A pilot study assessing the feasibility of contrast-enhanced ultrasound for triaging fine-needle aspiration in lateral cervical lymph nodes of papillary thyroid carcinoma

Dai Pan; Yuanbing Xu; Yichao Tao; Fen Huang; Cuiling Li

doi:10.1186/s12885-026-16243-4

A pilot study assessing the feasibility of contrast-enhanced ultrasound for triaging fine-needle aspiration in lateral cervical lymph nodes of papillary thyroid carcinoma

BMC Cancer. 2026 May 28. doi: 10.1186/s12885-026-16243-4. Online ahead of print.

Authors

Dai Pan^#^{1

2}, Yuanbing Xu^#³, Yichao Tao², Fen Huang¹, Cuiling Li^{4

5}

Affiliations

¹ Department of Medical Ultrasonics, Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, Guangxi, Nanning, China.
² Department of Ultrasound, Xiaogan hospital affiliated to Wuhan University of Science and Technology, Hubei, Xiaogan, China.
³ Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Guangxi, Nanning, China.
⁴ Department of Medical Ultrasonics, Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, Guangxi, Nanning, China. lcling@mail.sysu.edu.cn.
⁵ Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangdong, Guangzhou, China. lcling@mail.sysu.edu.cn.

^# Contributed equally.

PMID: 42204674
DOI: 10.1186/s12885-026-16243-4

Abstract

Background: To explore the role of contrast-enhanced ultrasound (CEUS) in preoperative ultrasound-guided fine-needle aspiration (US-FNA) of lateral cervical lymph nodes (LCLN) in patients with papillary thyroid carcinoma (PTC).

Methods: A total of 112 patients with 164 suspicious LCLN were enrolled into two cohorts based on whether they received CEUS examination before US-FNA. In the conventional cohort, 64 nodules from 42 patients underwent direct US-FNA, while in the CEUS-triage cohort, 100 nodules from 70 patients performed CEUS examination first. Among these, 28 homogeneously-centrifugal enhanced nodules were exempt from FNA, and 72 nodules proceeded to US-FNA. The effectiveness of FNA and the cumulative recurrence rate (CRR) during the follow-up period were compared between the two cohorts. The CEUS characteristics of metastatic LCLN were also summarized.

Results: There was a significant difference in the rate of US-FNA performed between the CEUS-triage cohort and the conventional cohort (72.0% vs. 100.0%, p < 0.001). The CEUS-triage cohort had a lower uncertainty rate of FNA (6.9% vs. 18.8%, p = 0.04). All patients were followed up for an average of 38.4 months. There was no significant difference in the CRR between the two groups in the entire cohort and the surgical population (all p > 0.05). CEUS of metastatic LCLN in PTC showed centripetal enhancement, hypo-enhancement, heterogeneous enhancement, and perfusion defects (all p < 0.001).

Conclusions: CEUS may have the potential to serve as a valuable triage tool for US-FNA of suspicious LCLN in PTC patients, potentially reducing unnecessary puncture rates and increasing the overall diagnostic yield of biopsies. Features such as centripetal enhancement, hypo-enhancement, heterogeneous enhancement, and perfusion defects observed on CEUS were more frequently linked to metastatic lymph nodes.

Keywords: Contrast-enhanced ultrasound (CEUS); Lateral cervical lymph node (LCLN); Metastasis; Papillary thyroid carcinoma (PTC); Ultrasound-guided fine-needle aspiration (US-FNA).