The Value of Microvascular Imaging for Triaging Indeterminate Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma

Abstract

Assessment of lymph node (LN) status in patients with papillary thyroid carcinoma (PTC) is often troublesome because of cervical LNs with indeterminate US (ultrasound) features. We aimed to explore whether Superb Microvascular Imaging (SMI) could be helpful for distinguishing metastasis from indeterminate LNs when combined with power Doppler US (PDUS). From 353 consecutive patients with PTC, LNs characterized as indeterminate by PDUS were evaluated by SMI to distinguish them from metastasis. Indeterminate LNs were reclassified according to the SMI, the malignancy risk of each category was assessed, and the diagnostic performance of suspicious findings on SMI was calculated. The incidence of US-indeterminate LNs was 26.9%. Eighty PDUS-indeterminate LNs (39 proven as benign, 41 proven as malignant) were reclassified into probably benign (n = 26), indeterminate (n = 20), and suspicious (n = 34) categories according to SMI, with malignancy risks of 19.2%, 20.0%, and 94.1%, respectively. After combining SMI with PDUS, 80.8% (21/26) of probably benign LNs and 94.1% (32/34) of suspicious LNs could be correctly diagnosed as benign and metastatic, respectively. The diagnostic sensitivity, specificity, and accuracy of categorizing LNs as suspicious based on SMI were 78.1%, 94.9%, and 86.3%, respectively. In conclusion, the combination of SMI with PDUS was helpful for the accurate stratification of indeterminate LNs based on US in patients with PTC.

2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations

“…Therefore, preoperatively identified macroscopic metastatic LNs have prognostic significance and are regarded as clinically apparent metastatic LNs, whereas most micrometastatic nodes that are undetected by imaging have little clinical significance [ 134 ]. Recent studies have investigated the roles of advanced US imaging modalities, such as US elastography [ 149 150 151 152 153 ], contrast-enhanced US [ 154 155 156 157 ], and US microvascular imaging [ 158 ]. However, there are insufficient data on their clinical utility.…”

Lymphadenopathy after the Anti-COVID-19 Vaccine: Multiparametric Ultrasound Findings

“…The elasticity assessment of the lymph nodes was done by evaluating two regions of interest (ROIs): one ROI positioned on the target region (lymph node) and the second ROI on the adjacent tissue (normal muscles or subcutaneous tissue). The strain ratio and the subsequent differentiation into "soft" and "hard" was then automatically computed by the USG device [21,22]. A dedicated flowchart summarizing the methodology is shown in Figure 1.…”

A Combination of Contrast‐Enhanced Ultrasound and Thyroglobulin Level in Fine‐Needle Aspirates Improves Diagnostic Accuracy for Metastatic Lymph Nodes of Papillary Thyroid Carcinoma

“…Therefore, it is necessary to create new inspection methods to better identify LN metastasis. In one report, the authors used a combination of Superb Microvascular Imaging and power Doppler US to help accurately stratify nonpreservative LNs based on US in PTC patients; however, the sensitivity of Superb Microvascular Imaging was only 78.1% 30 . Thus, our results are of particular importance because they represent the first evaluation of the value of the combination of CEUS and FNA‐Tg in significantly improving the sensitivity of the diagnosis of metastatic cervical LNs in PTC patients.…”