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Xu L, Haitao R, Li Z. Application of Ultrasound Shear Wave Elastography Combined With BRAFV600E Mutation for the Diagnosis of Papillary Thyroid Carcinoma. Ultrasound Q 2023; 39:199-205. [PMID: 37543733 DOI: 10.1097/ruq.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
ABSTRACT This prospective study aimed to investigate the combination of shear wave elastography (SWE) and BRAFV600E mutation testing for the diagnosis of papillary thyroid carcinoma (PTC). One hundred thyroid nodules with an American College of Radiology thyroid imaging reporting and data system classification of 4 or 5 were subjected to SWE measurement, BRAFV600E genotyping, fine-needle aspiration, and surgery. Nonparametric statistical tests were used to compare the differences in the elastic parameters and BRAF genotypes between benign and malignant thyroid nodules of PTC, and receiver operating characteristic curve analysis was conducted to compare the diagnostic efficacy. In addition, the correlations between elastic parameters and BRAFV600E mutation in PTC were analyzed using binary logistic regression. The SWE, BRAFV600E, and their combination exhibited sensitivities of 72.9%, 81.3%, and 85.4%, respectively, and specificities of 66.7%, 90.3%, and 86.5%, respectively, in the diagnosis of PTC ( P < 0.05). The SWE, BRAFV600E, and their combination exhibited sensitivities of 50.0%, 24.1% and 56.3%, respectively, and specificities of 89.7%, 87.5% and 82.8%, respectively, in the diagnosis of central cervical lymph node metastasis ( P < 0.05). The combined use of SWE and BRAFV600E detection had the largest area under the curve, indicating that this combination is more effective in diagnosing PTC and lymph node metastasis in the central region than either method alone. Furthermore, Emax was positively associated with the BRAFV600E genotype. In conclusion, the combination of SWE and BRAFV600E genotype detection can improve the diagnostic efficacy for PTC. Emax can predict the BRAFV600E mutation status.
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Affiliation(s)
- Li Xu
- Department of Ultrasound, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Ran Haitao
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Li
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ramalho D, Teixeira E, Cueto R, Correia S, Rocha G, Oliveira MJ, Soares P, Póvoa AA. Subcentimetric Papillary Thyroid Carcinoma: Does the Diagnosis Kind Impact Prognosis? Cureus 2023; 15:e49563. [PMID: 38156179 PMCID: PMC10754029 DOI: 10.7759/cureus.49563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Subcentimetric papillary thyroid carcinoma (SPTC) (papillary thyroid carcinoma with less than 10 mm in size) usually presents an excellent prognosis, with few aggressive reported cases. Given the globally increased incidence of SPTC, physicians are struggling with the need to identify prognostic factors to stratify SPTC. The aim was to compare clinicopathological variables and prognosis between clinically and incidentally diagnosed SPTC. Materials and methodsː This is a retrospective observational study on patients with SPTC who underwent thyroidectomy between 2002 and 2015. Two groups were considered: G1 (n=60 (61.9%)), clinical diagnosis (Bethesda III-VI cytology in the thyroid tumor/in cervical lymphadenopathies) and G2 (n=37 (38.1%)), incidental diagnosis (thyroidectomy for benign thyroid pathology). The histological material was reviewed, and molecular analysis of the BRAF, RAS, and TERT promoter (TERTp) genes was performed. Resultsː Ninety-seven individuals were included, 60 (61.9%) of which were from G1, with a predominance of female sex (n=83 (85.6%)). Individuals of G1 were younger (53.0±14.2 versus 59.3±13.9 years; p=0.035), were more frequently treated with 131-iodine (39.2% versus 13.4%; p=0.007), had the largest diameter (8 (p25-p75: 7-9) versus 5 (p25-p75: 4-6.5) mm; p<0.001), and higher frequency of minimal extracapsular invasion (45% versus 24.3%; p=0.041). Increased tumor size was the only independent predictor of a clinical diagnosis (p<0.001). Conclusionsː Clinically and incidentally diagnosed SPTC showed excellent medium- to long-term prognosis. A larger SPTC was more likely a driver of clinical detection than a marker of tumor aggressiveness, but caution should be taken as contradictory data persists.
