Value of combined lymphatic and intravenous contrast-enhanced ultrasound in diagnosis of cervical lymph node metastasis from papillary thyroid carcinoma

doi:10.3877/cma.j.issn.1672-6448.2022.08.006

Abstract

Abstract:

Objective

To assess the value of the combination of lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (IVCEUS) in the diagnosis of cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC).

Methods

From November 2019 to June 2021, 47 patients with PTC confirmed by puncture pathology at China-Japan Friendship Hospital were selected. All patients underwent routine US, LCEUS, and IVCEUS examinations. The accuracy of routine US, LCEUS, IVCEUS, and LCEUS combined IVCEUS in the diagnosis of CLNM was compared using pathological results as the gold standard.

Results

Perfusion defects (94.6%, 56/59) and interruption of the bright ring (71.2%, 42/59) were the two typical LCEUS signs for diagnosing CLNM. On IVCEUS, CLNM appeared as centripetal perfusion (61%, 36/59) and heterogeneous hyper-enhancement (57.6%, 34/59). The diagnostic accuracy of the combination of LCEUS and IVCEUS in CLNM was 92.1%, which was higher than those of LCEUS (86.8%), IVCEUS (76.3%), and routine US (64.5%). The area under the ROC curve for the combination of LCEUS and IVCEUS was 0.865, which was higher than those of IVCEUS (0.764, P=0.044) and routine US (0.553, P=0.0005).

Conclusion

The combination of LCEUS and IVCEUS has promising diagnostic value for CLNM from PTC.

Key words: Papillary thyroid carcinoma, Lymphatic metastasis, Ultrasonography, Contrast-enhanced ultrasound

Ying Wei, Zhenlong Zhao, Lili Peng, Yan Li, Naicong Lu, Jie Wu, Ming'an Yu. Value of combined lymphatic and intravenous contrast-enhanced ultrasound in diagnosis of cervical lymph node metastasis from papillary thyroid carcinoma[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(08): 761-766.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2022.08.006

https://chaosheng.cma-cmc.com.cn/EN/Y2022/V19/I08/761

Figures/Tables 6

References 17

1	Miller KD, Fidler-Benaoudia M, Keegan TH, et al. Cancer statistics for adolescents and young adults, 2020 [J]. CA Cancer J Clin, 2020, 70(6): 443-459.
2	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer [J]. Thyroid, 2016, 26(1): 1-133.
3	Perrier ND, Brierley JD, Tuttle RM. Differentiated and anaplastic thyroid carcinoma: Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual [J]. CA Cancer J Clin, 2018, 68(1): 55-63.
4	Sapuppo G, Palermo F, Russo M, et al. Latero-cervical lymph node metastases (N1b) represent an additional risk factor for papillary thyroid cancer outcome [J]. J Endocrinol Invest, 2017, 40(12): 1355-1363.
5	Zhao H, Li H. Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid cancer: Diagnosis of central and lateral compartment nodal metastases [J]. Eur J Radiol, 2019, 112: 14-21.
6	Hong YR, Luo ZY, Mo GQ, et al. Role of contrast-enhanced ultrasound in the pre-operative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma [J]. Ultrasound Med Biol, 2017, 43(11): 2567-2575.
7	Xiang D, Hong Y, Zhang B, et al. Contrast-enhanced ultrasound (CEUS) facilitated US in detecting lateral neck lymph node metastasis of thyroid cancer patients: diagnosis value and enhancement patterns of malignant lymph nodes [J]. Eur Radiol, 2014, 24(10): 2513-2519.
8	张艳, 罗渝昆, 张明博, 等. 对比增强超声与常规超声在判断甲状腺乳头状癌颈部淋巴转移中的意义 [J]. 中国医学科学院学报, 2017, 39(2): 177-182.
9	Shimazu K, Ito T, Uji K, et al. Identification of sentinel lymph nodes by contrast-enhanced ultrasonography with Sonazoid in patients with breast cancer: a feasibility study in three hospitals [J]. Cancer Med, 2017, 6(8): 1915-1922.
10	Omoto K, Matsunaga H, Take N, et al. Sentinel node detection method using contrast-enhanced ultrasonography with sonazoid in breast cancer: preliminary clinical study [J]. Ultrasound Med Biol, 2009, 35(8): 1249-1256.
11	Leboulleux S, Girard E, Rose M, et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer [J]. J Clin Endocrinol Metab, 2007, 92(9): 3590-3594.
12	张艳, 马冰, 赵佳航, 等. 经淋巴管超声造影诊断甲状腺癌颈部淋巴结转移的价值 [J]. 中国医学科学院学报, 2021, 43(3): 338-342.
13	Kim SY, Kim BW, Pyo JY, et al. Macrometastasis in papillary thyroid cancer patients is associated with higher recurrence in lateral neck nodes [J]. World J Surg, 2018, 42(1): 123-129.
14	Burman KD. Treatment of recurrent or persistent cervical node metastases in differentiated thyroid cancer: deceptively simple options [J]. J Clin Endocrinol Metab, 2012, 97(8): 2623-2625.
15	Liu SR, Liu C, Jing HM, et al. Subcapsular injection of ultrasonic contrast agent distinguishes between benign and malignant lymph node lesions exhibiting homogeneous enhancement in intravenous contrast-enhanced ultrasound images [J]. Ultrasound Med Biol, 2020, 46(3): 582-588.
16	Wakisaka N, Endo K, Kitazawa T, et al. Detection of sentinel lymph node using contrast-enhanced agent, Sonazoid^TM, and evaluation of its metastasis with superb microvascular imaging in oral and oropharyngeal cancers: a preliminary clinical study [J]. Acta Otolaryngol, 2019, 139(1): 94-99.
17	Curry JM, Ezzat WH, Merton DA, et al. Thyroid lymphosonography: a novel method for evaluating lymphatic drainage [J]. Ann Otol Rhinol Laryngol, 2009, 118(9): 645-650.

