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Does shear wave elastography for medullary thyroid carcinoma predict lateral cervical lymph node metastasis?

Xin Wen¹, Bo Li², Xiwen Yu³

¹Department of Ultrasound, the Fifth Affiliated Hospital of Sun Yat-Sen University, 52 Meihuadong Rd, Xiangzhou District, Zhuhai 519000, Guangdong Province, China; Department of Ultrasound, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, Harbin 150081, Heilongjiang Province, China.

European Journal of Radiology

|December 5, 2021

Summary

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Shear wave elastography (SWE) can predict lateral cervical lymph node metastasis in medullary thyroid carcinoma (MTC). The Emax value from SWE is an independent predictor, offering a noninvasive risk assessment tool for MTC patients.

Area of Science:

Oncology
Medical Imaging
Diagnostic Techniques

Background:

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor of the thyroid gland.
Lateral cervical lymph node metastasis (LNM) is a common occurrence in MTC and impacts prognosis.
Accurate preoperative assessment of LNM is crucial for treatment planning and patient management.

Purpose of the Study:

To evaluate the capability of shear wave elastography (SWE) in predicting lateral cervical lymph node metastasis (LNM) in patients with medullary thyroid carcinoma (MTC).
To determine if SWE parameters can serve as independent predictors of LNM in MTC.
To explore the utility of SWE as a noninvasive tool for preoperative risk stratification of MTC.

Main Methods:

Retrospective study of 76 MTC patients who underwent preoperative SWE and ultrasound (US) examinations.

Keywords:

Lateral cervical lymph node Medullary thyroid carcinoma Metastasis Shear wave elastography

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Analysis of clinicopathological and imaging characteristics in relation to lymphatic status.

Multivariable logistic regression to assess associations between lateral cervical LNM and SWE parameters, clinical factors, and US features.

Main Results:

Several factors were significantly associated with lateral cervical LNM, including male sex, younger age (≤35 years), larger tumor size (>1.0 cm), extrathyroidal extension (ETE), elevated calcitonin levels (>60 pg/ml), irregular US shape, non-circumscribed US margin, and specific SWE parameters (Emax >66 kPa, Emean >37.5 kPa, ER >1.65).
Multivariable analysis confirmed that younger age (≤35 years), high preoperative calcitonin levels (>60 pg/ml), irregular US shape, and Emax >66 kPa were independent predictors of lateral cervical LNM.
The SWE parameter Emax demonstrated a significant association with LNM.

Conclusions:

Emax, derived from shear wave elastography, is an independent predictor of lateral cervical lymph node metastasis in medullary thyroid carcinoma.
SWE offers a promising noninvasive method for preoperative assessment and risk stratification of lateral cervical LNM in MTC patients.
Integration of SWE into preoperative evaluations may improve the management of MTC by identifying patients at higher risk for LNM.