The diagnostic value of transfistular contrast-enhanced ultrasound in branchial cleft fistulas.

Abstract

Aims: This study aimed to assess the diagnostic value of transfistular contrast-enhanced ultrasound (CEUS) for branchial cleft fistulas (BCF), using surgical findings as the reference standard.

Materials and methods: Fifty - six patients were initially suspected of having BCF. Among them, 35 patients who underwent two-dimensional ultrasound (2D-US), transfistular CEUS, and prior to surgery were retrospectively enrolled. The diagnostic accuracy of transfistular CEUS and 2D-US for BCF detection was compared. The agreement between CEUS and surgical findings in internal orifice localization and BCF classification was assessed.

Results: Among the enrolled 35 patients, 29 were surgically confirmed as BCF. Postoperative surgical findings served as the reference standard for all analyses. Transfistular CEUS demonstrated superior diagnostic accuracy compared to 2D-US for BCF detection (91.4% vs. 82.9%). Excellent agreement was observed between CEUS and surgical findings in internal orifice localization (κ=0.814, p<0.001). For BCF classification, the accuracy, sensitivity, and specificity of transfistular CEUS were as follows: type I BCF (93.1%, 93.8%, 92.3%), type II BCF (89.7%, 71.4%, 91.3%), and pyriform fossa fistulas (96.6%, 100.0%, and 95.7%), respectively.  Conclusions: As a radiation-free, cost-effective, and non-invasive technique, transfistular CEUS can accurately diagnose BCF, precisely localize its internal orifice, and effectively differentiate its subtypes. For patients clinically suspected of BCF, transfistular CEUS is a reliable preoperative tool for individualized clinical guidance.