Abstract
The aim of the study was to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC). Two hundred and one cervical LNs (157 metastatic from PTC and 44 benign) were evaluated using conventional ultrasonography (US) and CEUS before biopsy or surgery. Histopathology was used as the gold standard. We evaluated the size, long axis/short axis ratio (L/S), fatty hilum, hyper-echogenicity, calcification, cystic change, peripheral vascularity and CEUS parameters for each lymph nodule. The CEUS parameters included enhancement type, homogeneity, perfusion type, ring enhancement, peak intensity (PI) index and area under the curve (AUC) index. Univariate analysis demonstrated that compared with benign LNs, malignant LNs more frequently had L/S < 2, absence of a fatty hilum, presence of hyper-echogenicity, presence of calcification, peripheral vascularity, hyper-enhancement, heterogeneous enhancement, centripetal perfusion, ring enhancement, PI index > 1 and AUC index > 1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that hyper-enhancement, centripetal perfusion, and ring enhancement are independent CEUS characteristics related to malignant LNs for their differentiation from benign LNs (all p < 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to identify malignant cervical LNs from benign cervical LNs.
Highlights
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer with a significantly increased incidence in recent years, constituting up to 80% to 90% of all thyroid cancers [1, 2]
The results indicated that hyper-enhancement (b= 1.182, odds ratio [OR] = 3.262, 95% confidence interval [CI] = 1.057-10.068, p = 0.040); centripetal perfusion (b= 3.340, odds ratio [OR] = 28.232, 95% confidence interval [CI] = 9.040-88.168, p = 0.000) and ring enhancement (b= 2.639, odds ratio [OR] = 14.006, 95% confidence interval [CI] = 2.715-72.248, p = 0.002) were independent characteristics related to malignant lymph nodes (LNs) for differentiating them from benign LNs (Table 3)
We found that the majority of metastatic LNs from papillary thyroid carcinoma (PTC) showed peak intensity (PI) > 1 and area under the curve (AUC) >1, which was consistent with the above observation of hyper-enhancement of qualitative contrast-enhanced ultrasound (CEUS) parameters
Summary
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer with a significantly increased incidence in recent years, constituting up to 80% to 90% of all thyroid cancers [1, 2]. Despite the indolent nature of PTC, cervical lymph node (LN) involvement is an important factor associated with local recurrence, and distant metastasis is quite common, which affects the surgical strategy, extent of surgery and prognosis [3, 4]. Central and ipsilateral neck dissections when there is Cervical Lymph Node Metastasis obvious nodal involvement from PTC might reduce the frequency of regional recurrence [1]. Preoperative neck ultrasonography (US) for cervical LNs is recommended to evaluate the surgical strategy and extent, especially for lymph node dissection according to the American Thyroid Association’s (ATA’s) guidelines [5]. It is urgently important to identify suspicious cervical LNs to allow for the design of individualized surgical treatment strategies to reduce the frequency of regional recurrence
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