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Affiliation(s)
- Diogo Ramalho
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Elisabete Teixeira
- Pathology, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, PRT
| | - Rosa Cueto
- Pathological Anatomy, Hospital Parc Taulí, Sabadell, ESP
| | - Sara Correia
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Gustavo Rocha
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Maria J Oliveira
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Paula Soares
- Pathology, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, PRT
| | - Antonia A Póvoa
- General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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Lu J, Liao J, Chen Y, Li J, Huang X, Zhang H, Zhang B. Risk factor analysis and prediction model for papillary thyroid carcinoma with lymph node metastasis. Front Endocrinol (Lausanne) 2023; 14:1287593. [PMID: 38027220 PMCID: PMC10646784 DOI: 10.3389/fendo.2023.1287593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective We aimed to identify the clinical factors associated with lymph node metastasis (LNM) based on ultrasound characteristics and clinical data, and develop a nomogram for personalized clinical decision-making. Methods A retrospective analysis was performed on 252 patients with papillary thyroid carcinoma (PTC). The patient's information was subjected to univariate and multivariate logistic regression analyses to identify risk factors. A nomogram to predict LNM was established combining the risk factors. The performance of the nomogram was evaluated using receiver operating characteristic (ROC) curve, calibration curve, cross-validation, decision curve analysis (DCA), and clinical impact curve. Results There are significant differences between LNM and non-LNM groups in terms of age, sex, tumor size, hypoechoic halo around the nodule, thyroid capsule invasion, lymph node microcalcification, lymph node hyperechoic area, peak intensity of contrast (PI), and area under the curve (AUC) of the time intensity curve of contrast (P<0.05). Age, sex, thyroid capsule invasion, lymph node microcalcification were independent predictors of LNM and were used to establish the predictive nomogram. The ROC was 0.800, with excellent discrimination and calibration. The predictive accuracy of 0.757 and the Kappa value was 0.508. The calibration curve, DCA and calibration curve demonstrated that the prediction model had excellent net benefits and clinical practicability. Conclusion Age, sex, thyroid capsule invasion, and lymph node microcalcification were identified as significant risk factors for predicting LNM in patients with PTC. The visualized nomogram model may assist clinicians in predicting the likelihood of LNM in patients with PTC prior to surgery.
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Affiliation(s)
- Juerong Lu
- Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jintang Liao
- Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunhao Chen
- Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Li
- Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinyue Huang
- Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huajun Zhang
- Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Oncology, National Health Commission of the People's Republic of China (NHC) Key Laboratory of Cancer Proteomics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Laboratory of Structural Biology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bo Zhang
- Department of Ultrasonic Imaging, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Molecular Imaging Research Center of Central South University, Changsha, Hunan, China
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Yang Z, Wang X, Tao T, Zou J, Qiu Z, Wang L, Du H, Chen N, Yin X. Diagnostic value of contrast-enhanced ultrasonography in the preoperative evaluation of lymph node metastasis in papillary thyroid carcinoma: a single-center retrospective study. BMC Surg 2023; 23:325. [PMID: 37875825 PMCID: PMC10599078 DOI: 10.1186/s12893-023-02199-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) has been recently used for the assessment of cervical lymph node metastasis (LNM) to guide surgical operation in patients with papillary thyroid carcinoma (PTC). However, the specificity and sensitivity of CEUS reported from previous studies are not consistent. The objective of this study was to evaluate the diagnostic value of CEUS for the metastasis of cervical lymph nodes in PTC patients based on data from one regional central hospital. METHODS The diagnostic value of CEUS in preoperative LNM of PTC patients was concluded by comparing the results of CEUS on lymph node status with postoperative pathology examination. In addition, this study conducted hierarchical analysis of PTC patients to explore whether tumor size, different lymph node regions, and Hashimoto's thyroiditis influence the assessment of CEUS. RESULTS This research study ultimately enrolled 965 PTC patients, including 266 males and 699 females with a mean age of 42.27 ± 11.34 years. A total of 527 patients were considered clinical-node negative, and 438 were clinical-node positive before surgery. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS in the assessment of LNM in PTC patients were 56.00%, 71.00%, 57.06%, 69.76% and 62.59%, respectively. For central and lateral lymph nodes, the accuracy of CEUS in PTC patients was 49.43% and 54.30%, respectively. In addition, it was shown that the accuracy of CEUS in PTC patients with Hashimoto's thyroiditis (HT) slightly decreased to 58.44%, and the accuracy of CEUS in PTC patients with non-HT in turn increased to 64.17%. The accuracy of CEUS in non-papillary thyroid microcarcinoma (PTMC) and PTMC patients was 65.68% and 61.24%, respectively. The accuracy of CEUS in predicting central LNM was significantly different between PTC patients with or without HT (P < 0.001) in this study but not for lateral lymph nodes (P = 0.114). CONCLUSION The accuracy of CEUS in the assessment of LNM in PTC is not consistently satisfactory, especially for central lymph nodes, small tumor diameters, or patients with HT. More diagnostic technologies for abnormal lymph nodes should be considered in PTC patients.
