Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 6;7(1):49-57.
doi: 10.12998/wjcc.v7.i1.49.

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

Wei Jiang  1 , Hong-Yan Wei  2 , Hai-Yan Zhang  2 , Qiu-Luan Zhuo  2
Affiliations

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

Wei Jiang et al. World J Clin Cases. .

Abstract

Background: Cervical lymph node metastasis in papillary thyroid carcinoma (PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.

Aim: To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.

Methods: A total of 94 patients with PTC were recruited. According to pathological results, lymph nodes were divided into two groups: metastatic group (n = 50) and reactive group (n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.

Results: The ratio of long diameter/short diameter (L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity (PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group (P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis (P < 0.05). Furthermore, the area under the curve (AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant (P < 0.05). The fitting equation for the combined diagnosis was logit(P) = -12.341 + 1.482 × L/S ratio + 3.529 × missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.

Conclusion: Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.

Keywords: Cervical lymph node metastasis; Contrast-enhanced ultrasound; Elastography; Papillary thyroid cancer.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Ultrasound contrast sonogram of metastatic lymph nodes. It reveals that the lymph nodes were enhanced, and the distribution was not uniform.
Figure 2
Figure 2
Elastography of metastatic lymph nodes in papillary thyroid carcinoma. It reveals that the lymph nodes had a hard texture and blue-green color.
Figure 3
Figure 3
Receiver operating characteristic curve analysis of combined evaluation of papillary thyroid carcinoma cervical lymph node metastasis.
See this image and copyright information in PMC

References

    1. Qu N, Zhang L, Ji QH, Chen JY, Zhu YX, Cao YM, Shen Q. Risk Factors for Central Compartment Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Meta-Analysis. World J Surg. 2015;39:2459–2470. - PubMed
    1. Park AY, Kim JA, Son EJ, Youk JH. Shear-Wave Elastography for Papillary Thyroid Carcinoma can Improve Prediction of Cervical Lymph Node Metastasis. Ann Surg Oncol. 2016;23:722–729. - PubMed
    1. Lee DW, Ji YB, Sung ES, Park JS, Lee YJ, Park DW, Tae K. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur J Surg Oncol. 2013;39:191–196. - PubMed
    1. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope. 2011;121:487–491. - PubMed
    1. Nam SY, Shin JH, Han BK, Ko EY, Ko ES, Hahn SY, Chung JH. Preoperative ultrasonographic features of papillary thyroid carcinoma predict biological behavior. J Clin Endocrinol Metab. 2013;98:1476–1482. - PubMed