Shear wave elastography (SWE) may provide additional value for the prediction of cervical lymph node metastasis (LNM) in patients with medullary thyroid carcinoma (MTC), according to a study published in the European Journal of Radiology.

The authors found that a maximum stiffness value (Emax) greater than 66 kPa recorded using SWE was significantly associated with lateral cervical LNM (P =.011) in a multivariate analysis. Other significantly associated factors were preoperative calcitonin levels > 60 pg/ml (P =.04), ages ≤ 35 years (P =.049), and irregular tumor shapes on ultrasounds (P =.036).

“SWE may serve as a non-invasive method of preoperative lateral cervical LNM risk assessment for MTC,” the authors said.

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In a univariate analysis, several factors demonstrated significant associations with lateral cervical LNM including male sex (P =.015), an invasive size larger than 1.0 cm (P =.028), an age ≤ 35 years (P =.049), the presence of pathological extrathyroidal extension (P =.005), preoperative calcitonin levels > 60 pg/ml (P < 0.001), an irregular tumor shape (P =.001), and the presence of a noncircumscribed margin (P =.009) on ultrasound.

Several elasticity parameters recorded by SWE were also found to be significant on the univariate analysis including Emax (P <.001), the mean stiffness value (Emean; P <.001), and the ratio of Emean values between the mass and the parenchyma (ER; P =.002).

The multivariate analysis, which included all of the significant univariate factors, revealed that only ages ≤ 35 years, preoperative calcitonin levels > 60 pg/ml, Emax, and irregular shapes maintained their significances, as previously mentioned.

A total of 76 patients (45 women and 31 men) met the inclusion criteria for the retrospective study and were included in the analyses. The mean age of the patients was 48.1 ± 11.8 years and the average mass sizes were 2.0 ± 1.4 cm. 

SWE has been used in the past for differentiating between benign and malignant tumors based on their hardness and has been shown to be a predictor for the cervical nodal status of papillary thyroid carcinoma in previous studies, the authors concluded.


Wen X, Li B, Yu X, Huang Y, Cheng W, Su Z. Does shear wave elastography for medullary thyroid carcinoma predict lateral cervical lymph node metastasis? Eur J Radiol. 2021;146. doi:10.1016/j.ejrad.2021.110079