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<meta name="DC.Title" content="Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5554" />
<meta name="DC.Date" content="2018-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2018 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist's standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy.

MATERIALS AND METHODS: Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method.

RESULTS: A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12–1.91; P = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36–0.92; P = .02) compared with the R method.

CONCLUSIONS: The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.

LN
:   lymph node
FNAB
:   fine-needle aspiration biopsy
M method
:   sonographic evaluation of lymph nodes using the predictive model
PTC
:   papillary thyroid carcinoma
R method
:   sonographic evaluation of the lymph node per standard clinical practice
rFPF
:   relative false-positive fraction
rTPF
:   relative true-positive fraction
Tg
:   thyroglobulin
US
:   ultrasound" />
<meta name="DC.Contributor" content="N.U. Patel" />
<meta name="DC.Contributor" content="K.E. Lind" />
<meta name="DC.Contributor" content="K. McKinney" />
<meta name="DC.Contributor" content="T.J. Clark" />
<meta name="DC.Contributor" content="S.S. Pokharel" />
<meta name="DC.Contributor" content="J.M. Meier" />
<meta name="DC.Contributor" content="E.R. Stamm" />
<meta name="DC.Contributor" content="K. Garg" />
<meta name="DC.Contributor" content="B. Haugen" />
<meta name="article:published_time" content="2018-04-01" />
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<meta name="citation_title" content="Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist9s standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12–1.91; &lt;i&gt;P&lt;/i&gt; = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36–0.92; &lt;i&gt;P&lt;/i&gt; = .02) compared with the R method.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.&lt;/p&gt;" />
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<meta name="twitter:title" content="Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist's standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy.

MATERIALS AND METHODS: Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method.

RESULTS: A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12–1.91; P = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36–0.92; P = .02) compared with the R method.

CONCLUSIONS: The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.

LN
:   lymph node
FNAB
:   fine-needle aspiration biopsy
M method
:   sonographic evaluation of lymph nodes using the predictive model
PTC
:   papillary thyroid carcinoma
R method
:   sonographic evaluation of the lymph node per standard clinical practice
rFPF
:   relative false-positive fraction
rTPF
:   relative true-positive fraction
Tg
:   thyroglobulin
US
:   ultrasound" />
<meta name="og-title" property="og:title" content="Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/4/756" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist's standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy.

MATERIALS AND METHODS: Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method.

RESULTS: A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12–1.91; P = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36–0.92; P = .02) compared with the R method.

CONCLUSIONS: The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.

