Blood-Rich Enhancement in Ultrasonography Predicts Worse Prognosis in Patients With Papillary Thyroid Cancer

Abstract

Contrast-enhanced ultrasound (CEUS) can be used to evaluate microcirculation in cancers, which in turn is associated with the biologic features and ultimately patient prognosis. We conducted a retrospective analysis to examine potential association between CEUS parameters and prognosis in patients with papillary thyroid cancer (PTC). The analysis included 306 patients who underwent CEUS prior to thyroidectomy at our center during a period from 2012 to 2019. Subjects with excellent response (ER) were compared to the non-ER group (including indeterminate response, biochemical incomplete response and structural incomplete response). During the median follow-up of 34 months, ER was observed in 195 (63.7%) subjects. The remaining 111 (36.3%) patients developed non-ER events, with distant metastasis in five (1.6%) cases. In a multivariate COX regression, non-ER event was associated with the male sex (OR = 1.83, 95%CI: 1.21–2.76) and blood-rich enhancement in CEUS (OR = 1.69, 95%CI: 1.04–2.75). Based on this finding, we developed a predictive model: high risk for developing non-ER events was defined as having both risk factors; low risk was defined as having none or only one risk. In receiver operating characteristic (ROC) analysis, the area under the curve was 0.59 (95%CI: 0.52–0.66). The sensitivity and specificity were 17.1 and 95.4%, respectively. The positive and negative predictive values were 67.9 and 66.9%, respectively. In conclusion, blood-rich enhancement in CEUS is associated with non-ER events after thyroidectomy in patients with PTC.

Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives

“…The correct diagnostic rate of CEUS was 85%, sensitivity 88% and specificity 80% for diagnosing microcarcinomas in 73 patients, but t0he use of CEUS had no clear advantages for diagnosing thyroid microcarcinomas as there were no statistically significant differences between malignant and benign nodules [61]. Furthermore, an interesting study by Gao et al also suggests that blood-rich enhancement on CEUS is associated with a non-excellent response after thyroidectomy in a study on 306 patients with PTC [85].…”

Risk Stratification of Thyroid Nodule: From Ultrasound Features to TIRADS

“…A recent consensus of the Italian Thyroid Association, the Italian Society of Endocrinology, the Italian Society of Ultrasonography in Medicine and Biology, and the Ultrasound Chapter of the Italian Society of Medical Radiology considered that the main limitation of US is the poor reproducibility, due to the varying experience of the operators and the different performance and settings of the equipment. A simplified nodule risk stratification was therefore proposed, which is based on the predictive value of each US sign, classified and evaluated according to the strength of association with malignancy, but also to the estimated reproducibility between different operators [85]. The risk score was classified into four categories on the basis of the estimated specificity and reproducibility among different operators for each US feature (Table 1).…”

“…The correct diagnostic rate of CEUS was 85%, sensitivity 88% and specificity 80% for diagnosing microcarcinomas in 73 patients, but t0he use of CEUS had no clear advantages for diagnosing thyroid microcarcinomas as there were no statistically significant differences between malignant and benign nodules [61]. Furthermore, an interesting study by Gao et al also suggests that blood-rich enhancement on CEUS is associated with a non-excellent response after thyroidectomy in a study on 306 patients with PTC [85].…”

Predicting Extrathyroidal Extension in Papillary Thyroid Carcinoma Using a Clinical-Radiomics Nomogram Based on B-Mode and Contrast-Enhanced Ultrasound

“…Compared with MRI and CT, US examination has become the preferred imaging method for preoperative thyroid tumor screening and prognosis assessments due to its advantages as follows: low cost, no ionizing radiation, real-time, and high resolution [15]. Contrast-enhanced ultrasound (CEUS) is a new technology that is widely used in clinical practice in recent years [16], which provides more reference information about microvascular perfusion for the evaluation of ETE [17]. Some studies have used some signs of conventional US and CEUS to evaluate ETE, such as the degree of contact between the thyroid tumor and capsule, and the disruption of capsule continuity [18][19][20][21][22].…”