AimThe study aimed to systematically evaluate the safety and efficacy of ultrasonography-guided percutaneous thermal ablation in the treatment of cervical lymph node metastasis (LNM) of recurrent papillary thyroid carcinoma (PTC).MethodsPubMed, PubMed Central (PMC), Embase, and Cochrane were examined. The inclusion and exclusion criteria were determined and the relevant data were extracted from the library and other databases for LNM thermal ablation of recurrent PTC. The data were analyzed using Stata15.1, Revman5.3 software, and the standard errors of 95% confidence intervals were estimated using fixed or random effects models. Volume reduction rate (VRR), Serum thyroglobulin (Tg) level before and after thermal ablation, the total complications and major complications incidence were analyzed.ResultsA total of 18 literature articles were included, namely, 10 radiofrequency ablation (RFA), 4 laser ablation (LA), and 4 microwave ablation (MWA). A total of 321 patients had 498 LNM. LNM volume changes before and at the last follow-up of thermal ablation (SMD = 1.04, I2 = 8%, 95% CI 0.86–1.21, P <0.0001). The postoperative lymph node VRR was 88.4% (95% CI 77.8–97.3%, I2 = 34%, P = 0.14). Tg measurements before and after thermal ablation (SMD = 1.15, 95% CI 0.69–1.60, I2 = 84%, P <0.0001). The incidence of total complications was 5.0% (95% CI 3.0–7.0%, I2 = 0.0%, P = 0.915), and the incidence of major complications was 4.0% (95% CI 2.0–6.0%, I2 = 0.0%, P = 0.888). A total of 131 LNM were located in the central region, and the major complication rate was 12.0% (95% CI 6.0–18.0%, I2 = 0.0%, P = 0.653).ConclusionUltrasonography-guided thermal ablation is safe and effective in the treatment of LNM of recurrent PTC. The ablation strategy of central LNM needs to be further explored and improved. It can be used as an alternative to surgery for patients with high surgical risk or who refuse resurgery.Systematic Review Registration10.37766/inplasy2022.6.0004, identifier INPLASY202260004.
AimWe aimed to evaluate the ability of contrast-enhanced ultrasonography (CEUS) to perform differential diagnosis of cervical tuberculous lymphadenitis and lymph node metastasis from papillary thyroid cancer (PTC).MethodsWe analyzed 102 enlarged cervical lymph nodes as diagnosed by conventional ultrasound (US) and CEUS. The US and CEUS enhancement pattern and the time intensity curve (TIC) of the metastatic lymph nodes or tuberculous lymph nodes were compared following standard pathological protocols. The TIC included peak time (TTP), peak intensity (PI), and area under the gamma curve (AUC).ResultsPathological results demonstrated that 48 out of the 102 enlarged lymph nodes were lymph node metastasis from PTC, while 54 were tuberculous lymphadenitis. There was statistically significant differences in hyperechoic islands, pulse-like enhancement, and asynchronous enhancement between tuberculous lymphadenitis and lymph node metastasis (P < 0.05), but their diagnostic sensitivity and specificity were unsatisfactory. In addition, our data did not show statistically significant difference in enhancement direction, enlarged range on CEUS, and perfusion defect (P > 0.05). Similarly, quantitative parameters such as PI, TTP, and AUC did not yield significant differences between the groups.ConclusionTaken together, the present results demonstrate that CEUS can provide valuable information on lymph node blood flow, which can be used to identify tuberculous lymphadenitis and lymph node metastasis of PTC.
Purpose: To retrospective analysis and summary the features of tuberous vas deferens tuberculosis (VD TB) and inguinal metastatic lymph nodes (MLN) in routine ultrasound (US) and contrast-enhanced US (CEUS) as well as to assess the utility of CEUS in differentiating between the two diseases. Methods: The US and CEUS findings of patients with pathologically confirmed tuberous VD TB (n = 17) and inguinal MLN (n = 28), including the number of lesions, presence of bilateral disease, differences in internal echogenicity, a conglomeration of lesions, and blood flow within the lesions, were retrospectively analyzed. Results: Routine US showed no significant difference in the number of lesions, nodule size, internal echogenicity, sinus tract, or skin rupture; however, significant differences were observed between the two conditions in the conglomeration of lesions (χ2 = 6.455; p = 0.023) and the degree, intensity, and echogenicity pattern on CEUS (χ2 = 18.865, 17.455, and 15.074, respectively; p = 0.000 for all). Conclusions: CEUS can show the blood supply of the lesion, and judge the physical condition of the lesion better than US. Homogeneous, centripetal, and diffuse enhancement should prompt a diagnosis of inguinal MLN, whereas lesions with heterogeneous and diffuse enhancement on CEUS should be considered as VD TB. CEUS has great diagnostic value in differentiating between tuberous VD TB and inguinal MLN.
AimTo summarize the features of splenic tuberculosis and splenic lymphoma by contrast-enhanced ultrasound (CEUS) and examine the application of CEUS in differentiating splenic tuberculosis from splenic lymphoma.MethodsThe ultrasound and CEUS manifestations of 30 cases of splenic tuberculosis and 19 cases of splenic lymphoma were retrospectively analyzed, and the number of lesions, degree of splenomegaly, internal echogenicity, color blood flow signal, and CEUS manifestations of the two diseases were statistically determined.ResultsA significant difference was noted in the internal echogenicity between splenic tuberculosis and splenic lymphoma lesions, particularly the strip-shaped hyperechoic areas of the lesions. The ultrasound features of perisplenic, retroperitoneal, and superficial lymph node enlargement were found to overlap (p < 0.05). Splenic tuberculosis showed heterogeneous enhancement and non-enhancement, whereas lymphoma showed low enhancement and high enhancement, and CEUS findings were statistically significant in distinguishing both, p < 0.05.ConclusionSplenic tuberculosis is characterized by a lack of blood supply, mostly heterogeneous enhancement, and non-enhancement noted in CEUS. Splenic lymphoma lesions are often characterized by a rich blood supply and homogeneous enhancement on CEUS. CEUS can help identify the microcirculation of lesions in both patients with splenic lymphoma and patients with splenic tuberculosis. Thus, CEUS has great application value.
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