特征	CLNM（n=59）	正常LNs（n=17）	χ²值	P值
常规超声
纵横比（L/S）			6.464	0.012
＜2	27（45.8）	2（11.8）
≥2	32（54.2）	15（88.2）
边缘			3.839	0.058
清晰	42（71.2）	16（94.1）
不清	17（28.8）	1（5.9）
特征	CLNM（n=59）	正常LNs（n=17）	χ²值	P值
淋巴门			8.464	0.006
存在	13（22.0）	10（58.8）
缺失	46（78.0）	7（41.2）
回声			14.282	＜0.001
低回声	18（30.6）	15（88.2）
等回声	11（18.6）	2（11.8）
高回声	30（50.8）	0
囊变			3.839	0.058
有	17（28.8）	1（5.9）
无	42（71.2）	16（94.1）
钙化			6.692	0.009
有	23（39.0）	1（5.9）
无	36（61.0）	16（94.1）
LCEUS
灌注缺损			50.483	＜0.001
有	56（94.9）	2（11.8）
无	3（5.1）	15（88.2）
亮环			27.051	＜0.001
完整	17（28.8）	17（100）
中断	42（71.2）	0
淋巴管			0.224	0.775
有	38（64.4）	12（70.6）
无	21（35.6）	5（29.4）
IVCEUS
向心性强化			12.806	0.001
是	36（61.0）	2（11.8）
否	23（39.0）	15（88.2）
同质性			14.223	＜0.001
均匀强化	25（42.4）	16（94.1）
不均匀强化	34（57.6）	1（5.9）
灌注缺损增强强度			5.993	0.026
无增强	8（13.6）	0
低增强	13（22.0）	3（17.6）
等增强	9（15.3）	11（64.7）
高增强	29（49.2）	3（17.6）

特征	CLNM（n=59）	正常LNs（n=17）	χ²值	P值
常规超声
纵横比（L/S）			6.464	0.012
＜2	27（45.8）	2（11.8）
≥2	32（54.2）	15（88.2）
边缘			3.839	0.058
清晰	42（71.2）	16（94.1）
不清	17（28.8）	1（5.9）
特征	CLNM（n=59）	正常LNs（n=17）	χ²值	P值
淋巴门			8.464	0.006
存在	13（22.0）	10（58.8）
缺失	46（78.0）	7（41.2）
回声			14.282	＜0.001
低回声	18（30.6）	15（88.2）
等回声	11（18.6）	2（11.8）
高回声	30（50.8）	0
囊变			3.839	0.058
有	17（28.8）	1（5.9）
无	42（71.2）	16（94.1）
钙化			6.692	0.009
有	23（39.0）	1（5.9）
无	36（61.0）	16（94.1）
LCEUS
灌注缺损			50.483	＜0.001
有	56（94.9）	2（11.8）
无	3（5.1）	15（88.2）
亮环			27.051	＜0.001
完整	17（28.8）	17（100）
中断	42（71.2）	0
淋巴管			0.224	0.775
有	38（64.4）	12（70.6）
无	21（35.6）	5（29.4）
IVCEUS
向心性强化			12.806	0.001
是	36（61.0）	2（11.8）
否	23（39.0）	15（88.2）
同质性			14.223	＜0.001
均匀强化	25（42.4）	16（94.1）
不均匀强化	34（57.6）	1（5.9）
灌注缺损增强强度			5.993	0.026
无增强	8（13.6）	0
低增强	13（22.0）	3（17.6）
等增强	9（15.3）	11（64.7）
高增强	29（49.2）	3（17.6）

方法	AUC（95%置信区间）	敏感度（%）	特异度（%）	PPV（%）	NPV（%）	准确性（%）
常规超声	0.553（0.419~0.688）	69.5	41.2	80.4	28.0	64.5
LCEUS	0.852（0.750~0.955）	88.1	82.4	94.5	66.7	86.8
IVCEUS	0.764（0.646~0.881）	76.3	76.5	91.8	48.1	76.3
LCEUS联合IVCEUS	0.865（0.759~0.972）	96.6	76.5	93.4	86.7	92.1

