Abstract
AimWe aimed to evaluate the ability of contrast-enhanced ultrasonography (CEUS) to perform differential diagnosis of cervical tuberculous lymphadenitis and lymph node metastasis from papillary thyroid cancer (PTC).MethodsWe analyzed 102 enlarged cervical lymph nodes as diagnosed by conventional ultrasound (US) and CEUS. The US and CEUS enhancement pattern and the time intensity curve (TIC) of the metastatic lymph nodes or tuberculous lymph nodes were compared following standard pathological protocols. The TIC included peak time (TTP), peak intensity (PI), and area under the gamma curve (AUC).ResultsPathological results demonstrated that 48 out of the 102 enlarged lymph nodes were lymph node metastasis from PTC, while 54 were tuberculous lymphadenitis. There was statistically significant differences in hyperechoic islands, pulse-like enhancement, and asynchronous enhancement between tuberculous lymphadenitis and lymph node metastasis (P < 0.05), but their diagnostic sensitivity and specificity were unsatisfactory. In addition, our data did not show statistically significant difference in enhancement direction, enlarged range on CEUS, and perfusion defect (P > 0.05). Similarly, quantitative parameters such as PI, TTP, and AUC did not yield significant differences between the groups.ConclusionTaken together, the present results demonstrate that CEUS can provide valuable information on lymph node blood flow, which can be used to identify tuberculous lymphadenitis and lymph node metastasis of PTC.
Highlights
Lymph node metastasis and tuberculous lymphadenitis are the leading causes of cervical lymphadenopathy
Whereas papillary thyroid carcinoma (PTC), the most common type of thyroid carcinoma, has high differentiation and good prognosis, 30%– 80% of patients experience cervical lymph node metastasis, which increases the chances of recurrence
Conventional ultrasonography showed no significant differences in the L/S ratio, absent hilum, cystic necrosis, sharpness, calcification, and distribution of blood flow between the two groups
Summary
Lymph node metastasis and tuberculous lymphadenitis are the leading causes of cervical lymphadenopathy. Whereas papillary thyroid carcinoma (PTC), the most common type of thyroid carcinoma, has high differentiation and good prognosis, 30%– 80% of patients experience cervical lymph node metastasis, which increases the chances of recurrence. Early identification of cervical lymph node metastasis in PTC is essential for proper clinical treatment [1,2,3,4]. China still carries a high burden of tuberculosis. The increase in immunodeficiency patients exacerbates the spread of tuberculosis, especially in non-Asian regions [5, 6]. Early and proper diagnosis of lymph node disease to inform appropriate treatment strategy remains a challenge [7]
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