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Affiliation(s)
- Zhixin Yang
- Department of Breast and Thyroid, Guiyang Maternal and Child Health Care Hospital & Guiyang Children's Hospital, Guiyang, China
| | - Xiaofeng Wang
- Department of Breast and Thyroid Surgery, Dongying People's Hospital, Dongying City, Shandong, China
| | - Tao Tao
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiali Zou
- Department of Breast and Thyroid, Guiyang Maternal and Child Health Care Hospital & Guiyang Children's Hospital, Guiyang, China
| | - Zhu Qiu
- Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Long Wang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huimin Du
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ni Chen
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xuedong Yin
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Gao Y, Fu X, Chen Y, Guo C, Wu J. Post-pandemic healthcare for COVID-19 vaccine: Tissue-aware diagnosis of cervical lymphadenopathy via multi-modal ultrasound semantic segmentation. Appl Soft Comput 2023; 133:109947. [PMID: 36570119 PMCID: PMC9762098 DOI: 10.1016/j.asoc.2022.109947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
With the widespread deployment of COVID-19 vaccines all around the world, billions of people have benefited from the vaccination and thereby avoiding infection. However, huge amount of clinical cases revealed diverse side effects of COVID-19 vaccines, among which cervical lymphadenopathy is one of the most frequent local reactions. Therefore, rapid detection of cervical lymph node (LN) is essential in terms of vaccine recipients' healthcare and avoidance of misdiagnosis in the post-pandemic era. This paper focuses on a novel deep learning-based framework for the rapid diagnosis of cervical lymphadenopathy towards COVID-19 vaccine recipients. Existing deep learning-based computer-aided diagnosis (CAD) methods for cervical LN enlargement mostly only depend on single modal images, e.g., grayscale ultrasound (US), color Doppler ultrasound, and CT, while failing to effectively integrate information from the multi-source medical images. Meanwhile, both the surrounding tissue objects of the cervical LNs and different regions inside the cervical LNs may imply valuable diagnostic knowledge which is pending for mining. In this paper, we propose an Tissue-Aware Cervical Lymph Node Diagnosis method (TACLND) via multi-modal ultrasound semantic segmentation. The method effectively integrates grayscale and color Doppler US images and realizes a pixel-level localization of different tissue objects, i.e., lymph, muscle, and blood vessels. With inter-tissue and intra-tissue attention mechanisms applied, our proposed method can enhance the implicit tissue-level diagnostic knowledge in both spatial and channel dimension, and realize diagnosis of cervical LN with normal, benign or malignant state. Extensive experiments conducted on our collected cervical LN US dataset demonstrate the effectiveness of our methods on both tissue detection and cervical lymphadenopathy diagnosis. Therefore, our proposed framework can guarantee efficient diagnosis for the vaccine recipients' cervical LN, and assist doctors to discriminate between COVID-related reactive lymphadenopathy and metastatic lymphadenopathy.
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Affiliation(s)
- Yue Gao
- School of Computer Science (National Pilot Software Engineering School), Beijing University of Posts and Telecommunications, Beijing, 100876, China,Key Laboratory of Trustworthy Distributed Computing and Service (BUPT), Ministry of Education, Beijing, 100876, China
| | - Xiangling Fu
- School of Computer Science (National Pilot Software Engineering School), Beijing University of Posts and Telecommunications, Beijing, 100876, China,Key Laboratory of Trustworthy Distributed Computing and Service (BUPT), Ministry of Education, Beijing, 100876, China,Corresponding author at: School of Computer Science (National Pilot Software Engineering School), Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Yuepeng Chen
- School of Computer Science (National Pilot Software Engineering School), Beijing University of Posts and Telecommunications, Beijing, 100876, China,Key Laboratory of Trustworthy Distributed Computing and Service (BUPT), Ministry of Education, Beijing, 100876, China
| | - Chenyi Guo
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, China
| | - Ji Wu
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, China
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Liu L, Li G, Jia C, Du L, Shi Q, Wu R. Preoperative strain ultrasound elastography can predict occult central cervical lymph node metastasis in papillary thyroid cancer: a single-center retrospective study. Front Oncol 2023; 13:1141855. [PMID: 37124540 PMCID: PMC10130523 DOI: 10.3389/fonc.2023.1141855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To determine whether preoperative ultrasound elastography can predict occult central cervical lymph node metastasis (CCLNM) in patients with papillary thyroid cancer. Methods This retrospective study included 541 papillary thyroid cancer patients with clinically negative lymph nodes prior to surgery between July 2019 and December 2021. Based on whether CCLNM was present on postoperative pathology, patients were categorized as CCLNM (+) or CCLNM (-). Preoperative clinical data, conventional ultrasound features, and ultrasound elastography indices were compared between the groups. Univariate and multivariate logistic regression analysis were performed to identify the independent predictors of occult CCLNM. Results A total of 36.60% (198/541) patients had confirmed CCLNM, while 63.40% (343/541) did not. Tumor location, bilaterality, multifocality, echogenicity, margin, shape, vascularity, capsule contact, extrathyroidal extension, aspect ratio, and shear wave elasticity parameters were comparable between the groups (all P > 0.05). Univariate analysis showed statistically significant differences between the two groups in age, sex, tumor size, calcification, capsule invasion, and strain rates ratio in strain ultrasound elastography (all P < 0.05). In multivariate logistic regression analysis, the independent predictors of occult CCLNM were age (OR = 0.975, 95% CI = 0.959-0.991, P = 0.002), sex (OR = 1.886, 95% CI = 1.220-2.915, P = 0.004), tumor size (OR = 1.054, 95% CI = 1.014-1.097, P = 0.008), and strain rates ratio (OR = 1.178, 95% CI = 1.065-1.304, P = 0.002). Conclusion Preoperative strain ultrasound elastography can predict presence of occult CCLNM in papillary thyroid cancer patients and help clinicians select the appropriate treatment strategy.
