Ultrasound-Based Nomogram for Predicting the Aggressiveness of Papillary Thyroid Carcinoma in Adolescents and Young Adults

Abstract

Rationale and objectives: Assessing the aggressiveness of papillary thyroid carcinoma (PTC) preoperatively might play an important role in guiding therapeutic strategy. This study aimed to develop and validate a nomogram that integrated ultrasound (US) features with clinical characteristics to preoperatively predict aggressiveness in adolescents and young adults with PTC.

Materials and methods: In this retrospective study, a total of 2373 patients were enrolled and randomly divided into two groups with 1000 bootstrap sampling. The multivariable logistic regression (LR) analysis or least absolute shrinkage and selection operator LASSO regression was applied to select predictive US and clinical characteristics in the training cohort. By incorporating most powerful predictors, two predictive models presented as nomograms were developed, and their performance was assessed with respect to discrimination, calibration, and clinical usefulness.

Results: The LR_model that incorporated gender, tumor size, multifocality, US-reported cervical lymph nodes (CLN) status, and calcification demonstrated good discrimination and calibration with an area under curve (AUC), sensitivity and specificity of 0.802 (0.781-0.821), 65.58% (62.61%-68.55%), and 82.31% (79.33%-85.46%), respectively, in the training cohort; and 0.768 (0.736-0.797), 60.04% (55.62%-64.46%), and 83.62% (78.84%-87.71%), respectively, in the validation cohort. Gender, tumor size, orientation, calcification, and US-reported CLN status were combined to build LASSO_model. Compared with LR_model, the LASSO_model yielded a comparable diagnostic performance in both cohorts, the AUC, sensitivity, and specificity were 0.800 (0.780-0.820), 65.29% (62.26%-68.21%), and 81.93% (78.77%-84.91%), respectively, in the training cohort; and 0.763 (0.731-0.792), 59.43% (55.12%-63.93%), and 84.98% (80.89%-89.08%), respectively, in the validation cohort. The decision curve analysis indicated that using the two nomograms to predict the aggressiveness of PTC provided a greater benefit than either the treat-all or treat-none strategy.

Conclusion: Through these two easy-to-use nomograms, the possibility of the aggressiveness of PTC in adolescents and young adults can be objectively quantified preoperatively. The two nomograms may serve as a useful clinical tool to provide valuable information for clinical decision-making.

Keywords: Adolescents and young adults; Aggressiveness; Nomogram; Papillary thyroid carcinoma; Ultrasound.