Preoperative assessment of cervical lymph node metastases in patients with papillary thyroid carcinoma: Incremental diagnostic value of dual-energy CT combined with ultrasound.

Jimin Yoon,Na-Young Shin,Jinhee Jang,Yangsean Choi,Kook-Jin Ahn,Bum-Soo Kim,Francis Moore

doi:10.1371/journal.pone.0261233

Jimin Yoon, Na-Young Shin + Show 5 more

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https://doi.org/10.1371/journal.pone.0261233

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Journal: PloS one	Publication Date: Dec 13, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: Seoul St. Mary's Hospital, Catholic University of Korea

Abstract

PurposeTo determine whether dual-energy CT (DECT) has incremental diagnostic value when combined with ultrasound (US) in the diagnosis of metastatic cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC).MethodsThis was a single-center retrospective cohort study of patients diagnosed with PTC between October 2019 and August 2020. US features of LNs to include hyperechogenicity, round shape, microcalcification, cystic component, and homogeneous/peripheral vascularity were considered suggestive of metastasis. The HU of arterial phase (HUarterial) and DECT-derived CT images [contrast media (CM) and areas under the 100 keV monoenergetic curve (AUC100keV)] were measured. Effective atomic numbers (Zeff), iodine concentration (mg/mL), and slope of the HU curve (λHU) were also obtained. The values for metastatic and benign LNs were compared using Student’s t-test with false-discovery correction. Logistic regression with areas under the receiver operating characteristic curves (AUCs) were performed for predicting metastatic LNs.ResultsA total of 102 patients were included (49 metastatic and 53 benign LNs; mean age, 46±15 years). Metastatic LNs showed significantly higher values for HUarterial, CM, Zeff, λHU, AUC100keV, and iodine concentration (all, P = 0.001). In logistic regression, the HUarterial demonstrated the highest AUC (0.824; 95% confidence interval [CI], 0.751–0.897), followed by CM HU (0.762; 95% CI, 0.679–0.846). Combination of DECT parameters with US features improved the AUC from 0.890 to 0.941.ConclusionCompared to US features alone, combination with DECT-derived quantitative parameters improved diagnostic performance in predicting metastatic cervical LNs in patients with PTC.

Highlights

Thyroid cancer is the most common head and neck malignancy, and its incidence is increasing with the widespread application of ultrasound (US) screening and needle biopsy of suspicious nodules [1]
In patients with papillary thyroid carcinoma (PTC), metastases to cervical lymph node (LN) at presentation are associated with local recurrence and cancer-related mortality [5, 6]
Accurate preoperative diagnosis of cervical LN metastasis is clinically relevant for optimizing treatment planning and improving patient prognosis

Summary

Introduction

Thyroid cancer is the most common head and neck malignancy, and its incidence is increasing with the widespread application of ultrasound (US) screening and needle biopsy of suspicious nodules [1]. Papillary thyroid carcinoma (PTC) accounts for more than 80% of all thyroid malignancies. Patients with PTC have high rates of lymph node (LN) metastasis at an early stage [2]. The incidence of LN metastasis in PTC ranges from 30% to 90% based on the literature [3, 4]. In patients with PTC, metastases to cervical LNs at presentation are associated with local recurrence and cancer-related mortality [5, 6]. Accurate preoperative diagnosis of cervical LN metastasis is clinically relevant for optimizing treatment planning and improving patient prognosis

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