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Affiliation(s)
- Long Liu
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Rong Wu,
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Liu Z, Li C. Correlation of lymph node metastasis with contrast-enhanced ultrasound features, microvessel density and microvessel area in patients with papillary thyroid carcinoma. Clin Hemorheol Microcirc 2022; 82:361-370. [PMID: 36213988 DOI: 10.3233/ch-221545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aims to investigate the relationship of cervical lymph node metastasis (LNM) with contrast-enhanced ultrasound (CEUS) features, microvessel density (MVD) and microvessel area (MVA) in patients with papillary thyroid carcinoma (PTC), and to evaluate the diagnostic value of CEUS for PTC. METHODS A total of 108 patients diagnosed with PTC at the First Affiliated Hospital of Jinzhou Medical University from January 2016 to December 2018 were selected and underwent preoperative CEUS of the thyroid, surgical resection and postoperative histopathological examination of their resected lesion. They were divided into a lymphatic metastasis-positive group (LNM+, n = 61) and a lymphatic metastasis-negative group (LNM-, n = 47) based on their lymph node status. The CEUS quantitative parameters, MVD and MVA, were compared between the two groups, and risk factors for LNM were analyzed by univariate and multivariate logistic regression. RESULTS Compared with patients with in the LNM-group, the tumor diameter and the proportion of capsule contact of patients in the LNM+group were significantly greater and the patients in this group were younger. The rise time (RT), peak intensity (PI), area under the curve (AUC), MVD, and MVA were also significantly higher in the LNM+group than in the LMN-group, while there was no significant difference in time to peak (TP), mean transit time (mTT), velocity of intensity increase (IIV), and velocity of intensity decrease (IDV) between the two groups. Univariate and multivariate correlation analysis indicated that tumor size, RT, PI, AUC, MVD, and MVA were risk factors for LNM, and ROC curves further suggested that RT had the best overall predictive performance. CONCLUSION Tumor size, RT, PI, AUC, MVD and MVA are risk factors for LNM in PTC. In other words, CEUS is an important non-invasive and preoperative tool for evaluating PTC, with MVD and MVA identified as vital postoperative diagnostic indicators.
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Affiliation(s)
- Zhining Liu
- Department of Ultrasound, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Chen Li
- Molecular Testing Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou City, Liaoning Province, China
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Xie F, Yan L, Li YM, Lan Y, Xiao J, Zhang MB, Jin Z, Zhang Y, Tian XQ, Zhu YQ, Li ZP, Luo YK. Targeting Diagnosis of High-Risk Papillary Thyroid Carcinoma Using Ultrasound Contrast Agent With the BRAF V600E Mutation: An Experimental Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2789-2802. [PMID: 35229905 DOI: 10.1002/jum.15967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE High-risk papillary thyroid carcinoma (PTC) patients with BRAF mutation have lymph node and distant metastases and poor prognosis. Therefore, this study aims to develop a targeted ultrasound contrast agent for the BRAFV600E mutation to screen high-risk PTC at early stage. METHODS The targeted lipid nanobubbles carrying BRAFV600E antibody were prepared using thin film hydration-sonication and avidin-biotin binding methods. The physicochemical properties and stability of the targeted nanobubbles were detected by transmission electron microscopy, atomic force microscopy, and confocal laser scanning microscopy. The target binding abilities of the targeted nanobubbles in the PTC cells (B-CPAP) overexpressed mutant BRAFV600E were evaluated by immunofluorescence staining, quantitative real-time polymerase chain reaction, western blot, and fluorescence microscopy. After PTC tumor models overexpressed mutant BRAFV600E were established, the enhanced images of targeted lipid nanobubbles and untargeted lipid nanobubbles on PTC tumors in nude mice were observed using contrast-enhanced ultrasound imaging. RESULTS The targeted lipid nanobubbles revealed uniform, round morphology, and good stability with a nanoscale size. Besides, BRAFV600E monoclonal antibody was observed to be combined on the surface of lipid nanobubbles. Furthermore, the targeted nanobubbles had a good targeting diagnosis ability in PTC cells with BRAFV600E overexpression. Moreover, the targeted nanobubbles had better ultrasound enhancement and peak intensity of the time-intensity curve (P < .001) in PTC tumors with BRAFV600E overexpression as compared to the untargeted lipid nanobubbles. CONCLUSION The targeted lipid nanobubbles carrying BRAFV600E antibody could be regarded as a potential targeted ultrasound contrast agent for the diagnosis of high-risk PTC.
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Affiliation(s)
- Fang Xie
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yi-Ming Li
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yu Lan
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ming-Bo Zhang
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhuang Jin
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Xiao-Qi Tian
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ya-Qiong Zhu
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
| | - Zhi-Ping Li
- Pharmacology Research Department, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yu-Kun Luo
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Beijing, China
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Ultrasonographic features of cervical lymph node metastases from medullary thyroid cancer: a retrospective study. BMC Med Imaging 2022; 22:151. [PMID: 36038830 PMCID: PMC9422133 DOI: 10.1186/s12880-022-00882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background To investigate sonographic features of cervical lymph node metastases from medullary thyroid cancer (LNM-MTC), as compared with lymph node metastases from papillary thyroid cancer (LNM-PTC). Methods A total of 42 MTC patients with 52 metastatic LNs and 222 PTC patients with 234 metastatic LNs who were confirmed by fine needle aspiration and post-operative pathology, were enrolled in this study. The clinical characteristics and sonographic features of LNs were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were performed on the sonographic features of LNs, including short and long-axis diameter, long-axis diameter/short-axis, shape, border, hilum, echogenicity, calcifications, cystic change and vascularity pattern. The discriminating performance was assessed with the area under the receiver operating characteristic curve (AUC). Results The mean age of patients with LNM-MTC was older than that of patients with LNM-PTC (46.81 ± 13.05 vs 39.09 ± 12.05, P < 0.001). No differences were observed in gender, location, long-axis diameter/short-axis, shape, border, echogenicity, cystic change and vascularity pattern between LNM-MTC and LNM-PTC groups (P > 0.05, for all). However, long-axis and short-axis diameter, hilum and calcifications were statistically different between these two groups (P < 0.05, for all). The AUC of discriminate value between LNM-MTC and LNM-PTC was 0.808 (95% confidence interval 0.739–0.877). Conclusion Compared with LNM-PTC, LNM-MTC tended to have the sonographic characteristics of larger size, absence of hilum, and less calcifications, and awareness of these features might be helpful to in the diagnosis of LNM-MTC.