方法	AUC（95%置信区间）	敏感度（%）	特异度（%）	PPV（%）	NPV（%）	准确性（%）
常规超声	0.553（0.419~0.688）	69.5	41.2	80.4	28.0	64.5
LCEUS	0.852（0.750~0.955）	88.1	82.4	94.5	66.7	86.8
IVCEUS	0.764（0.646~0.881）	76.3	76.5	91.8	48.1	76.3
LCEUS联合IVCEUS	0.865（0.759~0.972）	96.6	76.5	93.4	86.7	92.1

[1]	Qi Lyu, Pinjing Hui, Yafang Ding, Yanhong Yan. Carotid contrast-enhanced ultrasound assessment of plaque vulnerability and its correlation with ischemic stroke [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1040-1045.
[2]	Shujie Wei, Pinjing Hui, Yafang Ding, Bai Zhang, Yanhong Yan, Peng Zhou, Yabo Huang. Evaluation of cerebral hemodynamics in patients with unilateral internal carotid artery occlusion undergoing superficial temporal artery-middle cerebral artery bypass [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1046-1055.
[3]	Xuan Zhang, Yutong Ma, Yuqian Miao, Yun Zhang, Shiwen Wu, Xiaochu Dang, Yingying Chen, Zhaoming Zhong, Xuejuan Wang, Miao Hu, Yanfeng Sun, Xiuzhu Ma, Faqin Lyu, Haiyan Kou. Ultrasound assessment of diaphragm function in pediatric patients with Duchenne muscular dystrophy [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1068-1073.
[4]	Lei Ding, Wen Luo, Xiao Yang, Lina Pang, Peidi Zhang, Haijing Liu, Jiani Yuan, Jin Liu. Application of high-frame-rate contrast-enhanced ultrasound in evaluation of imaging features of C-TIRADS 4-5 thyroid nodules [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 887-894.
[5]	Qian Zhang, Jiahui Chen, Xuemeng Gao, Aoxue Zhao, Ying Huang. Value of radiomics features based on high-frame-rate contrast-enhanced ultrasound in differential diagnosis of benign and malignant thyroid nodules [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 895-903.
[6]	Lianhua Zhu, Xiang Fei, Peng Han, Bo Jiang, Nan Li, Yukun Luo. Value of high frame rate contrast-enhanced ultrasound in differential diagnosis of gallbladder polyp lesions [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 904-910.
[7]	Miao Li, Lianhua Zhu, Peng Han, Bo Jiang, Xiang Fei. Evaluation of relationsip between vascular morphology and risk factors for hepatocellular carcinoma by high-frame-rate contrast-enhanced ultrasound [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 911-915.
[8]	Weiping Zhang, Jingling Wang, Zhixing Liu, Li Chen, Fangqun Chen. Characteristics of time-intensity curve of high-frame-rate contrast-enhanced ultrasound in clear cell renal cell carcinoma [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 916-922.
[9]	Meifang Zhang, Ying Tan, Qiaozhen Zhu, Xin Wen, Ying Yuan, Yue Qin, Hongbo Guo, Lingxiu Hou, Wenlan Huang, Guiyan Peng, Shengli Li. Artificial intelligence-based quality control of mid-sagittal plane ultrasound images for first trimester fetal crown-rump length [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 945-950.
[10]	Ruina Zhao, Yuxin Jiang, Tao Chen, Li Zhang, Cheng Chen, Siqi Jin, Xueqi Chen, Xiao Yang, Jianchu Li. Present status and reform demands of continuing medical education for ultrasonic physicians in Beijing [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 966-973.
[11]	Yuhan Zhou, Huan Xiao, Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou. Diagnostic value of ultrasound in children with temporary hip synovitis [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 795-800.
[12]	Huanyan Liu, Yang Hua, Lingyun Jia, Xinyu Zhao, Beibei Liu. Lumen structure and hemodynamic characteristics of occluded internal carotid artery [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 809-815.
[13]	Lianlian Zhang, Pinjing Hui, Yafang Ding. Clinical value of carotid Doppler ultrasonography in assessing vulnerability of atherosclerotic plaques [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 816-821.
[14]	Yaping Jia, Shu'e Zeng. Ultrasound and pathological characteristics of breast metaplastic carcinoma containing squamous cell carcinoma components [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 844-848.
[15]	Hua Shao, Ziyue Na, Hui Jing, Bo Li, Qiucheng Wang, Wen Cheng. Value of preoperative percutaneous contrast-enhanced ultrasound in diagnosis of axillary sentinel lymph node metastasis and burden in breast cancer [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 849-853.

Please choose a citation manager

Content to export