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The occurrence of papillary thyroid cancer (PTC) has risen substantially and tends to exhibit early-stage lymph node metastasis (LNM), increasing the risk of postoperative recurrence and decreasing survival. There is a lack of a machine learning (ML) model to predict delphian LNM (DLNM) in PTC. This investigation seeks to comprehensively assess the significance of standard clinical indicators for DLNM prediction, while constructing a dependable and widely applicable ensemble ML framework to support surgical planning and therapeutic decision-making. This investigation incorporated 1993 sequential PTC patients who underwent curative surgical procedures from 2020 to 2023. Based on the time to surgery, we divided the cohort into the training cohort (n=1395) and the validation cohort (n=598). The Boruta algorithm was applied to select feature variables, succeeded by the development of an innovative ML structure combining 12 ML techniques across 113 permutations to create a unified prediction model (DLNM index). ROC analysis, calibration curve, Bootstrapping, 10-fold cross validation, restricted cubic spline (RCS) regression, multivariable logistic regression, and subgroup analysis were utilised to evaluate the predictive accuracy and discriminative ability of the DLNM index. Model interpretation and feature impact visualisation were accomplished through the Shapley Additive Explanations (SHAP) methodology. Based on 14 features via the Boruta algorithm selection, we integrated them into 12 ML approaches, yielding 113 permutations, from which we identified the superior algorithm to establish a consensus ML-derived diagnostic model (DLNM index). The DLNM index exhibited excellent diagnostic values with a mean AUC of 0.763 in two cohorts and discriminative ability, serving as an independent risk factor ( < 0.001). It performed better in predicting performance and yielded a larger net benefit than the published model ( < 0.05). Bootstrapping and 10-fold cross validation, and subgroup analysis showed that the DLNM index was generally robust and generalisable. SHAP explains the importance of ranking features (tumour size, right 4 region LN, FT4, TG, and T3) and visualises global and individual risk prediction. RCS regression suggested a nonlinear link between the DLNM index, TG, tumour size, FT3, and DLNM risk. An optimised explainable model (DLNM index) comprising 12 clinical features based on multiple ML algorithms was constructed and validated to provide an economical, readily available, and precise diagnostic instrument for DLNM in PTC, which has potential implications for clinical practice. The SHAP explanation and RCS regression quantify and visualise tumour size and FT4 as the most important variables that increase DLNM risk.

Introduction In papillary thyroid cancer patients, the extent of dissection is still a matter of debate. Evaluating Delphian lymph nodes (DLNs) during the surgery has been speculated as a valuable tool to determine the extent of dissection. Herein, we aimed to evaluate the incidence and features of DLNs involvement in patients with papillary thyroid carcinoma. Method We conducted this cross-sectional study among surgical cases of papillary thyroid cancer. Patients were divided based on their DLNs involvement status. Their age, gender, location of the mass, lymphatic involvement, tumor size, tumor characteristics, pathology report, and operation note features were compared between the two groups. Definitive pathology slides of the patients were evaluated regarding DLN features. Results Of the 61 patients (mean age: 38.2 ± 12.0), 45 (73.8%) were females. In 13 (21.3%) patients, DLNs involvement was reported. A statistically significant relationship was noted between DLNs involvement and other lymph nodes' involvement on the same side of the mass (P < 0.001), the opposite side (P = 0.041), and also central lymph nodes (P < 0.001). Vascular invasion was also significantly higher among patients with DLNs involvement (P = 0.012). Conclusion Since DLNs involvement is significantly associated with extensive nodal involvement, intraoperative evaluation of DLNs is recommended to establish the extent to which dissection should be performed.

This study aims to investigate the risk factors of prelaryngeal lymph node metastasis in papillary thyroid carcinoma and its clinical application value. The clinical pathological features and metastatic risks were statistically analyzed by reviewing 254 patients with papillary thyroid carcinoma, who received their first operation and prelaryngeal lymph node dissection in our department. The detection of prelaryngeal lymph nodes, tumor size and any paratracheal lymph node metastasis were correlated with the number of paratracheal lymph node metastasis ( <0.05), but these were not correlated with age, gender, multiple foci, tumor size, any paratracheal lymph node metastasis, metastatic location, or foci location ( >0.05). Paratracheal lymph node metastasis indicates a high possibility of prelaryngeal lymph node metastasis. Paratracheal lymph node dissection combined with prelaryngeal lymph node dissection should be simultaneously considered in operations for thyroid papilla carcinoma.

