title: A scoring system is an effective tool for predicting central lymph node metastasis in papillary thyroid microcarcinoma: a case-control study.
abstract: BACKGROUND
  The purpose of this study was to evaluate the clinicopathologic and ultrasonographic (US) characteristics and establish an effective scoring system for predicting central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC).
  
  
  METHODS
  A total of 498 patients with PTMC who underwent total thyroidectomy or lobectomy with therapeutic central lymph node dissection (CLND) were enrolled. Univariate and multivariate analyses were performed to find the independent predictors for CLNM based on clinicopathological and US characteristics. Using the standardized regression coefficient, a 10-point score system was constructed in line with these independent predictors. Then, the scoring system was evaluated for the diagnostic value in predicting CLNM.
  
  
  RESULTS
  Tumor location (the lower polo), tumor size (>5 mm), extrathyroidal extension, margin (no well-defined), display of enlarged lymph node, and contact of >25% with the adjacent capsule were independent predictors for CLNM. Verifying the scoring system, a cutoff value of 5 points was found to be the best prediction for CLNM, the sensitivity and specificity were 64.7 and 80.5%, respectively, and the positive and negative predictive values were 77.3 and 69.0%, respectively.
  
  
  CONCLUSIONS
  The points≤5 could be considered as a low risk for CLNM, and the points>5 could be identified as a high risk for CLNM. More advanced diagnostic approaches and prophylactic CLND are needed for patients with the points>5.
authors.affiliation: Department of Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. cyfoncology@gmail.com.
authors.forename: Ye-feng
authors.initials: YF
authors.lastname: Cai
authors.affiliation: Department of Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. wangqingxuan1991@163.com.
authors.forename: Qing-xuan
authors.initials: QX
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. cccrytial@163.com.
authors.forename: Chun-jue
authors.initials: CJ
authors.lastname: Ni
authors.affiliation: Department of Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. zxjzhongliu@126.com.
authors.forename: Xiang-jian
authors.initials: XJ
authors.lastname: Zhang
authors.affiliation: Department of Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. chenendong.oncology@gmail.com.
authors.forename: En-dong
authors.initials: ED
authors.lastname: Chen
authors.affiliation: Department of Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. dsyoncology@163.com.
authors.forename: Si-yang
authors.initials: SY
authors.lastname: Dong
authors.affiliation: Department of Diagnostic Ultrasound, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. zhmoncology@163.com.
authors.forename: Hua-min
authors.initials: HM
authors.lastname: Zheng
authors.affiliation: Department of Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. zxhoncology@126.com.
authors.forename: Xiao-hua
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: Department of Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China. lqsky1106@126.com.
authors.forename: Quan
authors.initials: Q
authors.lastname: Li
mesh_terms: D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D047368:Tumor Burden