Predictors of Level II and Vb Neck Disease in Metastatic Papillary Thyroid Cancer
Bibliographic record
Abstract
OBJECTIVE: To identify predictors of levels II and Vb involvement in papillary thyroid cancer (PTC) with lateral neck metastasis. DESIGN: Large case series. SETTING: High-volume tertiary care hospital. PATIENTS: Consecutive sample of 185 patients who underwent 248 selective neck dissections of at least levels II to V for pathologically proven PTC. MAIN OUTCOME MEASURES: Significant independent predictors of level II and Vb metastasis, including age and pathologic variables (tumor diameter, dominant nodule cellular pathology, multifocality, extracapsular invasion, positive margins, and lymphovascular invasion). RESULTS: Levels II and Vb were involved in 49.3% and 29.2% of our cohort, respectively. Age and lymphovascular invasion were independent predictors of level Vb involvement with metastasis (logistic regression: odds ratio for age = 0.92, SE = 0.03, P = .02; and odds ratio for lymphovascular invasion = 5.52, SE = 0.80, P = .03). No significant predictors were identified for level II involvement. CONCLUSIONS: Levels II and Vb were involved in a significant number of patients with PTC and lateral neck disease. Younger age and lymphovascular involvement were independent risk factors for level Vb involvement in patients with PTC and lateral neck metastasis. The increased risk might be of marginal clinical significance. No significant predictors were identified for level II involvement. Our findings do not favor a limited neck dissection on the basis of any of the study's clinical or pathologic variables, and we therefore recommend the routine excision of levels IIa to Vb in all patients with PTC presenting with lateral neck disease.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".