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Chen L, Chen L, Liang Z, Shao Y, Sun X, Liu J. Value of Contrast-Enhanced Ultrasound in the Preoperative Evaluation of Papillary Thyroid Carcinoma Invasiveness. Front Oncol 2022; 11:795302. [PMID: 35096595 PMCID: PMC8795613 DOI: 10.3389/fonc.2021.795302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/17/2021] [Indexed: 01/20/2023] Open
Abstract
Objective To evaluate the diagnostic performance of preoperative contrast-enhanced ultrasound (CEUS) in the detection of extracapsular extension (ECE) and cervical lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) and the added value of CEUS in the evaluation of PTC invasiveness to conventional ultrasound (US). Materials and Methods A total of 62 patients were enrolled retrospectively, including 30 patients with invasive PTCs (Group A, ECE or LNM present) and 32 patients with non-invasive PTCs (Group B). All patients underwent US and CEUS examinations before surgery. US and CEUS features of PTCs and lymph nodes were compared between groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US, CEUS, and the combination of the two in the detection of ECE and LNM of PTCs were calculated. Logistic regression was used to analyze relationships between variables. Results The PTC size was larger in group A on both US and CEUS (P = 0.001, P = 0.003). More PTCs showed hyper-enhancement in group A (P = 0.013) than in group B. More PTCs had >25% contact between PTC and the thyroid capsule and discontinued capsule on US and CEUS (all P < 0.05) in group A than in group B. More absent hilum and calcification of lymph nodes were observed in group A (both P < 0.05) than in group B on US. More centripetal perfusion and enlarged lymph nodes were observed in group A (both P < 0.05) than in group B on CEUS. CEUS alone and US combined with CEUS manifested higher diagnostic accuracy (79.0%) than US alone (72.6%) in the detection of ECE. The combination of US and CEUS manifested the highest diagnostic accuracy (95.2%) than CEUS alone (90.3%) and US alone (82.2%) in the detection of LNM. Diagnoses of ECE and LNM by the combination of US and CEUS were independent risk factors for PTC invasiveness [odds ratio (OR) = 29.49 and 97.20, respectively; both P = 0.001]. Conclusion CEUS or US combined with CEUS is recommended for the detection of PTC ECE, while the combination of US and CEUS is most recommended for LNM detection. CEUS plays an essential role in the preoperative evaluation of PTC invasiveness.
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Affiliation(s)
- Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Zhenwei Liang
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Yuhong Shao
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Xiuming Sun
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Jinghua Liu
- Department of Ultrasound, Peking University First Hospital, Beijing, China
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11
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Xue T, Liu C, Liu JJ, Hao YH, Shi YP, Zhang XX, Zhang YJ, Zhao YF, Liu LP. Analysis of the Relevance of the Ultrasonographic Features of Papillary Thyroid Carcinoma and Cervical Lymph Node Metastasis on Conventional and Contrast-Enhanced Ultrasonography. Front Oncol 2022; 11:794399. [PMID: 35004319 PMCID: PMC8733581 DOI: 10.3389/fonc.2021.794399] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/06/2021] [Indexed: 12/15/2022] Open
Abstract
Background Preoperative prediction of lymph node metastases has a major impact on prognosis and recurrence for patients with papillary thyroid carcinoma (PTC). Thyroid ultrasonography is the preferred inspection to guide the appropriate diagnostic procedure. Purpose To investigate the relationship between PTC and cervical lymph node metastasis (CLNM, including central and lateral LNM) using both conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Material and Methods Our study retrospectively analyzed 379 patients diagnosed with PTC confirmed by surgical pathology at our hospital who underwent US and CEUS examinations from October 2016 to March 2021. Individuals were divided into two groups: the lymph node metastasis group and the nonmetastasis group. The relationship between US and CEUS characteristics of PTC and CLNM was analyzed. Univariate and multivariable logistic regression methods were used to identify the high-risk factors and established a nomogram to predict CLNM in PTC. Furthermore, we explore the frequency of CLNM at each nodal level in PTC patients. Results Univariate analysis indicated that there were significant differences in gender, age, tumor size, microcalcification, contact with the adjacent capsule, multifocality, capsule integrity and enhancement patterns in CEUS between the lymph node metastasis group and the nonmetastasis group (all P<0.05). Multivariate regression analysis showed that tumor size ≥1 cm, age ≤45 years, multifocality, and contact range of the adjacent capsule >50% were independent risk factors for CLNM in PTC, which determined the nomogram. The diagnostic model had an area under the curve (AUC) of 0.756 (95% confidence interval, 0.707-0.805). And calibration plot analysis shown that clinical utility of the nomogram. In 162 PTC patients, the metastatic rates of cervical lymph nodes at levels I-VI were 1.9%, 15.4%, 35.2%, 34.6%, 15.4%, 82.1%, and the difference was statistically significant (P<0.001). Conclusion Our study indicated that the characteristics of PTC on ultrasonography and CEUS can be used to predict CLNM as a useful tool. Preoperative analysis of ultrasonographical features has important value for predicting CLNM in PTCs. The risk of CLNM is greater when tumor size ≥1 cm, age ≤45 years, multifocality, contact range of the adjacent capsule >50% are present.
