Sonographic Follow-Up of Patients with Differentiated Thyroid Carcinoma: A Comparison of the Ultrasound Elastography,Power Doppler Ultrasound,and B-Mode Ultrasound Features in Detecting Malignant Lymph Nodes |
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| Affiliation: | 1. Department of Endocrinology and Metabolism, Ankara University School of Medicine, Ankara, Turkey.;2. Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey.;3. *Current address: Hacettepe University Faculty of Medicine, Department of Endocrinology and Metabolism.;1. School of Medicine, University of California Irvine, Orange, California;2. Osteoporosis Center of Armenia, Yerevan, Armenia;3. College of Physicians & Surgeons, Columbia University, New York, New York;4. Yerevan State Medical University, Yerevan, Armenia;5. Management Mix, Yerevan, Armenia;6. School of Medicine, Boston University, Boston, Massachusetts;7. Manoukian Medical Group, Mountain View, California;8. Rollins School of Public Health, Emory University, Atlanta, Georgia;9. Iodine Global Network, Ottawa, Ontario, Canada.;1. From the Departments of Endocrinology and Metabolism Institute, Cleveland, Ohio.;2. the Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio. |
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| Abstract: | Objective: The aim of this study was to assess and compare the diagnostic power of B-mode ultrasonography (US), power Doppler US (PD), and ultrasound elastography (USE) in detecting malignant lymph nodes (LNs) during follow-up of patients who were operated on for differentiated thyroid cancer (DTC).Methods: In this prospective study, a total of 103 cervical LNs having suspicious malignant features from 72 patients with DTC were examined using US, PD, and USE. USE scores were classified from 1 to 3 according to the presence of elasticity (1, soft; 2, intermediate; 3, hard). The strain ratios (SRs) of all LNs were calculated according to adjacent muscle tissue.Results: The most-sensitive ultrasonographic features were hilum loss and hypoechogenicity, with 94.4% and 80.6% sensitivity and 93.5% and 84.4% negative predictive value, respectively. The most-specific feature was the presence of cystic component, with 98.5% specificity and 85.7% positive predictive value. Presence of diffuse/chaotic or irregular vascularity in PD had 47.2% sensitivity and 83.6% specificity in predicting metastasis. In USE, the sensitivity and specificity of score 3 were 56.7% and 74.2%, respectively. The median SR of metastatic LNs was higher than that of benign LNs (median SR [min–max], 3.0 [0.16 and 29] vs. 1.89 [0.26 and 37.9]), but the difference was not significant (P = .07). Multivariate logistic regression analyses revealed 4.9-, 6.6-, and 10-fold increases in metastasis risk for short/long axis ratio ≥0.5, nodal vascularity, and score 3 USE, respectively (P<.05).Conclusion: While USE had higher sensitivity, PD had higher specificity in detecting malignant LNs, but none of these techniques was as sensitive and specific as gray-scale US features.Abbreviations CI = confidence interval; DTC = differentiated thyroid cancer; LN = lymph node; LN-Tg = lymph node–thyroglobulin; NPV = negative predictive value; PD = power Doppler; PPV = positive predictive value; ROI = region of interest; SR = strain ratio; US = ultrasonography; USE = ultrasound elastography |
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