From the Departments of Ultrasound (L.X., J.Z., H.Z., G.W., W.Z., X.P., L.L.) and Head and Neck Surgery (A.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China; and Department of Ultrasound, Sun Yat-sen University, Affiliated Hospital 8, Shenzhen, PR China (W.T., Y.L.).
Radiology. 2023 May;307(4):e221465. doi: 10.1148/radiol.221465. Epub 2023 Apr 4.
Background Although metastasis of lateral cervical lymph nodes (LNs) is common in papillary thyroid carcinoma (PTC), correctly diagnosing small metastatic LNs with US remains challenging. The use of contrast-enhanced US (CEUS), especially the postvascular phase of CEUS with perfluorobutane contrast material, might contribute to improved diagnosis of metastatic LNs in PTC. Purpose To assess the diagnostic value of the postvascular phase of CEUS with perfluorobutane in suspicious small lateral cervical LNs (short-axis diameter ≤8 mm) in patients with PTC. Materials and Methods This single-center study prospectively enrolled consecutive participants with confirmed PTC and suspicious LNs at US from October 2020 to October 2021. All participants underwent CEUS, 1 week before biopsy or surgery, with intravenous perfluorobutane contrast material to visualize the LNs in the vascular phase (5-60 seconds after injection) and postvascular phase (10-30 minutes after injection). The reference standard was cytologic and surgical histologic assessment of the LNs. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of sonographic features were calculated, and the diagnostic performance of US, CEUS, and the combination of postvascular phase and US features was assessed using multivariable logistic regression models. Results A total of 135 participants (median age, 36 years [IQR, 30-46 years]; 100 women) with 161 suspicious LNs at US were evaluated, including 67 metastatic and 94 benign LNs. The specificity of perfusion defect as a sonographic feature in the vascular phase reached 96% (90 of 94 LNs), and the negative predictive value of non-isoenhancement (ie, hypoenhancement, partial enhancement, and no enhancement) in the postvascular phase reached 100% (83 of 83 LNs). The area under the receiver operating characteristic curve (AUC) of the combination of postvascular phase and US features was 0.94 (95% CI: 0.89, 0.97), significantly higher than that of US features alone (AUC, 0.73; 95% CI: 0.65, 0.79; < .001). Conclusion The postvascular phase of CEUS with perfluorobutane demonstrated excellent performance for diagnosing suspicious small lateral cervical LNs in participants with PTC. Published under a CC BY 4.0 license See also the editorial by Gunabushanam in this issue.
背景 尽管甲状腺乳头状癌（PTC）患者的颈侧淋巴结（LNs）转移很常见，但超声正确诊断小的转移性 LNs 仍然具有挑战性。使用对比增强超声（CEUS），尤其是使用全氟丁烷造影剂的血管后相 CEUS，可能有助于提高 PTC 患者转移性 LNs 的诊断。目的 评估在 PTC 患者中，使用全氟丁烷造影剂的 CEUS 血管后相在可疑小的颈侧 LNs（短轴直径≤8mm）中的诊断价值。材料与方法 本单中心前瞻性研究纳入了 2020 年 10 月至 2021 年 10 月间经超声证实为 PTC 且存在可疑 LNs 的连续患者。所有患者均在活检或手术前 1 周行 CEUS，静脉注射全氟丁烷造影剂，以在血管相（注射后 5-60 秒）和血管后相（注射后 10-30 分钟）显示 LNs。以 LNs 的细胞学和手术组织学评估作为参考标准。计算超声特征的敏感性、特异性、阳性预测值、阴性预测值和准确性，并使用多变量逻辑回归模型评估 US、CEUS 和血管后相及 US 特征联合的诊断性能。结果 共评估了 135 名参与者（中位年龄，36 岁[IQR，30-46 岁]；100 名女性）的 161 个可疑 LNs，包括 67 个转移性和 94 个良性 LNs。在血管相时，灌注缺损作为超声特征的特异性达到 96%（94 个 LNs 中的 90 个），而在血管后相时非等增强（即低增强、部分增强和无增强）的阴性预测值达到 100%（83 个 LNs 中的 83 个）。血管后相及 US 特征联合的受试者工作特征曲线下面积（AUC）为 0.94（95%CI：0.89，0.97），显著高于单独使用 US 特征的 AUC（0.73；95%CI：0.65，0.79；<.001）。结论 在 PTC 患者中，使用全氟丁烷造影剂的 CEUS 血管后相显示出对可疑小的颈侧 LNs 进行诊断的优异性能。