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Affiliation(s)
- Tian Xue
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chang Liu
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing-Jing Liu
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan-Hong Hao
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan-Ping Shi
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiu-Xiu Zhang
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan-Jing Zhang
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yu-Fang Zhao
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Li-Ping Liu
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China
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12
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Li QL, Ma T, Wang ZJ, Huang L, Liu W, Chen M, Sang T, Ren XG, Tong J, Cao CL, Dong J, Li J. The value of contrast-enhanced ultrasound for the diagnosis of metastatic cervical lymph nodes of papillary thyroid carcinoma: A systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:60-69. [PMID: 34625988 DOI: 10.1002/jcu.23073] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
To investigate the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) for the diagnosis of cervical lymph nodes metastasis (CLNM) of papillary thyroid carcinoma (PTC), eight available datasets of seven qualified articles before March 31, 2021 were included after a comprehensive search. Meta-analysis results showed that CEUS demonstrated acceptable diagnostic performance in the diagnosis of CLNM of PTC. Furthermore, meta-regression analysis was conducted to identify the reasons for heterogeneity and the results indicated that the criteria of CEUS for the diagnosis of CLNM in PTC need to be unified.
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Affiliation(s)
- Qiao-Li Li
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Ting Ma
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Zi-Jing Wang
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Lei Huang
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Wen Liu
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Ming Chen
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Tian Sang
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Xue-Gang Ren
- Department of Medical Ultrasound, Alar Hospital of the First Division of Xinjiang Production and Construction Corps, Alar, China
| | - Jin Tong
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Chun-Li Cao
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Jian Dong
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
| | - Jun Li
- Department of Medical Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, China
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13
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Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, Park JS, Yoo RE, Baek JH, Baek SM, Cho SW, Choi YJ, Hahn SY, Jung SL, Kim JH, Kim SK, Kim SJ, Lee CY, Lee HK, Lee JH, Lee YH, Lim HK, Shin JH, Sim JS, Sung JY, Yoon JH, Choi M. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2021; 22:2094-2123. [PMID: 34719893 PMCID: PMC8628155 DOI: 10.3348/kjr.2021.0713] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital, Gimpo, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyu Lee
- Department of Radiology, Jeju National University, Jeju, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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14
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Qin H, Que Q, Lin P, Li X, Wang XR, He Y, Chen JQ, Yang H. Magnetic resonance imaging (MRI) radiomics of papillary thyroid cancer (PTC): a comparison of predictive performance of multiple classifiers modeling to identify cervical lymph node metastases before surgery. Radiol Med 2021; 126:1312-1327. [PMID: 34236572 DOI: 10.1007/s11547-021-01393-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/25/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare predictive efficiency of multiple classifiers modeling and establish a combined magnetic resonance imaging (MRI) radiomics model for identifying lymph node (LN) metastases of papillary thyroid cancer (PTC) preoperatively. MATERIALS AND METHODS A retrospective analysis based on the preoperative MRI scans of 109 PTC patients including 77 patients with LN metastases and 32 patients without metastases was conducted, and we divided enroll cases into trained group and validation group. Radiomics signatures were selected from fat-suppressed T2-weighted MRI images, and the optimal characteristics were confirmed by spearman correlation test, hypothesis testing and random forest methods, and then, eight predictive models were constructed by eight classifiers. The receiver operating characteristic (ROC) curves analysis were performed to demonstrate the effectiveness of the models. RESULTS The area under the curve (AUC) of ROC based on MRI texture diagnosed LN status by naked eye was 0.739 (sensitivity = 0.571, specificity = 0.906). Based on the 5 optimal signatures, the best AUC of MRI radiomics model by logistics regression classifier had a considerable prediction performance with AUCs 0.805 in trained group and 0.760 in validation group, respectively, and a combination of best radiomics model with visual diagnosis of MRI texture had a high AUC as 0.969 (sensitivity = 0.938, specificity = 1.000), suggesting combined model had a preferable diagnostic efficiency in evaluating LN metastases of PTC. CONCLUSION Our combined radiomics model with visual diagnosis could be a potentially effective strategy to preoperatively predict LN metastases in PTC patients before clinical intervention.
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Affiliation(s)
- Hui Qin
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Qiao Que
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Peng Lin
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Xin Li
- Department of GE Healthcare Global Research, GE Healthcare, Shanghai, 201203, People's Republic of China
| | - Xin-Rong Wang
- Department of GE Healthcare Global Research, GE Healthcare, Shanghai, 201203, People's Republic of China
| | - Yun He
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Jun-Qiang Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China.
| | - Hong Yang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China.
