This prospective single-center study evaluated the value of lymphatic contrast-enhanced ultrasound (LCEUS) in distinguishing benign from malignant thyroid nodules. Patients identified by routine ultrasound as having nodules suspicious for thyroid cancer and scheduled for biopsy or surgery were enrolled between November 2020 and June 2024. Pathological diagnosis was used as the reference standard.
Consecutive patients who met the inclusion criteria—suspicion for thyroid cancer on ultrasound and planned puncture biopsy or surgical resection—underwent both conventional ultrasound and LCEUS prior to their procedure. Enhancement characteristics were systematically observed and recorded in three locations: within the nodule, around the nodule, and at the adjacent thyroid capsule. The pathological result after biopsy or surgery served as the diagnostic gold standard for classification as benign or malignant.
The study finally included 144 patients with 144 nodules. By pathology, 107 nodules were malignant and 37 were benign. The abstract reports that inter-observer agreement for each recorded LCEUS index was excellent, demonstrating reproducibility of the imaging features used for analysis.
Observers assessed multiple enhancement parameters on LCEUS. Inter-observer consistency was quantified with Kappa values ranging from 0.84 to 0.93, a level the authors describe as excellent. This supports that the recorded LCEUS features can be reliably identified by different operators or reviewers.
Key LCEUS features compared between benign and malignant nodules included:
Significant differences in LCEUS patterns were observed between malignant and benign nodules. Malignant nodules markedly more often showed non-enhancement on LCEUS (88.79% of malignant nodules vs 18.92% of benign nodules; P < 0.001). Malignant lesions also more frequently exhibited an enlarged lesion area after contrast injection (60.75% vs 18.92%; P < 0.001) and irregular ring-shaped peripheral enhancement (49.53% vs 10.81%; P < 0.001).
The study compared overall diagnostic performance of LCEUS against conventional ultrasound. The reported area under the receiver operating characteristic curve (AUC) for LCEUS was 0.864, which the authors state is significantly higher than the AUC for conventional ultrasound (0.761; P < 0.001). This indicates improved discrimination between benign and malignant nodules when LCEUS is used.
Using pathological diagnosis as the gold standard, the diagnostic metrics reported for LCEUS in identifying malignant thyroid nodules were:
These values indicate that LCEUS detected a high proportion of malignant nodules (high sensitivity) and improved overall diagnostic ability relative to conventional ultrasound, with a moderate increase in specificity.
According to the authors, LCEUS reveals lymphatic perfusion characteristics inside and around thyroid nodules. Patterns observed—particularly non-enhancement within malignant nodules, post-contrast lesion expansion, and irregular peripheral enhancement—are interpreted as reflecting differences in lymphatic perfusion between malignant and benign lesions.
Because LCEUS achieved higher AUC and greater specificity than conventional ultrasound in this cohort, the technique is presented as having important clinical application value for preoperative differentiation of thyroid nodules. Improved specificity can potentially reduce unnecessary biopsies or surgeries in lesions that are ultimately benign, while high sensitivity supports identification of malignancy.
The abstract provides core findings but omits several operational details. The specific contrast agent, dosage and injection protocol, imaging equipment and settings, operator experience or training requirements, and any adverse event reporting are not detailed in the available abstract. Those details would be necessary to evaluate generalizability and to implement LCEUS in routine practice.
Additionally, as a single-center study, the results reflect the population and practice patterns at that center; external validation in other centers and larger populations would be required to confirm performance metrics.
This prospective single-center study of 144 thyroid nodules found that LCEUS demonstrates excellent inter-observer consistency and strong diagnostic performance for differentiating benign from malignant nodules. Malignant nodules more commonly showed non-enhancement, post-contrast lesion enlargement, and irregular ring-shaped peripheral enhancement. Reported sensitivity was 97.20%, specificity 75.68%, and accuracy 91.67%, with an AUC of 0.864—significantly better than conventional ultrasound (AUC 0.761; P < 0.001). The authors conclude that LCEUS, by revealing lymphatic perfusion features, offers improved specificity and overall diagnostic ability compared with conventional ultrasound and has important clinical application value. The abstract does not report technical protocol details or safety/adverse event data.