Quantitative Rating Scale Based on Preoperative Prediction of Lymph Node Dissection in Patients With Thyroid Cancer
Conditions: Papillary Thyroid Cancer
Sponsor: Second Affiliated Hospital of Xi'an Jiaotong University

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Quantitative rating scale based on 
preoperative prediction of lymph 
node dissection in patients with 
thyroid cancer 
 
 
Research program 
 
 
 
 
NCT ID：Not yet assigned 
 
Date of document：2023.10.29 
 
 
 
 
 
 

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Research program 
I. Background of the study 
      The incidence of papillary thyroid carcinoma (PTC) has been on an elevated 
trend in recent years, and lymph node metastasis is present in 20%-50% of PTC 
patients. Usually, lymph node involvement in PTC patients is related to the 
recurrence of PTC after surgery, and 30% of patients recur without lymph node 
dissection, among which the risk of cervical central lymph node metastasis is the 
greatest, so it seems to be a good choice to perform lymph node dissection for 
patients after thyroidectomy, but in fact, there is a controversy at home and 
abroad as to whether to perform lymph node dissection or not. The 2021 Chinese 
Society of Clinical Oncology (CSCO) guidelines for the diagnosis and treatment of 
differentiated thyroid cancer state that prophylactic central lymph node dissection 
(PCND) may increase the incidence of postoperative complications, but due to the 
high metastatic rate of PTC and the ability of PCND to effectively prevent 
recurrence and reoperation, countries in the East Asian region perform 
prophylactic lymph node dissection on almost all patients with PTC. However, for 
more countries in Europe and the United States, performing PCND has become a 
non-essential, individualized option. 
       The aim of this study is to produce a new type of scoring scale by 
collecting multifactorial data from patients who have undergone previous 
thyroidectomy from 2021-2023, to individualize the scoring of patients based on 

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a variety of factors prior to surgery, to be able to more accurately predict whether 
a patient does have lymph node metastasis and whether prophylactic lymph node 
dissection is needed before surgery is performed, and to be able to avoid 
complications from surgery for patients who do not need dissection. For patients 
who do not need lymph node dissection, it can avoid complications caused by 
surgery, while for patients who do have lymph node metastasis, it can prevent the 
recurrence of their cancer. This will change the current situation in which it is 
impossible to accurately determine the actual situation through simple 
preoperative examination or to perform prophylactic lymph node dissection for 
all PTC patients. 
II.Purpose of the study 
      To create a quantitative rating scale for preoperative prediction of the need 
for lymph node dissection in patients with thyroid cancer. 
Objects of the study 
1. Selection of research subjects 
     From 2021 to 2023, 500 patients with previous papillary thyroid cancer 
surgery were selected in the Second Affiliated Hospital of Xi'an Jiaotong University 
for the production of quantitative scoring scales, as well as 300 patients with 
subsequent new admissions of papillary thyroid cancer for validation. 
Inclusion criteria: (1) Age 16-80 years old; 
                  (2) Patients with papillary thyroid cancer; 
                  (3) Consciousness and ability to communicate normally. 
Exclusion criteria: (1) Preoperative puncture pathology suggests that there are 
other types of tumors, such as medullary carcinoma or undifferentiated carcinoma; 
                  (2) Age less than 16 years old. 

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Exclusion criteria: (1) Postoperative pathology suggests that there are other types 
of tumors, such as medullary carcinoma or undifferentiated carcinoma. 
IV. Observation indicators 
       Basic information of patients: gender, age, height, weight, BMI and 
whether lymph node dissection was performed during previous surgery; 
       Tumor primary foci: unilateral/bilateral tumor, tumor diameter size, tumor 
focality, tumor invasion, and cases suggesting lymph node metastasis; 
      Preoperative ultrasonographic manifestations: cystic solidity of the tumor, 
echo intensity, whether the border is clear, whether there is calcification, aspect 
ratio, and whether there are enlarged lymph nodes in the neck; 
      Preoperative laboratory tests: TSH, TPOAb, TgAb, and blood calcium; 
      Genetic test results: TERT gene polymorphism (C250T), TERT gene 
polymorphism (C228T), NRAS gene polymorphism (Q61R), B-raf gene mutation. 
      The above data were collected from the medical records of previous 
patients to create a quantitative rating scale, and then new patients were 
evaluated using the scale and the above data information was collected from the 
new patients for comparison and validation.