Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

Jiang, Wei; H, Wei; Zhang, Haiyan; Zhuo, Qiu-Luan

doi:10.12998/wjcc.v7.i1.49

Cited by 24 publications

(26 citation statements)

References 28 publications

(24 reference statements)

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“…On the other hand, very aggressive PTMC might be sometimes observed [3]. One of the most unfavorable clinicopathological features of aggressive PTMCs is lymph node metastasis [7, 8]. Jiang et al suggested that the presence of central or lateral lymph node metastases in papillary thyroid cancer (PTC) cases affects the prognosis and treatment of the individuals [8].…”

Section: Discussionmentioning

confidence: 99%

“…One of the most unfavorable clinicopathological features of aggressive PTMCs is lymph node metastasis [7, 8]. Jiang et al suggested that the presence of central or lateral lymph node metastases in papillary thyroid cancer (PTC) cases affects the prognosis and treatment of the individuals [8]. Moreover, these metastases increase the rate of regional recurrence and mortality, especially in elderly patients [30].…”

Section: Discussionmentioning

confidence: 99%

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Which papillary thyroid microcarcinoma should be treated as “true cancer” and which as “precancer”?

et al. 2019

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Background Papillary thyroid microcarcinoma (PTMC) generally is a cancer with excellent prognosis, but the term “cancer” sounds severe and harsh, which can elicit emotional and physical responses from patients. To eliminate the word “cancer,” the term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced. However, not all PTMCs can be classified as NIFTP. Sometimes, very aggressive PTMC cases might be observed. Some authors suggest that one of the risk factors for poor prognosis is lymph node metastasis. The aim of the study was to evaluate some clinicopathological features of PTMC as the risk factors for lymph node metastasis. Material and methods We performed a retrospective chart review and selected 177 patients with PTMC. To analyze the cases with potentially aggressive behavior, we enrolled PTMC patients with lymph node metastases (pN1, central, and/or lateral) and evaluated some of their clinicopathological features. Results The logistic regression analysis results demonstrated significantly higher rates of multifocal or bilateral tumor occurrence in the PTMC patients with pN1 than in the patients with pN0 ( P < 0.0001 for both). In addition, the occurrence of thyroid tumors with sizes above 0.5 cm was a significant risk factor for lymph node metastasis ( P < 0.0001). The results of the ROC analyses showed that the presence of multifocal or bilateral tumors and tumor sizes above 0.5 cm were significant predictors of lymph node metastasis ( P < 0.0001 for all). Conclusions Multifocal and bilateral PTMC tumors with diameters above 0.5 cm should be treated aggressively as “true cancer” and might benefit from lymph node dissection. Unifocal PTMC tumors with diameters equal to or below 0.5 cm may be treated less aggressively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Which papillary thyroid microcarcinoma should be treated as “true cancer” and which as “precancer”?

et al. 2019

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“…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.…”

Section: Diagnosis Of Cervical Metastatic Lymph Nodes On Usmentioning

confidence: 99%

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

et al. 2021

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Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1–2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

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“…PTC develops indolently, but 30% to 80% of patients with PTC demonstrate highly aggressive diseases, such as cervical lymph node metastasis ( 3 ). The presence of cervical lymph node metastasis (CLNM) is well associated with an increased risk of recurrence and affects the postoperative survival rate in select patient populations ( 4 , 5 ). The early diagnosis of lymph node metastasis can guide clinicians to perform aggressive therapeutic neck dissection.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Relevance of the Ultrasonographic Features of Papillary Thyroid Carcinoma and Cervical Lymph Node Metastasis on Conventional and Contrast-Enhanced Ultrasonography

Tian

Liu

et al. 2021

Front. Oncol.

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BackgroundPreoperative prediction of lymph node metastases has a major impact on prognosis and recurrence for patients with papillary thyroid carcinoma (PTC). Thyroid ultrasonography is the preferred inspection to guide the appropriate diagnostic procedure.PurposeTo investigate the relationship between PTC and cervical lymph node metastasis (CLNM, including central and lateral LNM) using both conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS).Material and MethodsOur study retrospectively analyzed 379 patients diagnosed with PTC confirmed by surgical pathology at our hospital who underwent US and CEUS examinations from October 2016 to March 2021. Individuals were divided into two groups: the lymph node metastasis group and the nonmetastasis group. The relationship between US and CEUS characteristics of PTC and CLNM was analyzed. Univariate and multivariable logistic regression methods were used to identify the high-risk factors and established a nomogram to predict CLNM in PTC. Furthermore, we explore the frequency of CLNM at each nodal level in PTC patients.ResultsUnivariate analysis indicated that there were significant differences in gender, age, tumor size, microcalcification, contact with the adjacent capsule, multifocality, capsule integrity and enhancement patterns in CEUS between the lymph node metastasis group and the nonmetastasis group (all P<0.05). Multivariate regression analysis showed that tumor size ≥1 cm, age ≤45 years, multifocality, and contact range of the adjacent capsule >50% were independent risk factors for CLNM in PTC, which determined the nomogram. The diagnostic model had an area under the curve (AUC) of 0.756 (95% confidence interval, 0.707-0.805). And calibration plot analysis shown that clinical utility of the nomogram. In 162 PTC patients, the metastatic rates of cervical lymph nodes at levels I-VI were 1.9%, 15.4%, 35.2%, 34.6%, 15.4%, 82.1%, and the difference was statistically significant (P<0.001).ConclusionOur study indicated that the characteristics of PTC on ultrasonography and CEUS can be used to predict CLNM as a useful tool. Preoperative analysis of ultrasonographical features has important value for predicting CLNM in PTCs. The risk of CLNM is greater when tumor size ≥1 cm, age ≤45 years, multifocality, contact range of the adjacent capsule >50% are present.

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Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

Cited by 24 publications

References 28 publications

Which papillary thyroid microcarcinoma should be treated as “true cancer” and which as “precancer”?

Which papillary thyroid microcarcinoma should be treated as “true cancer” and which as “precancer”?

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

Analysis of the Relevance of the Ultrasonographic Features of Papillary Thyroid Carcinoma and Cervical Lymph Node Metastasis on Conventional and Contrast-Enhanced Ultrasonography

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