma (PTC) critically determines the type of lymph node dissection performed. Currently, ultrasonography is the primary method for initial CLNM screening in PTC patients. This study aims to analyze the efficacy of an ultrasonic-characteristics-based scoring system in diagnosing lymph node metastasis in PTC and construct a predictive nomogram. Methods The imaging findings, fine-needle aspiration (FNA) results, and surgical pathology data from 269 suspected CLNM cases at Peking University Shenzhen Hospital, spanning from July 2021 to October 2022, were retrospectively analyzed. We identified specific ultrasound characteristics and assigned scores based on our clinical experience. The diagnostic performance of the ultrasound scoring system was assessed by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC). Additionally, a nomogram was developed using least absolute shrinkage and selection operator (LASSO)-logistic regression. The nomogram's discrimination was evaluated using ROC analysis, its accuracy was assessed with calibration curves, and its clinical utility was determined by decision curve analysis (DCA) . Results In this study, factors such as age, sex, lymph node length, thickness, aspect ratio, shape, hilum status, echogenicity, microcalcification, cystic necrosis, blood flow pattern, and the ultrasonic score were included in the analysis. The ultrasound score had the highest (AUC = 0.914, 95% confidence interval [CI] : 0.880–0.950), with an optimal cutoff value of 2.5. A score of 3 or higher had a diagnostic sensitivity for CLNM of 81.1%, specificity of 85.2%, positive predictive value (PPV) of 83.1%, negative predictive value (NPV) of 83.4%, and Kappa value of 0.664. Subsequent LASSO regression analysis identified sex, hyperechogenicity, peripheral disordered blood flow, and the ultrasonic score as independent predictors of CLNM, which were incorporated into a logistic regression-based predictive nomogram. The model exhibited strong discriminatory performance in both the training set (AUC = 0.933, 95% CI: 0.820–0.910) and the test set (AUC = 0.958, 95% CI: 0.790–0.890) for distinguishing PTC with and without CLNM. Furthermore, calibration curves and decision curve analysis (DCA) confirmed the model’s good fit and favorable clinical net benefit. Conclusion The ultrasonic scoring method and the Nomogram have significant clinical utility in the preoperative assessment of CLNM in PTC, reducing unnecessary FNA procedures, and are simple and practical for clinical application. Nomogram Papillary thyroid carcinoma(PTC) cervical lymph node metastasis(CLNM) Ultrasonography Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Jul, 2025 Read the published version in Thyroid Research → Version 1 posted Editorial decision: Accepted 28 Jun, 2025 Reviews received at journal 01 May, 2025 Reviewers agreed at journal 16 Apr, 2025 Reviewers invited by journal 16 Apr, 2025 Submission checks completed at journal 14 Apr, 2025 First submitted to journal 12 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5555235","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444038799,"identity":"cbe49ed7-7470-4150-914f-7a01c70b02e4","order_by":0,"name":"LiPing Chen","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"LiPing","middleName":"","lastName":"Chen","suffix":""},{"id":444038801,"identity":"8ccc4e99-75ca-437c-a451-3bc23fea9e78","order_by":1,"name":"Yan Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYDACCQglJ8/MfODwjwoJOXlitRgbtrclHmY4Y2Fs2ECklsSGM2eMDzO2VSQyHCCgg39287HHPDV3jBln5BgcLpwnkcDYwPzw0Q18ltw5lm7Mc+yZHLtEWsHhmdsk8tgZ2IyNc/BoMZDIMZPmYTsMtCV5wwHebRLFjA08bNL4teR/k+b5dzix4UaCwQHeORKJDQcIaslhk+ZtA2o5c8TgMG8DEVokbqSZSc7tOwwK5ISDM45JGBs2E/AL/4zkZxJvvh0GReXhDx9q6uTk2ZsfPsanBQSYeFC4zASUgwDjDyIUjYJRMApGwQgGAG0+UFFJYoixAAAAAElFTkSuQmCC","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yan","middleName":"","lastName":"Chen","suffix":""},{"id":444038803,"identity":"5a8a9c5a-8c9b-4bd3-b3a9-88471901393f","order_by":2,"name":"Zhengming Hu","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhengming","middleName":"","lastName":"Hu","suffix":""},{"id":444038804,"identity":"ea1e981d-5b16-408e-995d-1e418c61fe00","order_by":3,"name":"Huali Cai","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huali","middleName":"","lastName":"Cai","suffix":""},{"id":444038806,"identity":"897e7d11-9e03-4bdb-a14e-25e0800625fe","order_by":4,"name":"Xiaona Lin","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaona","middleName":"","lastName":"Lin","suffix":""},{"id":444038807,"identity":"ce41dc6c-78dd-4562-a7e8-3a6901f7b24d","order_by":5,"name":"Jieyu Zhong","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jieyu","middleName":"","lastName":"Zhong","suffix":""},{"id":444038808,"identity":"f29af064-1e33-4028-837e-0d69bdc41c48","order_by":6,"name":"Desheng Sun","email":"","orcid":"","institution":"Peking University Shenzhen Hospital","correspondingAuthor":false,"prefix":"","firstName":"Desheng","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2024-11-30 15:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5555235/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5555235/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13044-025-00255-6","type":"published","date":"2025-07-22T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87756710,"identity":"23fa4413-6d29-48ad-9188-cc171c8e1bdf","added_by":"auto","created_at":"2025-07-28 16:07:59","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":907994,"visible":true,"origin":"","legend":"","description":"","filename":"TheValueofUltrasonographicScoringMethodandNomograminAssessingCervicalLymphNodeMetastasisofPapillaryThyroidCarcinoma.