Jiang Wei, Wei Hong-Yan, Zhang Hai-Yan, Zhuo Qiu-Luan
Department of Ultrasound, Shenzhen Nanshan District People's Hospital, Shenzhen 518052, Guangdong Province, China.
World J Clin Cases. 2019 Jan 6;7(1):49-57. doi: 10.12998/wjcc.v7.i1.49.
Cervical lymph node metastasis in papillary thyroid carcinoma (PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.
To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.
A total of 94 patients with PTC were recruited. According to pathological results, lymph nodes were divided into two groups: metastatic group ( = 50) and reactive group ( = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.
The ratio of long diameter/short diameter (L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity (PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group ( < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis ( < 0.05). Furthermore, the area under the curve (AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant ( < 0.05). The fitting equation for the combined diagnosis was logit(P) = -12.341 + 1.482 × L/S ratio + 3.529 × missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.
Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.
甲状腺乳头状癌（PTC）颈部淋巴结转移影响患者的治疗及预后。超声是检测PTC患者颈部淋巴结的常用影像学方法；然而，其在判断淋巴结转移方面并不准确。
评估超声造影联合弹性成像在评估PTC颈部淋巴结转移中的价值。
共纳入94例PTC患者。根据病理结果，将淋巴结分为两组：转移组（n = 50）和反应性组（n = 63）。记录并比较常规超声表现、超声造影及弹性成像数据。采用Logistic回归分析得出不同指标诊断淋巴结转移的预测概率分布。采用受试者工作特征曲线分析，检验基于常规超声的超声造影联合弹性成像在评估PTC颈部淋巴结转移中的效能。
转移组的长径/短径（L/S）比值≤2、边缘形态不规则、淋巴门缺失、周边或混合血流分布、峰值强度（PI）、造影剂分布不均匀及弹性评分均显著高于反应性组（P < 0.05）。L/S比值、淋巴门缺失、PI及弹性评分对PTC颈部淋巴结转移的发生有显著影响（P < 0.05）。此外，联合PI比值、弹性评分、淋巴门缺失及L/S诊断淋巴结转移的曲线下面积（AUC）为0.936，显著高于单独PI比值的AUC。差异具有统计学意义（P < 0.05）。联合诊断的拟合方程为logit(P) = -12.341 + 1.482×L/S比值 + 3.529×淋巴门缺失 + 0.392×PI + 3.288×弹性评分。
基于灰阶超声，超声造影联合弹性成像可准确评估PTC颈部淋巴结转移。
