Homogeneity Parameter in Contrast-Enhanced Ultrasound Imaging Improves the Classification of Abnormal Cervical Lymph Node after Thyroidectomy in Patients with Papillary Thyroid Carcinoma.

Xue-Hong Diao,Yue Chen,Hong Ding,Jia Zhan,Wen-Ping Wang

doi:10.1155/2019/9296010

Xue-Hong Diao, Yue Chen + Show 3 more

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https://doi.org/10.1155/2019/9296010

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Abstract

Objective To explore the conventional and contrast-enhanced ultrasound (CEUS) features of cervical lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) patients postoperatively and analyze its pathological basis. Materials and Methods Conventional and CEUS were performed in 86 abnormal cervical lymph nodes (ACLNs) from 56 PTC patients who had received thyroidectomy. Then, fine-needle aspiration (FNA) was taken to confirm pathological results, a multivariate analysis was performed to correlate the sonographic features of the CLNM, and then an equation for CLNM was established. Results Fifty-four lymph nodes were confirmed to be metastasis of PTC by FNA. Intensity at peak time, homogeneity, and color flow patterns, cystic change, or microcalcification and echogenicity were significantly associated with CLNM. Multivariate analysis showed three strongest features (homogeneity, intensity of peak, and cystic change or calcification) to be significantly associated with the evidence of CLNM. Then, the equation was established with the following significant predictive factors: P = 1/1 + exp∑[−3.213 + 2.77 ∗ cystic or calcification + 0.13 ∗ CDFI patterns + 3.65 ∗ homogeneity + 2.43 ∗ intensity at peak time]. Conclusion Depiction of a heterogeneous hyperenhancement of cervical lymph nodes within CEUS studies and cystic change or microcalcification in conventional ultrasound were identified as predictive for metastatic lymph node invasion, and the equation was more accurate for predicting CLNM compared to single B-mode ultrasound and CEUS feature.

Highlights

Papillary thyroid carcinoma (PTC) is frequently associated with synchronous or cervical lymph node metastasis (CLNM), which caused regional recurrence [1]
Fifty-four CLNMs originated from 33 patients; as a result, unilateral modified neck dissection was performed on 27 patients, and 6 patients underwent radioiodine (RAI) therapy
Metastasis history on first thyroidectomy was significantly different between the patients with and without CLNM (P < 0.05). e characteristics such as mean age, gender, multiple nodules, and mean fine-needle aspiration (FNA) period after operation did not show significant differences between the two groups

Summary

Introduction

Papillary thyroid carcinoma (PTC) is frequently associated with synchronous or cervical lymph node metastasis (CLNM), which caused regional recurrence [1]. Conventional ultrasound (US) is recommended by the American yroid Association (ATA) guidelines for preoperative evaluation and postoperative follow-up of CLNM in PTC patients [3]. Contrast-enhanced ultrasound (CEUS), which could study the diffuse pattern and alterations of nodal perfusion, has been widely used for differentiating between benign and malignant thyroid nodules [6, 7]. Several papers report that CEUS shows a higher degree of diagnostic accuracy than conventional US on CLNM assessment preoperatively [8]. As far as we know, there were few CEUS studies evaluating the postoperative follow-up patients with cervical lymph nodes

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