Diagnostic value of preoperative advanced doppler imaging with cervical maneuvers in the detection of central cervical lymph node metastasis in papillary thyroid carcinoma.

Objective: This study assesses the diagnostic value of preoperative greyscale and Doppler imaging and their combinative use with simultaneous advanced Doppler imaging and cervical maneuvers in detecting central cervical lymph node metastasis in papillary thyroid carcinoma patients.

Methods: In this cross-sectional survey, we included candidates for total or partial thyroidectomy with concomitant cervical lymph node dissection who referred to the TIRAD imaging center from February 2022 to September 2023 with papillary thyroid carcinoma diagnosis. Patients underwent preoperative ultrasonographic examination using the Aixplorer device (Supersonic Imagine, France) with a linear array transducer of 7.5-16 MHz to identify potential metastasis within the cervical lymph nodes. Ultrasonic assessments are presented using the totaling attributes such as sensitivity, specificity, positive and negative predictive values, and likelihood ratios.

Results: The post-operation pathology results showed metastasis in 85 (42.5%) patients. Standard imaging protocol without cervical approaches and advanced Doppler imaging capability detected metastatic involvement in 34 (17.0%) subjects. Meanwhile, the modified approach utilizing advanced Doppler imaging capability and cervical maneuvers identified metastatic involvement in 84 (42.0%) cases. The preoperative sensitivity without advanced Doppler imaging and maneuvers was 35.3%, specificity - 96.5%, positive predictive value - 88.2%, and negative predictive value - 66.9%. The introduction of advanced Doppler imaging and maneuvers yielded a sensitivity of 97.6%, specificity - of 99.1%, positive predictive value - 98.8%, and negative predictive value - 98.3%.

Conclusion: Advanced Doppler imaging can improve the visualization of the cervical areas, due to its ultrafast and ultrasensitive perception qualities, facilitating the early recognition of vascular pattern changes.