Value of Thyroid Lymphatic Contrast-Enhanced Ultrasound in the Differential Diagnosis of Benign and Malignant Thyroid Nodules：A Prospective Single-Center Study.

Objective To explore the value of thyroid lymphatic contrast-enhanced ultrasound （LCEUS） in the differential diagnosis of benign and malignant thyroid nodules. Methods Patients who were suspected of having thyroid cancer by ultrasound and were planned to undergo puncture biopsy or surgery from November 2020 to June 2024 were prospectively enrolled.All the patients underwent conventional ultrasound and LCEUS before surgery.The enhancement characteristics within the nodules，around the nodules，and in the adjacent thyroid capsule were observed and recorded.With the pathological results as the gold standard，the above characteristics were compared between the benign and malignant groups. Results A total of 144 （37 benign and 107 malignant） nodules in 144 patients were finally included.The inter-observer consistency of each LCEUS index was excellent （Kappa value：0.84-0.93）.Compared with benign nodules，malignant nodules were more likely to show non-enhancement （88.79% vs. 18.92%，P<0.001），an enlarged lesion area after contrast injection （60.75% vs. 18.92%，P<0.001），and irregular ring-shaped enhancement （49.53% vs. 10.81%，P<0.001）.The sensitivity，specificity，and accuracy of LCEUS in diagnosing malignant nodules were 97.20%，75.68%，and 91.67% respectively.The area under the receiver operating characteristic curve was 0.864，higher than that （0.761） of conventional ultrasound （P<0.001）. Conclusions By revealing the lymphatic perfusion characteristics inside and around the nodules，LCEUS shows excellent efficacy in the differential diagnosis of benign and malignant thyroid nodules.LCEUS exhibits significantly better specificity and overall diagnostic ability than conventional ultrasound，demonstrating important clinical application value.