Abstract
Aims To evaluate shear-wave elastography (SWE) as a tool to detect postoperative cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). Methods Forty-three LNs of 43 patients with PTC undergoing ultrasound (US) and SWE before ultrasound-guided fine-needle aspiration (FNA) for the evaluation of postoperative cervical LN recurrences were analyzed. The mean (EMean), minimum (EMin), maximum (EMax), and standard deviation (ESD) of SWE elasticity indices were measured. Results Among 43 indeterminate or suspicious LNs, 12 were malignant and 31 were benign. The EMean, EMin, EMax, and ESD values were significantly higher in malignant LNs than in benign LNs (EMean: 37.1 kPa in malignant versus 11.8 kPa in benign LNs, P < 0.001; EMin: 11.3 kPa versus 5.1 kPa, P = 0.046; EMax: 50.5 kPa versus 23.7 kPa, P < 0.001; and ESD: 7.8 kPa versus 4.1 kPa, P = 0.006). EMax had the highest accuracy (93.0%) when applied with a cut-off value of 37.5 kPa. It had a positive likelihood ratio of 25.83 and a diagnostic odds ratio of 150.0. Conclusions The shear elasticity index of EMax, with higher likelihood ratios for malignant LNs, may help identify postoperative cervical LN metastasis in PTC patients with indeterminate or suspicious LNs.
Highlights
Papillary thyroid carcinoma (PTC) accounts for approximately 80% of thyroid cancer
We evaluated the sensitivity and specificity of the elasticity values to predict metastatic lymph node (LN) using a receiver operating characteristic (ROC) curve analysis, estimating the area under the curve (AUC) with 95% confidence intervals (CI)
Gray-scale US features of calcification were significantly more frequently found in malignant LNs than in benign LNs (P = 0 002)
Summary
Papillary thyroid carcinoma (PTC) accounts for approximately 80% of thyroid cancer. Postoperative metastasis usually occurs as cervical lymph node (LN) metastasis, and a regular checkup of cervical ultrasound (US) has been established as a routine procedure with serum thyroglobulin (Tg) measurement [1]. The differentiation of malignant from benign LNs in PTC is very important to decide further management plans of the patients [1]. Conventional US is commonly used for diagnosing malignant cervical LNs. Usually, gray-scale US features including round shape of the LNs, microcalcification, loss of fatty hilum, hyperechogenicity, and cystic change suggest to be suspicious for malignant LNs, but variable portions (10~86%) of these LNs on US revealed thyroid cancer on fine-needle aspiration (FNA) or surgery [2]. Some studies have focused on providing the efficacy and diagnostic accuracy of shear-wave elastography (SWE) in the differential diagnosis of benign and malignant LNs but have reported on different SWE parameters with different cut-off values and variable inclusion of the study samples with different types of thyroid cancer [4,5,6,7]
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