Capsular extension at ultrasound is associated with lateral lymph node metastasis in patients with papillary thyroid carcinoma: a retrospective study.

BACKGROUND: In patients with papillary thyroid cancer (PTC), cervical lymph node metastasis (LNM) must be carefully assessed to determine the extent of lymph node dissection required and patient prognosis. Few studies attempted to determine whether the ultrasound (US) appearance of the primary thyroid tumor could be used to predict cervical lymph node involvement. This study aimed to identify the US features of the tumor that could predict cervical LNM in patients with PTC. METHODS: This was a retrospective study of patients with pathologically confirmed PTC. We evaluated the following US characteristics: lobe, isthmus, and tumor size; tumor position; parenchymal echogenicity; the number of lesions (i.e., tumor multifocality); parenchymal and lesional vascularity; tumor margins and shape; calcifications; capsular extension; tumor consistency; and the lymph nodes along the carotid vessels. The patients were grouped as no LNM (NLNM), central LNM (CLNM) alone, and lateral LNM (LLNM) with/without CLNM, according to the postoperative pathological examination. RESULTS: Totally, 247 patients, there were 67 men and 180 women. Tumor size of > 10 mm was significantly more common in the CLNM (70.2%) and LLNM groups (89.6%) than in the NLNM group (45.4%). At US, capsular extension > 50% was most common in the LLNM group (35.4%). The multivariable analysis revealed that age (OR = 0.203, 95%CI: 0.095-0.431, P < 0.001) and tumor size (OR = 2.657, 95%CI: 1.144-6.168, P = 0.023) were independently associated with CLNM compared with NLNM. In addition, age (OR = 0.277, 95%CI: 0.127-0.603, P = 0.001), tumor size (OR = 6.069, 95%CI: 2.075-17.75, P = 0.001), and capsular extension (OR = 2.09, 95%CI: 1.326-3.294, P = 0.001) were independently associated with LLNM compared with NLNM. CONCLUSION: Percentage of capsular extension at ultrasound is associated with LLNM. US-guided puncture cytology and eluent thyroglobulin examination could be performed as appropriate to minimize the missed diagnosis of LNM.

Value of ultrasound elastography combined with contrast-enhanced ultrasound and micro-flow imaging in differential diagnosis of benign and malignant breast lesions.

OBJECTIVE: Breast cancer is one of the most common malignant tumors in women and shows a rising incidence at younger ages. Therefore, early diagnosis is of great significance for treatment and prognosis. This study aimed to compare the value of ultrasound elastography (UE) combined with contrast-enhanced ultrasound (CEUS) and micro-flow imaging (MFI) in differential diagnosis of benign and malignant lesions of the breast. METHODS: The sonographic characteristics of UE and CEUS as well as the vascular characteristics of MFI of 109 breast lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) category 4, confirmed by surgical or biopsy pathology were retrospectively analyzed. Receiver operating characteristic (ROC) curves were used to compare the diagnostic efficacy of the three examination modalities, either alone or in combination. RESULTS: Of the 109 breast lesions, 78 lesions were pathologically diagnosed as malignant and 31 as benign. At diagnosis, the area under the ROC curve (AUC), sensitivity, specificity, and accuracy of UE were 0.8495, 65.38%, 83.87% and 83.34%, respectively. The AUC, sensitivity, specificity and accuracy of MFI were 86.29%, 70.51%, 87.10% and 85.56%, respectively. The AUC, sensitivity, specificity and accuracy of CEUS were 90.84%, 88.46%, 74.19% and 89.16%, respectively. The AUC, sensitivity, specificity and accuracy of the combined diagnosis of UE, MFI, and CEUS were 93.90%, 85.90%, 90.32%, and 92.07%, respectively. CONCLUSIONS: The combination of UE, CEUS and MFI has the highest specificity and accuracy in the differential diagnosis of benign and malignant breast lesions compared to any one used singly.