Diagnostic performance of conventional and contrast-enhanced ultrasound for extrathyroidal extension in papillary thyroid carcinoma

Abstract

Objective: To evaluate and compare the diagnostic performance of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) for extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC). Methodology: This study retrospectively analyzed imaging data from 150 patients (187 cancerous nodules) with pathologically confirmed PTC who underwent preoperative conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations at Lishui Municipal Central Hospital from January 2019 to April 2025. The imaging features of the nodules and CEUS perfusion parameters were analyzed. With pathological diagnosis as the gold standard, receiver operating characteristic (ROC) curves were used to compare the diagnostic value and efficacy (including diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value) of the two examination modalities for ETE. Results: Postoperative pathological confirmation detected ETE in 82 cancerous nodules from 67 patients, accounting for 43.9% (82/187). Multivariable logistic regression showed that an aspect ratio >1, microcalcification, RT, TTP, WIS, TPH, and AUC were independently associated with ETE. The AUC of CEUS for predicting ETE in PTC was 0.901, significantly higher than that of US (0.814; P<0.05). The accuracy (90.4%) and positive predictive value (90.0%) of CEUS were notably higher than those of US (81.8% and 80.0%, respectively) (P<0.05). Conclusion: CEUS showed higher overall discriminatory performance and diagnostic accuracy than conventional US for identifying ETE in PTC in this retrospective cohort.