Researchers from China constructed and validated an ultrasound-based nomogram to predict the risk of cervical lymph node metastasis in patients with medullary thyroid carcinoma (MTC).

The nomogram “may guide clinicians in stratifying patients and assist surgeons to choose the appropriate surgical strategy and thus reduce overtreatment of indolent MTC,” the authors said. The study is published in the journal Frontiers in Oncology.

Cervical lymph node metastasis occurs often in MTC. However, it is not clear how to manage cervical lymph node involvement in clinically negative MTC.

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To predict the cervical lymph node metastasis of MTC before surgery, a team of researchers led by Pintong Huang, from the Department of Ultrasound Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University in Hangzhou, China, developed an ultrasound-based nomogram.

The researchers analyzed 74 patients with MTC whose disease was confirmed histologically. Based on the pathology results, the patients were divided into 2 groups: those with cervical lymph node metastasis and those without.

The team then evaluated the potential association between cervical lymph node metastasis and the preoperative characteristics of the tumor, including its size, location, solid component, shape, margin, echogenicity, calcification, and extracapsular invasion. 

The researchers constructed the nomogram based on 3 factors: the tumor margin, suspicious lymph node reported by ultrasound, and extracapsular invasion. They said that the nomogram had good discriminatory features with an area under the curve of 0.919.

They reported that there was also good agreement between the probability of cervical lymph node metastasis that the nomogram predicted and the actual incidence of cervical lymph node metastasis.

“This model is helpful for clinical decision-making,” the researchers concluded.

MTC is a rare malignancy of the thyroid gland characterized by early lymph node metastasis, predominantly cervical lymph node metastasis.


Luo Z, Hong Y, Yan C, Ye Q, Wang Y, Huang P. Nomogram for preoperative estimation risk of cervical lymph node metastasis in medullary thyroid carcinoma. Front Oncol. Published online October 12, 2022. doi:10.3389/fonc.2022.883429