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15
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Wang J, Ben Z, Gao S, Lyu S, Wei X. The role of ultrasound elastography and virtual touch tissue imaging in the personalized prediction of lymph node metastasis of breast cancer. Gland Surg 2021; 10:1460-1469. [PMID: 33968697 DOI: 10.21037/gs-21-199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study examined the effects of different ultrasound imaging technologies in the identification and prediction of axillary lymph node metastasis of breast cancer. It also investigated the relationship between human papilloma virus (HPV) infection and axillary lymph node metastasis. Methods Eighty-five female patients diagnosed with breast masses participated in this study. Each patient underwent a conventional ultrasound, ultrasonic elastography, and virtual touch tissue imaging quantification (VTIQ). The differential diagnosis efficiency of a conventional ultrasound, ultrasound elastography, VTIQ, and ultrasound elastography combined with VTIQ technology was compared with a pathological diagnosis, which represents the gold standard. 85 axillary lymph node tissues and 25 normal breast tissues were used to detect HPV positive infection rate differences in different tissues. Results The results showed that metastatic lymph nodes and reactive lymph node hyperplasia accounted for 54.12% and 45.88% of the 85 axillary lymph nodes of breast cancer, respectively. The conventional ultrasound, ultrasound elastography, and VTIQ scores of metastatic lymph nodes were significantly higher than those of reactive lymph node hyperplasia (P<0.05). The diagnostic sensitivity (Se) (91.30%), specificity (Sp) (92.31%), accuracy (Ac) (91.76%), positive predictive value (PPV) (93.33%), and negative predictive value (NPV) (90.00%) of ultrasound elastography combined with VTIQ technology were the highest among the diagnostic efficiency test results of different computer ultrasound imaging technologies. The positive infection rate of HPV in metastatic lymph node tissues was significantly higher than that in reactive lymph node hyperplasia and normal breast tissues (P<0.05). Conclusions Combining ultrasound elastography with VTIQ technology has high value in the differential diagnosis of axillary lymph nodes of breast cancer. Further, it appears that HPV infection may have an etiological role in lymph node metastasis in breast cancer patients.
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Affiliation(s)
- Jue Wang
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhifei Ben
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Shanshan Gao
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Shuyi Lyu
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Xiuzhi Wei
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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16
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Luo ZY, Hong YR, Yan CX, Wang Y, Ye Q, Huang P. Utility of quantitative contrast-enhanced ultrasound for the prediction of lymph node metastasis in patients with papillary thyroid carcinoma. Clin Hemorheol Microcirc 2020; 80:37-48. [PMID: 33252064 DOI: 10.3233/ch-200909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to find the optimal parameters and cutoffs to differentiate metastatic lymph nodes (LNs) from benign LNs in the patients with papillary thyroid carcinoma (PTC) on the quantitative contrast-enhanced ultrasound (CEUS) features. METHODS A total of 134 LNs in 105 patients with PTCs were retrospectively enrolled. All LNs were evaluated by conventional ultrasound (US) and CEUS before biopsy or surgery. The diagnostic efficacy of CEUS parameters was analyzed. RESULTS Univariate analysis indicated that metastatic LNs more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, ring-enhancing margins, higher PI, larger AUC, longer TTP and DT/2 than benign LNs at pre-operative CEUS (p < 0.001, for all). Multivariate analysis showed that centripetal or asynchronous perfusion (OR = 3.163; 95% CI, 1.721-5.812), hyper-enhancement(OR = 0.371; 95% CI, 0.150-0.917), DT/2 (OR = 7.408; 95% confidence interval CI, 1.496-36.673), and AUC (OR = 8.340; 95% CI, 2.677-25.984) were predictive for the presence of metastatic LNs. The sensitivity and accuracy of the quantitative CEUS were higher than qualitative CEUS (75% vs 55 % and 83.6% vs 76.1 % , respectively). CONCLUSIONS Quantitative CEUS parameters can provide more information to distinguish metastatic from benign LNs in PTC patients; In particular, DT/2 and AUC have a higher sensitivity and accuracy in predicting the presence of metastatic LNs and reduce unnecessary sampling of benign LNs.
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Affiliation(s)
- Zhi-Yan Luo
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yu-Rong Hong
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Cao-Xin Yan
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yong Wang
- Department of Surgery, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Qin Ye
- Department of Pathology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou City, Zhejiang Province, China
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Ding Z, Deng C, Wang Z, Liu L, Ma X, Huang J, Wang X, Xuan M, Xie H. Comparison of contrast-enhanced ultrasound and contrast-enhanced computed tomography for the diagnosis of cervical lymph node metastasis in squamous cell carcinoma of the oral cavity. Int J Oral Maxillofac Surg 2020; 50:294-301. [PMID: 32739248 DOI: 10.1016/j.ijom.2020.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/29/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023]
Abstract
Early detection of cervical lymph node metastasis (CLNM) from squamous cell carcinoma (SCC) of the oral cavity remains challenging. This prospective study was performed to evaluate the ability of contrast-enhanced ultrasound (CEUS) to detect CLNM from oral cavity SCC. Additionally, its diagnostic value was compared with that of contrast-enhanced computed tomography (CECT). Forty-eight consecutive patients with SCC of the oral cavity were enrolled. All subjects were examined preoperatively with both CEUS and CECT. Subsequently, neck dissections were performed for these patients, and cervical lymph nodes separated from the surgical specimens were assessed histologically. The diagnostic performance of these two examinations was compared based on the results of histopathology. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index for CEUS and CECT were 69.39% vs. 44.90%, 94.71% vs. 97.12%, 89.88%% vs. 87.16%, 75.56% vs. 78.57%, 92.92% vs. 88.21%, and 64.10% vs. 42.02%, respectively. A significant difference was observed in terms of sensitivity (P=0.024) and Youden index (rate difference 22.08%, 95% confidence interval 2.72-41.44%). Therefore, CEUS appears to be a promising diagnostic tool that is superior to CECT for detecting CLNM from SCC of the oral cavity, with a higher sensitivity.
