From the Departments of Ultrasound (Yan Zhang, W.L., J.H.Z., Ying Zhang, H.Y.H., Y.K.L.) and Pathology (J.L.), Division of First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Rd, Beijing 100853, China; and Department of Ultrasound, Division of Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China (Y.Y.L.).
Radiology. 2023 May;307(4):e221265. doi: 10.1148/radiol.221265. Epub 2023 Apr 4.
Background The presence of cervical lymph node (LN) metastases (LNMs) affects clinical staging and prognosis of thyroid cancer, but the role of conventional B-mode US is limited for preoperative diagnosis of LNMs. The diagnostic value of lymphatic contrast-enhanced US (LCEUS) in thyroid cancer is still being explored. Purpose To explore the diagnostic performance of LCEUS by means of thyroidal injection of contrast agent in comparison with US in detecting LNMs of suspected thyroid cancer. Materials and Methods In this single-center prospective study conducted from November 2020 to January 2021, consecutive participants with suspected thyroid cancer underwent B-mode US and LCEUS of cervical LNs before biopsy. LNMs were confirmed with fine-needle aspiration cytologic examination, thyroglobulin washout assessment, or histopathologic examination after surgery. The diagnostic performance of LCEUS for cervical LNs was compared with that of conventional B-mode US, and its association with LN size and location was evaluated. Results The final data set included 64 participants (mean age, 45 years ± 12 [SD]; 52 women) with 76 LNs. The sensitivity, specificity, and accuracy of LCEUS for LNM were 97%, 90%, and 93%, respectively, whereas they were 81%, 80%, and 80%, respectively, for LNM at conventional B-mode US. Compared with US, LCEUS had better diagnostic accuracy for the LNs smaller than 1 cm (82% vs 95%; = .03) and for central neck LNs (level VI) (83% vs 96%; = .04). Conclusion Lymphatic contrast-enhanced US had better diagnostic performance than conventional B-mode US for detecting cervical LN metastases in suspected thyroid cancer before surgery, especially for LNs smaller than 1 cm and central neck LNs. © RSNA, 2023 See also the editorial by Grant and Kwon in this issue.
背景 颈部淋巴结（LN）转移（LNM）的存在影响甲状腺癌的临床分期和预后，但常规 B 型超声（US）在术前诊断 LNM 方面的作用有限。淋巴对比增强超声（LCEUS）在甲状腺癌中的诊断价值仍在探索中。
目的 探讨经甲状腺注射对比剂的 LCEUS 对疑似甲状腺癌 LNMs 的诊断性能，与 US 进行比较。
材料与方法 这是一项于 2020 年 11 月至 2021 年 1 月在单中心进行的前瞻性研究，连续入组的疑似甲状腺癌患者在活检前接受 B 型 US 和颈部 LN 的 LCEUS 检查。通过细针抽吸细胞学检查、甲状腺球蛋白洗脱评估或手术后的组织病理学检查，对 LNMs 进行确诊。比较 LCEUS 对颈部 LN 的诊断性能，并评估其与 LN 大小和位置的关系。
结果 最终数据集包括 64 名参与者（平均年龄，45 岁±12[标准差]；52 名女性）的 76 个 LN。LCEUS 对 LNM 的敏感性、特异性和准确性分别为 97%、90%和 93%，而 LNM 的常规 B 型 US 分别为 81%、80%和 80%。与 US 相比，LCEUS 对小于 1cm 的 LN（82%比 95%； =.03）和中央颈部 LN（VI 级）（83%比 96%； =.04）具有更好的诊断准确性。
结论 在术前疑似甲状腺癌患者中，LCEUS 检测颈 LN 转移的诊断性能优于常规 B 型 US，尤其是对于小于 1cm 的 LN 和中央颈部 LN。
