title: 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.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
authors.forename: Jun-Mei
authors.initials: JM
authors.lastname: Xu
authors.affiliation: Department of Ultrasound, Guangdong Medical College Affiliated Hospital, 524001, Zhanjiang, China.
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Xu
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China. xuhuixiong@hotmail.com.|Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China. xuhuixiong@hotmail.com.|Department of Ultrasound, Guangdong Medical College Affiliated Hospital, 524001, Zhanjiang, China. xuhuixiong@hotmail.com.|Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301, Yanchangzhong Road, Shanghai, 200072, China. xuhuixiong@hotmail.com.
authors.forename: Hui-Xiong
authors.initials: HX
authors.lastname: Xu
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
authors.forename: Le-Hang
authors.initials: LH
authors.lastname: Guo
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
authors.forename: Lin-Na
authors.initials: LN
authors.lastname: Liu
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
authors.forename: Xiao-Wan
authors.initials: XW
authors.lastname: Bo
authors.affiliation: Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
authors.forename: Shen
authors.initials: S
authors.lastname: Qu
authors.affiliation: Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Department of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
authors.forename: Mingzhao
authors.initials: M
authors.lastname: Xing
authors.affiliation: Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.|Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
authors.forename: Xiao-Long
authors.initials: XL
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D002291:Carcinoma, Papillary; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D015203:Reproducibility of Results; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography; D055815:Young Adult
keywords: Acoustic radiation force impulse; Conventional ultrasound; Thyroid cancer; Thyroid nodule; Virtual touch tissue imaging