Abstract
OBJECTIVES: This study aimed to develop an artificial intelligence-assisted model for the preoperative prediction of lateral cervical lymph node metastasis (LCLNM) in papillary thyroid carcinoma (PTC) using computed tomography (CT) radiomics, providing a new noninvasive and accurate diagnostic tool for PTC patients with LCLNM. METHODS: This retrospective study included 389 confirmed PTC patients, randomly divided into a training set ( n = 272) and an internal validation set ( n = 117), with an additional 40 patients from another hospital as an external validation set. Patient demographics were evaluated to establish a clinical model. Radiomic features were extracted from preoperative contrast-enhanced CT images (venous phase) for each patient. Feature selection was performed using analysis of variance and the least absolute shrinkage and selection operator algorithm. We employed support vector machine, random forest (RF), logistic regression, and XGBoost algorithms to build CT radiomic models for predicting LCLNM. A radiomics score (Rad-score) was calculated using a radiomic signature-based formula. A combined clinical-radiomic model was then developed. The performance of the combined model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS: A total of 1724 radiomic features were extracted from each patient's CT images, with 13 features selected based on nonzero coefficients related to LCLNM. Four clinically relevant factors (age, tumor location, thyroid capsule invasion, and central cervical lymph node metastasis) were significantly associated with LCLNM. Among the algorithms tested, the RF algorithm outperformed the others with five-fold cross-validation on the training set. After integrating the best algorithm with clinical factors, the areas under the ROC curves for the training, internal validation, and external validation sets were 0.910 (95% confidence interval [CI]: 0.729-0.851), 0.876 (95% CI: 0.747-0.911), and 0.821 (95% CI: 0.555-0.802), respectively, with DCA demonstrating the clinical utility of the combined radiomic model. CONCLUSIONS: This study successfully established a clinical-CT radiomic combined model for predicting LCLNM, which may significantly enhance surgical decision-making for lateral cervical lymph node dissection in patients with PTC.