Background To evaluate the possible predictive value and clinicopathological characteristics of Delphian lymph node metastasis in papillary thyroid carcinoma. Methods A retrospective analysis of papillary thyroid carcinoma patients with Delphian lymph node metastasis in a single institution and meta-analysis of literature reports were performed. Results In own series, Delphian lymph node metastasis was detected in 19 (9.9%) of 192 papillary thyroid carcinoma patients and was significantly associated with tumor size≥1 cm ( P  = 0.003), multifocality ( P  = 0.006) and extrathyroid extension ( P  < 0.001) in the multivariate analysis. Female was a protective factor for Delphian lymph node metastasis ( P  = 0.001). Delphian lymph node metastasis was highly predictive of further central lymph node metastasis (positive predictive value = 89.5%, negative predictive value = 67.6%) and moderately predictive of lateral lymph node metastasis (positive predictive value = 26.3%, negative predictive value = 95.4%). In this meta-analysis, there was a strong correlation between Delphian lymph node metastasis and aggressive clinicopathologic characteristics with regards to multifocality ( P  = 0.0008), bilaterality ( P  = 0.04), extrathyroid extension ( P  < 0.00001), lymphovascular invasion ( P  < 0.00001), further central lymph node metastasis ( P  < 0.00001) and lateral lymph node metastasis ( P  < 0.00001). Conclusions This single-institution observational study and meta-analysis identified that Delphian lymph node metastasis was significantly associated with unfavorable clinicopathological characteristics and had a strong predictive power for further disease in the central compartment. Trial registration The clinical study was retrospectively registered to UMIN clinical trials registry (the registry number: UMIN000033835 ).

Background Recently, lymph node metastasis (LNM) has been regarded as an important factor influencing loco-regional recurrence and survival rate in papillary thyroid cancer (PTC) patients. The aims of this study were to investigate the detection rate and metastasis rate of the Delphian lymph node (DLN) and clinical patterns related to regional LNM, and to examine how DLN metastasis affects PTC treatment. Methods We reviewed the medical records of 413 patients with pathologically confirmed PTC from among 452 patients who underwent thyroid surgery between January 2010 and October 2010 in the Department of Endocrine Surgery at Kosin University Gospel Hospital in Busan, South Korea. Results Multivariate analyses revealed a significantly higher proportion of cases with lymphovascular invasion (56.6% vs. 12.5%, P <0.001), central neck node metastasis (88.6% vs. 34.5%, P <0.001) and lateral neck node metastasis (47.2% vs. 10.2%, P <0.005) among cases with DLN metastasis compared to those without. The negative predictive value (NPV) of DLN metastasis with regard to the presence of contralateral central LNM for cases with a tumor size 1 cm or smaller than 1 cm was found to be 93.3% (127/136). Conclusion When DLN metastasis is not detected in papillary thyroid microcarcinomas (PTMC), thyroid lobectomy on the affected side and ipsilateral central neck lymph node dissection should be sufficient. In addition, even in cases where lateral neck LNM is not detected on preoperative examination, if DLN metastasis is detected postoperatively, more careful attention should be paid to the lateral neck nodes during follow-up.

The Delphian nodes (DNs) are frequently involved in cancers of the head and neck, including laryngeal and thyroid malignancies. Positivity in the DN has been considered a predictor of recurrence as well as an overall aggressive tumor biology. However, little has been written regarding the consequences of recurrence at the site of the DN. We present two case reports regarding recurrence in the DN and the unique challenges associated with DN metastases. In addition, we discuss our surgical approach to disease at the prelaryngeal space, including workup, imaging, and resection.Delphian lymph nodes are a rare site of thyroid cancer recurrence but can have significant associated morbidity. We review recurrence and a multidisciplinary approach to treatment.

The lymph nodes associated with the glands and structures in the neck are classified into compartments or levels according to anatomic landmarks and boundaries. Ultrasonography of the neck is a first-line imaging modality for evaluation of the cervical lymph nodes in addition to examination of the thyroid and parathyroid glands themselves. Recognition and communication of suspicious or malignant findings involving the cervical lymph nodes requires familiarity with these landmarks and with the sonographic characteristics of benign lymph nodes in the neck.