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5555235/v1_covered_94c3f4bc-ea9f-4d2a-862a-3ceff9100c31.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Value of Ultrasonographic Scoring Method and Nomogram in Assessing Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma ","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"thyroid-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"thyr","sideBox":"Learn more about [Thyroid Research](http://thyroidresearchjournal.biomedcentral.com/)","snPcode":"13044","submissionUrl":"https://submission.nature.com/new-submission/13044/3","title":"Thyroid Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nomogram, Papillary thyroid carcinoma(PTC), cervical lymph node metastasis(CLNM), Ultrasonography","lastPublishedDoi":"10.21203/rs.3.rs-5555235/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5555235/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe preoperative cervical lymph node metastasis (CLNM) status in patients with papillary thyroid carcinoma (PTC) critically determines the type of lymph node dissection performed. Currently, ultrasonography is the primary method for initial CLNM screening in PTC patients. This study aims to analyze the efficacy of an ultrasonic-characteristics-based scoring system in diagnosing lymph node metastasis in PTC and construct a predictive nomogram.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe imaging findings, fine-needle aspiration (FNA) results, and surgical pathology data from 269 suspected CLNM cases at Peking University Shenzhen Hospital, spanning from July 2021 to October 2022, were retrospectively analyzed. We identified specific ultrasound characteristics and assigned scores based on our clinical experience. The diagnostic performance of the ultrasound scoring system was assessed by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC). Additionally, a nomogram was developed using least absolute shrinkage and selection operator (LASSO)-logistic regression. The nomogram's discrimination was evaluated using ROC analysis, its accuracy was assessed with calibration curves, and its clinical utility was determined by decision curve analysis (DCA) .\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn this study, factors such as age, sex, lymph node length, thickness, aspect ratio, shape, hilum status, echogenicity, microcalcification, cystic necrosis, blood flow pattern, and the ultrasonic score were included in the analysis. The ultrasound score had the highest (AUC\u0026thinsp;=\u0026thinsp;0.914, 95% confidence interval [CI] : 0.880\u0026ndash;0.950), with an optimal cutoff value of 2.5. A score of 3 or higher had a diagnostic sensitivity for CLNM of 81.1%, specificity of 85.2%, positive predictive value (PPV) of 83.1%, negative predictive value (NPV) of 83.4%, and Kappa value of 0.664. Subsequent LASSO regression analysis identified sex, hyperechogenicity, peripheral disordered blood flow, and the ultrasonic score as independent predictors of CLNM, which were incorporated into a logistic regression-based predictive nomogram. The model exhibited strong discriminatory performance in both the training set (AUC\u0026thinsp;=\u0026thinsp;0.933, 95% CI: 0.820\u0026ndash;0.910) and the test set (AUC\u0026thinsp;=\u0026thinsp;0.958, 95% CI: 0.790\u0026ndash;0.890) for distinguishing PTC with and without CLNM. Furthermore, calibration curves and decision curve analysis (DCA) confirmed the model\u0026rsquo;s good fit and favorable clinical net benefit.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe ultrasonic scoring method and the Nomogram have significant clinical utility in the preoperative assessment of CLNM in PTC, reducing unnecessary FNA procedures, and are simple and practical for clinical application.\u003c/p\u003e","manuscriptTitle":"The Value of Ultrasonographic Scoring Method and Nomogram in Assessing Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-18 12:45:42","doi":"10.21203/rs.3.rs-5555235/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-06-28T18:57:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-01T20:53:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224952166265616366071139750588444150226","date":"2025-04-16T21:14:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-16T21:07:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-14T14:14:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Thyroid Research","date":"2025-04-12T11:10:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"thyroid-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"thyr","sideBox":"Learn more about [Thyroid Research](http://thyroidresearchjournal.biomedcentral.com/)","snPcode":"13044","submissionUrl":"https://submission.nature.com/new-submission/13044/3","title":"Thyroid Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d867565c-136f-49b3-977b-f10ed76f6439","owner":[],"postedDate":"April 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-28T16:01:26+00:00","versionOfRecord":{"articleIdentity":"rs-5555235","link":"https://doi.org/10.1186/s13044-025-00255-6","journal":{"identity":"thyroid-research","isVorOnly":false,"title":"Thyroid Research"},"publishedOn":"2025-07-22 15:57:36","publishedOnDateReadable":"July 22nd, 2025"},"versionCreatedAt":"2025-04-18 12:45:42","video":"","vorDoi":"10.1186/s13044-025-00255-6","vorDoiUrl":"https://doi.org/10.1186/s13044-025-00255-6","workflowStages":[]},"version":"v1","identity":"rs-5555235","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5555235","identity":"rs-5555235","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}