Annals of Surgical Oncology

, Volume 22, Issue 1, pp 111–116 | Cite as

Shear Wave Elastography in Evaluation of Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma: Elasticity Index as a Prognostic Implication

  • Woo Sang Jung
  • Jeong-Ah KimEmail author
  • Eun Ju Son
  • Ji Hyun Youk
  • Cheong Soo Park
Endocrine Tumors



The aim of this study was to evaluate the usefulness of shear wave elastography (SWE) for predicting cervical lymph node (LN) metastasis and the prognostic implication of SWE as histopathologic factors of papillary thyroid carcinoma (PTC).


Eighty-four LNs of 66 patients with PTC underwent B-mode ultrasonography (BUS) and SWE before ultrasound-guided fine-needle aspiration biopsy or preoperative evaluation. SWE elasticity indices (EI) of mean (Emean), minimum (Emin), maximum (Emax) and the ratio of Emean in LNs and surrounding muscle (Emean−m) were measured at the stiffest portion of LNs (kPa). SWE EI were correlated with the pathologic diagnosis and the histopathologic findings, including number and size of metastatic LNs, the ratio of the number of metastatic LN/dissected LN, and the presence of extranodal extension. Diagnostic performances of SWE EI and BUS for predicting LN metastasis were assessed using receiver operating curve analysis.


All SWE EI were significantly higher in metastatic LNs than in benign LNs (p < 0.005). Combined Emean [area under the curve (AUC) 0.811] or Emin (AUC 0.812) with BUS showed significantly higher AUC than BUS (0.738) for predicting metastatic LNs (p = 0.041 and 0.033, respectively). The number of positive LNs/dissected LNs and the largest LN size were significantly correlated with SWE EI (p < 0.05 and p < 0.005, respectively). Metastatic LNs with extranodal extension showed significantly higher SWE EI (p < 0.005) than those without extranodal extension.


Combined use of SWE and BUS was adjunctive to the diagnostic performance of BUS for the prediction of LN metastasis of PTC, and quantitative SWE could predict pathologic prognostic factors of LN metastasis of PTC.


Papillary Thyroid Carcinoma Shear Wave Elastography Papillary Thyroid Carcinoma Patient Elasticity Index Extranodal Extension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

Woo Sang Jung, Jeong-Ah Kim, Eun Ju Son, Ji Hyun Youk, and Cheong Soo Park disclose no conflicts of interest in this study.


  1. 1.
    Jemal A, Siegel R, Xu J, Ward E. 2010 Cancer statistics. Cancer J Clin. 2010;60:277–300.CrossRefGoogle Scholar
  2. 2.
    Shaha AR, Shah JP, Loree TR. Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg. 1996;172:692–694.PubMedCrossRefGoogle Scholar
  3. 3.
    Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–428.PubMedCrossRefGoogle Scholar
  4. 4.
    Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008;144:1070–1077.PubMedCrossRefGoogle Scholar
  5. 5.
    Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid 2009;19:683–689.PubMedCrossRefGoogle Scholar
  6. 6.
    Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001;86:1447–1463.PubMedCrossRefGoogle Scholar
  7. 7.
    Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2,444 consecutively treated patients. World J Surg. 2002;26:879–885.PubMedCrossRefGoogle Scholar
  8. 8.
    Simon D, Goretzki PE, Witte J, Roher HD. Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg. 1996;20:860–866.PubMedCrossRefGoogle Scholar
  9. 9.
    Esnaola NF, Cantor SB, Sherman SI, Lee JE, Evans DB. Optimal treatment strategy in patients with papillary thyroid cancer: a decision analysis. Surgery. 2001;130:921–930.PubMedCrossRefGoogle Scholar
  10. 10.
    Randolph GW, Duh QY, Heller KS, et al.; American Thyroid Association Surgical Affairs Committee’s Taskforce on Thyroid Cancer Nodal Surgery. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22:1144–1152.PubMedCrossRefGoogle Scholar
  11. 11.
    Gao L, Parker KJ, Lerner RM, Levinson SF. Imaging of the elastic properties of tissue: a review. Ultrasound Med Biol. 1996;22:959–977.PubMedCrossRefGoogle Scholar
  12. 12.
    Garra BS, Cespedes EI, Ophir J, Spratt SR, Zuurbier RA, Magnant CM, et al. Elastography of breast lesions: initial clinical results. Radiology. 1997;202:79–86.PubMedCrossRefGoogle Scholar
  13. 13.
    Friedrich-Rust M, Ong MF, Herrmann E, Dries V, Samaras P, Zeuzem S, et al. Real-time elastography for noninvasive assessment of liver fibrosis in chronic viral hepatitis. AJR Am J Roentgenol. 2007;188:758–764.PubMedCrossRefGoogle Scholar
  14. 14.
    Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–350.PubMedCrossRefGoogle Scholar
  15. 15.
    Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–211.PubMedCrossRefGoogle Scholar
  16. 16.
    Taylor LS, Rubens DJ, Porter BC, et al. Prostate cancer: three-dimensional sonoelastography for in vitro detection. Radiology. 2005;237:981–985.PubMedCrossRefGoogle Scholar
  17. 17.
    Thomas A, Fischer T, Frey H, et al. Real-time elastography–an advanced method of ultrasound: first results in 108 patients with breast lesions. Ultrasound Obstet Gynecol. 2006;28:335–340.PubMedCrossRefGoogle Scholar
  18. 18.
    Thomas A, Kummel S, Gemeinhardt O, Fischer T. Real-time sonoelastography of the cervix: tissue elasticity of the normal and abnormal cervix. Acad Radiol. 2007;14:193–200.PubMedCrossRefGoogle Scholar
  19. 19.
    Bhatia K, Tong CS, Cho CC, Yuen EH, Lee J, Ahuja AT. Reliability of shear wave ultrasound elastography for neck lesions identified in routine clinical practice. Ultraschall Med. 2012;33:463–468.PubMedCrossRefGoogle Scholar
  20. 20.
    Bhatia KS, Tong CS, Cho CC, Yuen EH, Lee YY, Ahuja AT. Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy. Eur Radiol. 2012;22:2397–2406.PubMedCrossRefGoogle Scholar
  21. 21.
    Bhatia KS, Cho CC, Tong CS, Tong CS, Yuen EHY, Yuen EH, et al. Shear wave elasticity imaging of cervical lymph nodes. Ultrasound Med Biol. 2012;38:195–201.PubMedCrossRefGoogle Scholar
  22. 22.
    Sebag F, Vaillant-Lombard J, Berbis J, Griset V, Henry JF, Petit P, et al. Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab. 2010;95:5281–5288.PubMedCrossRefGoogle Scholar
  23. 23.
    Park YJ, Kim JA, Son EJ, Youk JH, Park CS. Quantitative shear wave elastography as a prognostic implication of papillary thyroid carcinoma (PTC): elasticity index can predict extrathyroidal extension (ETE). Ann Surg Oncol. 2013;20:2765–2771.PubMedCrossRefGoogle Scholar
  24. 24.
    van den Brekel MW, Stel HV, Castelijns JA, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology. 1990;177:379–384.PubMedCrossRefGoogle Scholar
  25. 25.
    Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol. 1992;158:961–969.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Woo Sang Jung
    • 1
  • Jeong-Ah Kim
    • 1
    Email author
  • Eun Ju Son
    • 1
  • Ji Hyun Youk
    • 1
  • Cheong Soo Park
    • 2
  1. 1.Department of Radiology, Gangnam Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Surgery, Gangnam Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea

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