Analysis of risk factors related to the invasiveness of cN0 single papillary thyroid microcarcinoma

Recently, we had the honor of reading the article titled “A nomogram based on ultrasound radiomics for predicting the invasiveness of cN0 single papillary thyroid microcarcinoma” (1). This study included 317 cases of cN0 single papillary thyroid microcarcinoma (PTMC) patients, randomly divided into training and testing groups in an 8:2 ratio. Ultrasound (US) images of all patients were segmented, and radiomic features were extracted. In the training dataset, US features with minimal redundancy-maximal relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) were selected. Radiomic features were then established based on their respective weighted coefficients. Single-factor and multiple-factor logistic regression analyses were conducted to identify risk factors for potentially invasive PTMC. A nomogram was created by combining three risk factors (lesion diameter, lesion location, and gender) and seven radiomic features. The area under the curve (AUC), accuracy, sensitivity, and specificity in the training set were 0.76, 0.811, 0.914, and 0.727, respectively, while in the testing set, the results were 0.71, 0.841, 0.533, and 0.868, respectively. Additionally, decision curve analysis (DCA) curves demonstrated that the nomogram could provide a higher net benefit. Calibration curves also indicated its good performance. The model holds value in predicting the invasiveness of cN0 PTMC without clinical lymph node metastasis.

We sincerely appreciate the contributions made by the authors. However, there are issues in this study that require further exploration.

Firstly, the clinical factors included in this study lack statistical analysis of the thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) test indicators. These indicators can reflect the thyroid’s functional status. Studies have shown a positive correlation between low TPOAb levels and central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) (2). TgAb (positive) is an independent predictor of CLNM in PTC (3). Since these indicators are routinely tested preoperatively, they are easily obtainable. If these indicators show statistical differences, incorporating them into the nomogram may further enhance the model’s efficacy.

Secondly, the discussion section lacks an explanation of the radiomic features of the Rad score. For example, the equation includes features such as original_shape_SurfaceVolumeRatio, which represents the surface area-to-volume ratio. A larger value of this feature suggests a tumor morphology less inclined towards a spherical shape, indicating increased irregularity. A study has shown that more irregular tumor morphology is associated with higher malignancy and invasiveness (4), aligning with the meaning and weight of this feature in the model.

Finally, we express our gratitude once again for the authors’ contributions to this study. We hope our insights would be valuable for their further research, and we look forward to hearing their opinions.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-73/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Zhang M, Lyu S, Yang L, et al. A nomogram based on ultrasound radiomics for predicting the invasiveness of cN0 single papillary thyroid microcarcinoma. Gland Surg 2023;12:1735-45. [Crossref] [PubMed]
2. Li X, Zhang H, Zhou Y, et al. Risk factors for central lymph node metastasis in the cervical region in papillary thyroid carcinoma: a retrospective study. World J Surg Oncol 2021;19:138. [Crossref] [PubMed]
3. Gao X, Luo W, He L, et al. Predictors and a Prediction Model for Central Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma (cN0). Front Endocrinol (Lausanne) 2021;12:789310. [Crossref] [PubMed]
4. Matsuo K, Akiba J, Kusukawa J, et al. Squamous cell carcinoma of the tongue: subtypes and morphological features affecting prognosis. Am J Physiol Cell Physiol 2022;323:C1611-23. [Crossref] [PubMed]