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Affiliation(s)
- Z Ding
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - C Deng
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Z Wang
- Department of Ultrasound, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - L Liu
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - X Ma
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - J Huang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - M Xuan
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - H Xie
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Chen L, Chen L, Liu J, Wang B, Zhang H. Value of Qualitative and Quantitative Contrast-Enhanced Ultrasound Analysis in Preoperative Diagnosis of Cervical Lymph Node Metastasis From Papillary Thyroid Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:73-81. [PMID: 31222782 DOI: 10.1002/jum.15074] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/13/2019] [Accepted: 06/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the qualitative and quantitative characteristics of contrast-enhanced ultrasound (CEUS) in assessing cervical lymph node metastasis from papillary thyroid carcinoma (PTC) and to evaluate its value in the preoperative diagnosis of cervical lymph node metastasis from PTC. METHODS A total of 55 lymph nodes in 46 patients were enrolled retrospectively, including 29 metastases from PTC and 26 normal/reactive ones. All lymph nodes were evaluated by conventional ultrasound (US) and CEUS before biopsy or surgery. A receiver operating characteristic curve analysis was used to analyze the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US and CEUS features in the diagnosis of lymph node metastasis as well as the overall diagnostic performance of US, CEUS, and a combination of the two. RESULTS Significant differences were found in the enhancement direction, enhancement type, and enhancement range between metastatic and normal/reactive lymph nodes on CEUS (P < .05). Quantitative CEUS parameters were not statistically significant (P > .05). The combination of US and CEUS had the highest diagnostic accuracy (92.7%) compared with US (80.8%) and CEUS (89.1%) alone in the diagnosis of lymph node metastasis from PTC. CONCLUSIONS The characteristics of cervical lymph node metastasis from PTC on CEUS include centripetal perfusion, peripheral or mixed enhancement, and an enlarged range on CEUS compared with US, and the first feature was the most meaningful. The combination of CEUS and US is a promising imaging tool for the preoperative diagnosis of cervical metastatic lymph nodes in patients with PTC.
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Affiliation(s)
- Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Jinghua Liu
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Bin Wang
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Hui Zhang
- Department of Ultrasound, Peking University First Hospital, Beijing, China
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Kaliszewski K, Diakowska D, Wojtczak B, Forkasiewicz Z, Pupka D, Nowak Ł, Rudnicki J. Which papillary thyroid microcarcinoma should be treated as "true cancer" and which as "precancer"? World J Surg Oncol 2019; 17:91. [PMID: 31146753 PMCID: PMC6543635 DOI: 10.1186/s12957-019-1638-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 05/24/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Papillary thyroid microcarcinoma (PTMC) generally is a cancer with excellent prognosis, but the term "cancer" sounds severe and harsh, which can elicit emotional and physical responses from patients. To eliminate the word "cancer," the term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced. However, not all PTMCs can be classified as NIFTP. Sometimes, very aggressive PTMC cases might be observed. Some authors suggest that one of the risk factors for poor prognosis is lymph node metastasis. The aim of the study was to evaluate some clinicopathological features of PTMC as the risk factors for lymph node metastasis. MATERIAL AND METHODS We performed a retrospective chart review and selected 177 patients with PTMC. To analyze the cases with potentially aggressive behavior, we enrolled PTMC patients with lymph node metastases (pN1, central, and/or lateral) and evaluated some of their clinicopathological features. RESULTS The logistic regression analysis results demonstrated significantly higher rates of multifocal or bilateral tumor occurrence in the PTMC patients with pN1 than in the patients with pN0 (P < 0.0001 for both). In addition, the occurrence of thyroid tumors with sizes above 0.5 cm was a significant risk factor for lymph node metastasis (P < 0.0001). The results of the ROC analyses showed that the presence of multifocal or bilateral tumors and tumor sizes above 0.5 cm were significant predictors of lymph node metastasis (P < 0.0001 for all). CONCLUSIONS Multifocal and bilateral PTMC tumors with diameters above 0.5 cm should be treated aggressively as "true cancer" and might benefit from lymph node dissection. Unifocal PTMC tumors with diameters equal to or below 0.5 cm may be treated less aggressively.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland.
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland
| | | | - Dominika Pupka
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland
| | - Łukasz Nowak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556, Wroclaw, Poland
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