Jung Woo Sang, Kim Jeong-Ah, Son Eun Ju, Youk Ji Hyun, Park Cheong Soo
Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Ann Surg Oncol. 2015 Jan;22(1):111-6. doi: 10.1245/s10434-014-3627-4. Epub 2015 Jan 5.
The aim of this study was to evaluate the usefulness of shear wave elastography (SWE) for predicting cervical lymph node (LN) metastasis and the prognostic implication of SWE as histopathologic factors of papillary thyroid carcinoma (PTC).
Eighty-four LNs of 66 patients with PTC underwent B-mode ultrasonography (BUS) and SWE before ultrasound-guided fine-needle aspiration biopsy or preoperative evaluation. SWE elasticity indices (EI) of mean (Emean), minimum (Emin), maximum (Emax) and the ratio of Emean in LNs and surrounding muscle (Emean-m) were measured at the stiffest portion of LNs (kPa). SWE EI were correlated with the pathologic diagnosis and the histopathologic findings, including number and size of metastatic LNs, the ratio of the number of metastatic LN/dissected LN, and the presence of extranodal extension. Diagnostic performances of SWE EI and BUS for predicting LN metastasis were assessed using receiver operating curve analysis.
All SWE EI were significantly higher in metastatic LNs than in benign LNs (p < 0.005). Combined Emean [area under the curve (AUC) 0.811] or Emin (AUC 0.812) with BUS showed significantly higher AUC than BUS (0.738) for predicting metastatic LNs (p = 0.041 and 0.033, respectively). The number of positive LNs/dissected LNs and the largest LN size were significantly correlated with SWE EI (p < 0.05 and p < 0.005, respectively). Metastatic LNs with extranodal extension showed significantly higher SWE EI (p < 0.005) than those without extranodal extension.
Combined use of SWE and BUS was adjunctive to the diagnostic performance of BUS for the prediction of LN metastasis of PTC, and quantitative SWE could predict pathologic prognostic factors of LN metastasis of PTC.
本研究旨在评估剪切波弹性成像（SWE）在预测甲状腺乳头状癌（PTC）颈部淋巴结（LN）转移中的应用价值，以及SWE作为PTC组织病理学因素的预后意义。
66例PTC患者的84个LN在超声引导下细针穿刺活检或术前评估前接受了B超（BUS）和SWE检查。在LN最硬的部分测量SWE弹性指数（EI），包括平均（Emean）、最小（Emin）、最大（Emax）以及LN与周围肌肉的Emean比值（Emean-m）（kPa）。SWE EI与病理诊断及组织病理学结果相关，包括转移LN的数量和大小、转移LN数量/切除LN数量的比值以及有无结外侵犯。采用受试者操作特征曲线分析评估SWE EI和BUS预测LN转移的诊断性能。
转移LN的所有SWE EI均显著高于良性LN（p < 0.005）。在预测转移LN方面，联合Emean[曲线下面积（AUC）0.811]或Emin（AUC 0.812）与BUS显示的AUC显著高于BUS（0.738）（分别为p = 0.041和0.033）。阳性LN数量/切除LN数量以及最大LN大小与SWE EI显著相关（分别为p < 0.05和p < 0.005）。有结外侵犯的转移LN的SWE EI显著高于无结外侵犯者（p < 0.005）。
SWE与BUS联合使用辅助了BUS对PTC的LN转移预测诊断性能，定量SWE可预测PTC的LN转移病理预后因素。
