Utility of quantitative contrast-enhanced ultrasound for the prediction of lymph node metastasis in patients with papillary thyroid carcinoma

Article type: Research Article

Authors: Luo, Zhi-Yan^a | Hong, Yu-Rong^{a; *} | Yan, Cao-Xin^a | Wang, Yong^b | Ye, Qin^c | Huang, Pintong^{a; *}

Affiliations: [a] Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China; | [b] Department of Surgery, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China; | [c] Department of Pathology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China

Correspondence: [*] Corresponding authors. Pin-Tong Huang, Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, No. 88, Jiefang Road, Hangzhou, Zhejiang, 310009, China. Email: huangpintong@zju.edu.cn; and Yu-Rong Hong, Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China. E-mail: hongyurong@zju.edu.cn.

Abstract: OBJECTIVES:The aim of this study was to find the optimal parameters and cutoffs to differentiate metastatic lymph nodes (LNs) from benign LNs in the patients with papillary thyroid carcinoma (PTC) on the quantitative contrast-enhanced ultrasound (CEUS) features. METHODS: A total of 134 LNs in 105 patients with PTCs were retrospectively enrolled. All LNs were evaluated by conventional ultrasound (US) and CEUS before biopsy or surgery. The diagnostic efficacy of CEUS parameters was analyzed. RESULTS: Univariate analysis indicated that metastatic LNs more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, ring-enhancing margins, higher PI, larger AUC, longer TTP and DT/2 than benign LNs at pre-operative CEUS (p < 0.001, for all). Multivariate analysis showed that centripetal or asynchronous perfusion (OR = 3.163; 95% CI, 1.721–5.812), hyper-enhancement(OR = 0.371; 95% CI, 0.150–0.917), DT/2 (OR = 7.408; 95% confidence interval CI, 1.496–36.673), and AUC (OR = 8.340; 95% CI, 2.677–25.984) were predictive for the presence of metastatic LNs. The sensitivity and accuracy of the quantitative CEUS were higher than qualitative CEUS (75% vs 55 % and 83.6% vs 76.1 %, respectively). CONCLUSIONS:Quantitative CEUS parameters can provide more information to distinguish metastatic from benign LNs in PTC patients; In particular, DT/2 and AUC have a higher sensitivity and accuracy in predicting the presence of metastatic LNs and reduce unnecessary sampling of benign LNs.

Keywords: Contrast-enhanced ultrasound, lymph node metastasis, papillary thyroid carcinoma, ultrasound

DOI: 10.3233/CH-200909

Journal: Clinical Hemorheology and Microcirculation, vol. 80, no. 1, pp. 37-48, 2022