Combination of Lymphatic and Intravenous Contrast-Enhanced Ultrasound for Evaluation of Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Preliminary Study

• Main Authors: Cao, X.-J (Author), Di, J.-X (Author), Hao, Y. (Author), Li, Y. (Author), Niu, Y. (Author), Peng, L.-L (Author), Wei, Y. (Author), Yu, M.-A (Author), Zhao, Z.-L (Author)
• Format: Article
• Language: English
• Published: Elsevier Inc. 2021
• Subjects: adult; Adult; Area Under Curve; area under the curve; Article; cervical lymph node metastasis; Cervical lymph nodes; clinical article; clinical practice; Confidence interval; Contrast; Contrast enhanced ultrasound; Contrast Media; contrast medium; contrast-enhanced ultrasound; controlled study; Defects; Diagnosis; diagnostic accuracy; diagnostic imaging; diagnostic test accuracy study; diagnostic value; echography; female; Female; Ferric Compounds; ferric ion; fine needle aspiration biopsy; human; human tissue; Humans; image enhancement; image processing; immunohistochemistry; injection site erythema; Injections, Intralymphatic; Injections, Intravenous; intralymphatic drug administration; Intravenous contrast; intravenous contrast-enhanced ultrasound; intravenous drug administration; iron; Iron; lymph node; lymph node metastasis; Lymph nodes; Lymph Nodes; lymphatic contrast-enhanced ultrasound; Lymphatic Metastasis; Lymphatic vessels; male; Male; Metastasis; middle aged; Middle Aged; neck; Neck; oxide; Oxides; Papillary thyroid carcinoma; Papillary thyroid carcinomata; pathology; Pathology; perflubutane; Perfusion defects; practice guideline; priority journal; procedures; Prospective Studies; prospective study; receiver operating characteristic; Receiver operating characteristic curves; ROC Curve; sensitivity and specificity; Thyroid Cancer, Papillary; Thyroid Neoplasms; thyroid papillary carcinoma; thyroid tumor; tumor seeding; Ultrasonics; Ultrasonography; Ultrasound; young adult; Young Adult
• Online Access: View Fulltext in Publisher

 The aim of this prospective study was to evaluate the value of the combination of lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (IVCEUS) for the identification of cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC). From November 2018 to March 2019, 24 consecutive patients with PTC were evaluated. All patients underwent routine US, LCEUS and IVCEUS. Pathology was used as the gold standard. After injection of a contrast agent into the thyroid parenchyma, lymphatic vessels and lymph nodes (LNs) could be exclusively displayed as hyper-enhancement on LCEUS. Benign LNs displayed a complete bright ring (100%) and homogeneous perfusion (88.9%) on LCEUS, while displaying centrifugal perfusion (66.7%) and homogenous enhancement (88.9%) on IVCEUS. Perfusion defects (94.9%) and interruption of the bright ring (71.8%) were the two characteristic LCEUS signs for diagnosing CLNM. On IVCEUS, CLNM appeared as centripetal perfusion (59.0%) and heterogeneous enhancement (59.0%). After comparison with pathology, perfusion defect was correlated to the metastatic foci in the medulla and interruption of the bright ring to the tumor seeding in the marginal sinus (all p values <0.05). LCEUS had more value (area under the receiver operating characteristic curve [AUC] = 0.850, 95% confidence interval [CI]: 0.682–1.000) in diagnosing CLNM than IVCEUS (AUC = 0.692, 95% CI: 0.494–0.890) and routine US (AUC = 0.581, 95% CI: 0.367–0.796). The combination of LCEUS and IVCEUS has the highest diagnostic value (AUC = 0.863, 95% CI: 0.696–1.000). LCEUS had higher diagnostic value than IVCEUS and US for CLNM from PTC. The combination of LCEUS and IVCEUS has the highest diagnostic value for CLNM. © 2020 The Authors