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European Radiology

, Volume 26, Issue 8, pp 2611–2622 | Cite as

Prediction of cervical lymph node metastasis in patients with papillary thyroid cancer using combined conventional ultrasound, strain elastography, and acoustic radiation force impulse (ARFI) elastography

  • Jun-Mei Xu
  • Xiao-Hong Xu
  • Hui-Xiong XuEmail author
  • Yi-Feng Zhang
  • Le-Hang Guo
  • Lin-Na Liu
  • Chang Liu
  • Xiao-Wan Bo
  • Shen Qu
  • Mingzhao Xing
  • Xiao-Long Li
Head and Neck

Abstract

Objectives

To investigate the value of combined conventional ultrasound (US), strain elastography (SE) and acoustic radiation force impulse (ARFI) elastography for prediction of cervical lymph node metastasis (CLNM) in papillary thyroid cancer (PTC).

Methods

A consecutive series of 203 patients with 222 PTCs were preoperatively evaluated by US, SE, and ARFI including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ). A multivariate analysis was performed to predict CLNM by 22 independent variables. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance.

Results

Multivariate analysis demonstrated that VTI area ratio (VAR) > 1 was the best predictor for CLNM, followed by abnormal cervical lymph node (ACLN), capsule contact, microcalcification, capsule involvement, and multiple nodules (all P < 0.05). ROC analyses of these characteristics showed the areas under the curve (Az), sensitivity, and specificity were 0.600–0.630, 47.7 %–93.2 %, and 26.9 %–78.4 % for US, respectively; and they were 0.784, 83.0 %, and 73.9 %, respectively, for VAR > 1. As combination of US characteristics with and without VAR, the Az, sensitivity, and specificity were 0.803 and 0.556, 83.0 % and 100.0 %, and 77.6 % and 11.2 %, respectively (P < 0.001).

Conclusions

ARFI elastography shows superior performance over conventional US, particularly when combined with US, in predicting CLNM in PTC patients.

Key Points

• Conventional ultrasound is useful in predicting cervical lymph node metastasis preoperatively.

• Virtual touch tissue imaging area ratio is the strongest predicting factor.

• Predictive performance is markedly improved by combining ultrasound characteristics with VAR.

• Acoustic radiation force impulse elastography may be a promising complementary tool.

Keywords

Thyroid nodule Thyroid cancer Acoustic radiation force impulse Virtual touch tissue imaging Conventional ultrasound 

Abbreviations

CLNM

Cervical lymph node metastasis

PTC

Papillary thyroid carcinoma

SE

Strain elastography

ARFI

Acoustic radiation force impulse

VTI

Virtual touch tissue imaging

VTQ

Virtual touch tissue quantification

ROC

Receiver operating characteristic

Az

Areas under the curve

VAR

Virtual touch tissue imaging area ratio

ACLN

Abnormal cervical lymph node

SWV

Shear wave velocity

FNAB

Fine–needle aspiration biopsy

ROI

Region of interest

OR

Odds ratio

CI

Confidence interval

PTMC

Papillary thyroid microcarcinoma

Notes

Acknowledgments

The scientific guarantor of this publication is Hui-Xiong Xu, head of the Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine. This study was funded by a grant SHDC12014229 from the Shanghai Hospital Development Center, grants 14441900900 and 15411969000 from the Science and Technology Commission of Shanghai Municipality, a grant 2012045 from the Shanghai Municipal Human Resources and Social Security Bureau, and grants 81501475, 81401417 and 81472579 from the National Natural Science Foundation of China.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. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Informed consent was obtained from all subjects (patients) to include their data for analysis in this study. Some malignant nodules (N = 57) in this study have been reported in two previously published articles: Xu JM, Xu XH, Xu HX, et al (2014) Conventional US, US elasticity imaging, and acoustic radiation force impulse imaging for prediction of malignancy in thyroid nodules. Radiology, 272(2): 577–586 and Zhang YF, Liu C, Xu HX, et al (2014) Acoustic radiation force impulse imaging: a new tool for the diagnosis of papillary thyroid microcarcinoma. Biomed Res Int, 2014: 416969.

Methodology: retrospective, observational, performed at one institution.

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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Jun-Mei Xu
    • 1
    • 2
  • Xiao-Hong Xu
    • 3
  • Hui-Xiong Xu
    • 1
    • 2
    • 3
    • 6
    Email author
  • Yi-Feng Zhang
    • 1
    • 2
  • Le-Hang Guo
    • 1
    • 2
  • Lin-Na Liu
    • 1
    • 2
  • Chang Liu
    • 1
    • 2
  • Xiao-Wan Bo
    • 1
    • 2
  • Shen Qu
    • 2
    • 4
  • Mingzhao Xing
    • 2
    • 5
  • Xiao-Long Li
    • 1
    • 2
  1. 1.Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education InstituteTongji University School of MedicineShanghaiChina
  2. 2.Thyroid InstituteTongji University School of MedicineShanghaiChina
  3. 3.Department of UltrasoundGuangdong Medical College Affiliated HospitalZhanjiangChina
  4. 4.Department of Endocrinology and Metabolism, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiChina
  5. 5.Department of Endocrinology, Diabetes & MetabolismJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of Medical Ultrasound, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiChina

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