Researchers from China developed a new model for predicting the occurrence of lateral lymph node metastasis (LLNM) in medullary thyroid carcinoma (MTC) patients.

“In our study, male sex, tumor size >38 mm, multifocality, extrathyroidal extension, and distant metastasis in MTC patients were significant risk factors for predicting LLNM metastasis,” Zhou et al wrote in the article recently published in the journal Frontiers in Endocrinology. Therefore, they used these 5 clinical features to develop a nomogram.

The predictive model showed good performance (C-index in the training set, 0.825, 95% CI, 0.697-0.840). The analysis of the external testing set, composed of 35 cases of MTC, indicated a sensitivity of 68.0% and a specificity of 86.4%.

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These results are promising when compared to those of ultrasonography, which is commonly used to assess cervical lymph node metastasis in MTC patients preoperatively. Previous studies indicate that ultrasonography has high specificity (85%-97.4%) but low sensitivity (36.7%-61%) for this use.

Their study cohort constituted of 714 patients retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and 35 patients from the Department of Surgical Oncology, Hangzhou First People’s Hospital, China. The rate of LLNM was 46.64% in the SEER dataset and 34.23% in the hospital dataset.

In addition, Zhou et al found that patients with LLNM had worse recurrence rates and cancer-specific survival when compared with patients without LLNM.

“Patients with LLNM predict a higher grade, higher aggression (tumor invasiveness), and increase in the risk of recurrence and death,” Zhou et al explained. Hence, they believe this pathological finding should be carefully monitored. The model they developed could be a valuable contribution after additional validation in a large and multicenter study cohort.


Zhou T-H, Zhao L-Q, Zhang Y, et al. The prediction of metastases of lateral cervical lymph node in medullary thyroid carcinoma. Front Endocrinol. 2021;12:1507. doi:10.3389/fendo.2021.741289.