LN
:   lymph node
FNAB
:   fine-needle aspiration biopsy
M method
:   sonographic evaluation of lymph nodes using the predictive model
PTC
:   papillary thyroid carcinoma
R method
:   sonographic evaluation of the lymph node per standard clinical practice
rFPF
:   relative false-positive fraction
rTPF
:   relative true-positive fraction
Tg
:   thyroglobulin
US
:   ultrasound" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node60164--5" data-node-nid="60164" id="top-node-60164--61380169297" data-pisa="ajnr;39/4/756" data-pisa-master="ajnr;ajnr.A5554" data-apath="/ajnr/39/4/756.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">HEAD &amp; NECK</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Clinical Validation of a Predictive Model for the Presence of Cervical Lymph Node Metastasis in Papillary Thyroid Cancer</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">N.U. Patel</span>, <span class="highwire-citation-author" data-delta="1">K.E. Lind</span>, <span class="highwire-citation-author" data-delta="2">K. McKinney</span>, <span class="highwire-citation-author" data-delta="3">T.J. Clark</span>, <span class="highwire-citation-author" data-delta="4">S.S. Pokharel</span>, <span class="highwire-citation-author" data-delta="5">J.M. Meier</span>, <span class="highwire-citation-author" data-delta="6">E.R. Stamm</span>, <span class="highwire-citation-author" data-delta="7">K. Garg</span> and <span class="highwire-citation-author" data-delta="8">B. Haugen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">756-761; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5554 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-60164--61380169297" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">N.U. Patel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.U.%2BPatel%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Patel%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.U.%2BPatel%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1131-3964" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N.U. Patel</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">K.E. Lind </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Health Systems, Management and Policy (K.E.L.), Colorado School of Public Health, Aurora, Colorado.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.E.%2BLind%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lind%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.E.%2BLind%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8850-1576" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K.E. Lind</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">K. McKinney </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BMcKinney%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=McKinney%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BMcKinney%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3415-8108" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. McKinney</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">T.J. Clark </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.J.%2BClark%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Clark%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.J.%2BClark%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4058-5632" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.J. Clark</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">S.S. Pokharel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.S.%2BPokharel%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pokharel%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.S.%2BPokharel%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8637-6081" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.S. Pokharel</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">J.M. Meier </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.M.%2BMeier%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Meier%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.M.%2BMeier%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6305-6162" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.M. Meier</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">E.R. Stamm </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.R.%2BStamm%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Stamm%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.R.%2BStamm%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2896-259X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E.R. Stamm</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">K. Garg </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (N.U.P., K.E.L., K.M., T.J.C., S.S.P., E.R.S., J.M.M., K.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BGarg%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Garg%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BGarg%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2175-543X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. 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Haugen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Division of Endocrinology (B.H.), University of Colorado School of Medicine, Aurora, Colorado</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.%2BHaugen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Haugen%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.%2BHaugen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7005-8994" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Ultrasound is a standard technique to detect lymph node metastasis in papillary thyroid cancer. Cystic changes and microcalcifications are the most specific features of metastasis, but with low sensitivity. This prospective study compared the diagnostic accuracy of a predictive model for sonographic evaluation of lymph nodes relative to the radiologist's standard assessment in detecting papillary thyroid cancer metastasis in patients after thyroidectomy.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> Cervical lymph node sonographic images were reported by a radiologist (R method) per standard practice. The same images were independently evaluated by another radiologist using a sonographic predictive model (M method). A test was considered positive for metastasis if the R or M method suggested lymph node biopsy. The result of lymph node biopsy or surgical pathology was used as the reference standard. We estimated relative true-positive fraction and relative false-positive fraction using log-linear models for correlated binary data for the M method compared with the R method.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> A total of 237 lymph nodes in 103 patients were evaluated. Our analysis of relative true-positive fraction and relative false-positive fraction included 54 nodes with pathologic results in which at least 1 method (R or M) was positive. The M method had a higher relative true-positive fraction of 1.46 (95% CI, 1.12–1.91; <em>P</em> = .006) and a lower relative false-positive fraction of 0.58 (95% CI, 0.36–0.92; <em>P</em> = .02) compared with the R method.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> The sonographic predictive model outperformed the standard assessment to detect lymph node metastasis in patients with papillary thyroid cancer and may reduce unnecessary biopsies.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">LN<span class="def-item-dt-sep"></span></dt><dd>lymph node<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">FNAB<span class="def-item-dt-sep"></span></dt><dd>fine-needle aspiration biopsy<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">M method<span class="def-item-dt-sep"></span></dt><dd>sonographic evaluation of lymph nodes using the predictive model<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">PTC<span class="def-item-dt-sep"></span></dt><dd>papillary thyroid carcinoma<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">R method<span class="def-item-dt-sep"></span></dt><dd>sonographic evaluation of the lymph node per standard clinical practice<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">rFPF<span class="def-item-dt-sep"></span></dt><dd>relative false-positive fraction<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">rTPF<span class="def-item-dt-sep"></span></dt><dd>relative true-positive fraction<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">Tg<span class="def-item-dt-sep"></span></dt><dd>thyroglobulin<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">US<span class="def-item-dt-sep"></span></dt><dd>ultrasound</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2018 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/39/4/756.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 39</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 4 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Apr 2018 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">756-761; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5554 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">N.U.</span> <span class="nlm-surname">Patel</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">K.E.</span> <span class="nlm-surname">Lind</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">K.</span> <span class="nlm-surname">McKinney</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.J.</span> <span class="nlm-surname">Clark</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">S.S.</span> <span class="nlm-surname">Pokharel</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Meier</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">E.R.</span> <span class="nlm-surname">Stamm</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Garg</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Haugen</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">756-761; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5554 </span></div>
  
  
  
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