Department of Ultrasound, Bethune Hospital Affiliated to Shanxi Medical University, China.
Department of Ultrasound, Bethune Hospital Affiliated to Shanxi Medical University, China.
Surg Oncol. 2021 Mar;36:1-6. doi: 10.1016/j.suronc.2020.11.004. Epub 2020 Nov 25.
To investigate the relationship between shear wave elastography (SWE) elasticity indices of papillary thyroid carcinoma (PTC) and central lymph node metastasis (CLNM) and to evaluate the value of SWE combined with gray-scale ultrasound (US) for predicting preoperative CLNM.
This study included 172 patients with a pathology diagnosis of PTC who underwent preoperative gray-scale US and SWE evaluation. Patients were divided into CLNM-positive and CLNM-negative groups. We analyzed the association between SWE elasticity indices (Emax, Emean and Emin) and CLNM, compared the diagnostic efficacy of gray-scale US alone versus SWE combined with gray-scale US for predicting CLNM, and analyzed the influence of Hashimoto's thyroiditis (HT) on the diagnostic efficacy of CLNM.
SWE elasticity values Emax, Emean and Emin were significantly higher in CLNM-positive patients (P=0.000, 0.000 and 0.003, respectively). The AUC of Emax was higher than that of other SWE indices for predicting CLNM (AUC = 0.749; 95% CI = 0.676-0.822). In multivariate analysis, microcalcification (OR = 5.254; 95% CI = 2.496-11.061), extrathyroidal extension (OR = 4.210; 95% CI = 1.423-12.456), multifocality (OR = 3.084; 95% CI = 1.190-7.991) and Emax >59.0 kpa (OR = 4.934; 95% CI = 2.318-10.500) were independent risk factors for predicting CLNM. The AUC of SWE combined with gray-scale US for predicting CLNM (AUC = 0.825; 95% CI = 0.760-0.879) was significantly higher (P = 0.011) than that for gray-scale US alone (AUC = 0.774; 95% CI = 0.704-0.834). There was no significant difference in AUC between the HT and non-HT subgroups in predicting CLNM (0.798 vs. 0.833, P = 0.640).
SWE can be used to predict CLNM in PTC patients. SWE combined with gray-scale US can improve the prediction of CLNM.
探讨甲状腺乳头状癌（PTC）剪切波弹性成像（SWE）弹性指标与中央区淋巴结转移（CLNM）的关系，并评估 SWE 联合灰阶超声（US）预测术前 CLNM 的价值。
本研究纳入了 172 例经病理诊断为 PTC 的患者，所有患者均行术前灰阶 US 和 SWE 评估。患者被分为 CLNM 阳性组和 CLNM 阴性组。分析 SWE 弹性指标（Emax、Emean 和 Emin）与 CLNM 的关系，比较单独使用灰阶 US 与 SWE 联合灰阶 US 预测 CLNM 的诊断效能，并分析桥本甲状腺炎（HT）对 CLNM 诊断效能的影响。
CLNM 阳性患者的 SWE 弹性值 Emax、Emean 和 Emin 均显著升高（P=0.000、0.000 和 0.003）。Emax 的 AUC 用于预测 CLNM 的效能高于其他 SWE 指标（AUC=0.749；95%CI=0.676-0.822）。多因素分析显示，微钙化（OR=5.254；95%CI=2.496-11.061）、甲状腺外侵犯（OR=4.210；95%CI=1.423-12.456）、多灶性（OR=3.084；95%CI=1.190-7.991）和 Emax＞59.0 kPa（OR=4.934；95%CI=2.318-10.500）是预测 CLNM 的独立危险因素。SWE 联合灰阶 US 预测 CLNM 的 AUC（AUC=0.825；95%CI=0.760-0.879）显著高于单独使用灰阶 US 的 AUC（AUC=0.774；95%CI=0.704-0.834）（P=0.011）。HT 亚组和非 HT 亚组预测 CLNM 的 AUC 之间无显著差异（0.798 与 0.833，P=0.640）。
SWE 可用于预测 PTC 患者的 CLNM，SWE 联合灰阶 US 可提高 CLNM 的预测能力。
