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Contrast-enhanced ultrasound: a valuable modality for extracapsular extension assessment in papillary thyroid cancer

  • Ultrasound
  • Published:
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Abstract

Objectives

To evaluate the diagnostic accuracy of preoperative contrast-enhanced ultrasound (CEUS) to detect extracapsular extension (ECE) and identify the relationship between ECE and nodule enhancement patterns in patients with papillary thyroid cancer (PTC).

Methods

Patients with suspected thyroid cancer underwent ultrasound (US) and CEUS examinations. The US and CEUS features of the PTC nodules and thyroid capsule were recorded and classified individually. The accuracy of US and CEUS in detecting ECE was compared individually, and its relationship with various tumour enhancement patterns was analysed. The presence or absence of ECE and cervical lymph node metastasis (LNM) was confirmed pathologically.

Results

The final dataset included 119 patients with 124 PTC nodules. Seventy-two (60.5%) of these patients with PTC had no ECE (including 38 patients with single capsule invasion), while the remaining 52 had ECE. A significant difference was found in nodules with non-capsule invasion, single capsule invasion, and ECE between the cervical LNM and non-LNM groups (p < 0.01). Receiver operating characteristic curve analysis demonstrated that area under the curve (AUC) of ECE for cervical LNM was higher than that of capsule invasion (71.9% vs. 49.6%). Moreover, the CEUS images acquired to detect ECE showed higher AUC values than those of US images (79.4% vs. 65.8%) (p = 0.02). Among the PTC nodules with differential enhancement, hyper-enhanced nodules had the highest incidence of capsule invasion (41.9%), while hypo-enhanced ones had a higher incidence of ECE (47.4%).

Conclusions

Compared with conventional US, CEUS is a more valuable and non-invasive imaging modality to detect ECE.

Key Points

• Single capsular invasion was a poor predictor of cervical lymph node metastasis, while extracapsular extension assessments were clinically significant for predicting cervical lymph node metastasis.

• CEUS is better than conventional US in detecting extracapsular extension in papillary thyroid carcinoma (AUC: 79.4% vs. 65.8%) (p = 0.02).

• Among the thyroid papillary carcinoma nodules with differential enhancement, hyper-enhanced nodules had the highest incidence of single capsule invasion (41.9%), while hypo-enhanced ones had a higher incidence of ECE (47.4%).

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Abbreviations

AUC:

Area under the curve

CEUS:

Contrast-enhanced ultrasound

CI:

Confidence interval

ECE:

Extracapsular extension

LNM:

Lymph node metastasis

NPV:

Negative predictive value

PPV:

Positive predictive value

PTC:

Papillary thyroid cancer

ROC:

Receiver operating characteristic

US:

Ultrasound

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Funding

This study was supported by the Natural Science Foundation of Beijing, China (7194318) and the National Nature Science Foundation of China (81901746).

Author information

Author notes

  1. Yan Zhang, Xia Zhang and Jie Li contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Ultrasound, Division of First Medical Center, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China

    Yan Zhang, Qian Cai & Yu kun Luo

  2. Department of Oncology, Division of First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China

    Xia Zhang

  3. Department of Pathology, Division of First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China

    Jie Li

  4. Department of Surgery, Division of First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China

    Zhi Qiao

Authors
  1. Yan Zhang
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  2. Xia Zhang
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  6. Yu kun Luo
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Correspondence to Yu kun Luo.

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The scientific guarantor of this publication is Yu kun Luo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• prospective

• randomised controlled trial

• performed at one institution

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Zhang, Y., Zhang, X., Li, J. et al. Contrast-enhanced ultrasound: a valuable modality for extracapsular extension assessment in papillary thyroid cancer. Eur Radiol 31, 4568–4575 (2021). https://doi.org/10.1007/s00330-020-07516-y

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  • DOI: https://doi.org/10.1007/s00330-020-07516-y

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