Contrast-enhanced ultrasound improves the potency of fine-needle aspiration in thyroid nodules with high inadequate risk

Abstract

Background This study aims to determine the clinical value of contrast enhanced ultrasound (CEUS) for fine-needle aspiration (FNA) of high inadequate risky thyroid nodules. Methods During April 2018 and April 2021, consecutive 3748 thyroid nodules underwent FNA were retrospectively analyzed. CEUS guided FNA (CEUS-FNA) was applied in 115 nodules with high inadequate risk in Lingnan Campus. Ten nodules underwent CEUS-FNA presented non-enhancing, and would be further analyzed independently. Other 105 partial or total enhancing nodules were included as CEUS-FNA group, and 210 nodules with high inadequate risk in Tianhe Campus were match as the US-FNA control group. FNA specimens were collected for liquid-based preparation. Cytological results were classified following the Bethesda System for Reporting Thyroid Cytopathology. Results The overall FNA specimen inadequate rate in our center was 6.6%. All of the ten non-enhancing nodules under CEUS have an inadequate result in cytopathological analyzes. The subsequent postoperative pathology and follow-up ultrasonography showed the non-enhancing nodules were benign or stable without further malignant features. Total specimen inadequate rate of high inadequate risk thyroid nodules in CEUS-FNA group was significantly lower than US-FNA group (6.7% vs. 16.7%, P = 0.014). Further stratified analyzed shown that FNA under US guidance, the inadequate rates in cystic, predominantly cystic, predominantly solid and solid sub-groups were 28.1%, 17.1%, 10.0% and 9.2% (P = 0.019). In contrast, the inadequate rates in cystic, predominantly cystic, predominantly solid and solid sub-groups were 7.4%, 6.7%, 5.6% and 6.7% (P = 0.996) in CEUS-FNA group. Conclusions CEUS can improve the specimen adequacy of FNA in high inadequate risk thyroid nodules by avoiding unnecessary FNAs of the non-enhancing nodules, and accurately locating the viable tissue and precise guidance in real-time. CEUS is a recommend modality for FNA guidance of high inadequate risk thyroid nodules.

The Utility of Contrast-Enhanced Ultrasound (CEUS) in Assessing the Risk of Malignancy in Thyroid Nodules

“…Further multicentre studies on the implementation of a standardised CEUS TIRADS classifier for use in routine clinical practice need to continue. The authors of the current study also plan to continue work on the development of the CEUS EU-TIRADS-PL classifier, taking into account the results of studies conducted to date on the use of CEUS for optimal qualification for FNAB, including, among others, the paper by Tinghui et al, which confirmed that the CEUS increases the adequacy of FNAB in high inadequate-risk thyroid nodules by avoiding unnecessary biopsies of non-enhancing lesions [47].…”

Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach

“…Shortly after the injection of SonoVue the myocardium shows a granular echogenicity abdominal tumors, but their use is extending to many other tumors and to lymph nodes and is not limited to diagnosis. [83][84][85][86][87] Echocardiographic perfusion imaging using UEAs with very low mechanical index and with intermittent flash (high-Mechanical Index flashes) has been used mostly for the detection of cardiac ischemia, but it can also characterize the vascularization of cardiac tumors differentiating highly vascular tumors from hypo-vascular benign tumors and a-vascular thrombi. 88 Even without the use of intermittent flash, UEAs may improve both the visualization of the tumor and the CDI of the abnormal tumor vessels (Video clip 7).…”

“…Ultrasound‐enhancing agents (UEAs) have been routinely used in the echographic detection of tumors, mostly in the liver and other abdominal tumors, but their use is extending to many other tumors and to lymph nodes and is not limited to diagnosis. 83 , 84 , 85 , 86 , 87 …”

Applying machine-learning models to differentiate benign and malignant thyroid nodules classified as C-TIRADS 4 based on 2D-ultrasound combined with five contrast-enhanced ultrasound key frames

“…Contrast-enhanced ultrasound (CEUS), which describes focal microcirculation perfusion status by distinguishing acoustic features of tissue backgrounds, plays an essential role in the diagnosis of thyroid nodules and differentiation of necrotic benign nodules from malignant ones to avoid FNA procedures ( 10 ). Additionally, CEUS is utilized in the field of interventional ultrasonography, which includes assisting biopsy and FNA procedures and estimating therapeutic conditions after ablation ( 11 , 12 ).…”