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Song B, Zheng T, Wang H, Tang L, Xie X, Fu Q, Liu W, Wu PY, Zeng M. Prediction of Follicular Thyroid Neoplasm and Malignancy of Follicular Thyroid Neoplasm Using Multiparametric MRI. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01102-0. [PMID: 38839672 DOI: 10.1007/s10278-024-01102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 06/07/2024]
Abstract
The study aims to evaluate multiparametric magnetic resonance imaging (MRI) for differentiating Follicular thyroid neoplasm (FTN) from non-FTN and malignant FTN (MFTN) from benign FTN (BFTN). We retrospectively analyzed 702 postoperatively confirmed thyroid nodules, and divided them into training (n = 482) and validation (n = 220) cohorts. The 133 FTNs were further split into BFTN (n = 116) and MFTN (n = 17) groups. Employing univariate and multivariate logistic regression, we identified independent predictors of FTN and MFTN, and subsequently develop a nomogram for FTN and a risk score system (RSS) for MFTN prediction. We assessed performance of nomogram through its discrimination, calibration, and clinical utility. The diagnostic performance of the RSS for MFTN was further compared with the performance of the Thyroid Imaging Reporting and Data System (TIRADS). The nomogram, integrating independent predictors, demonstrated robust discrimination and calibration in differentiating FTN from non-FTN in both training cohort (AUC = 0.947, Hosmer-Lemeshow P = 0.698) and validation cohort (AUC = 0.927, Hosmer-Lemeshow P = 0.088). Key risk factors for differentiating MFTN from BFTN included tumor size, restricted diffusion, and cystic degeneration. The AUC of the RSS for MFTN prediction was 0.902 (95% CI 0.798-0.971), outperforming five TIRADS with a sensitivity of 73.3%, specificity of 95.1%, accuracy of 92.4%, and positive and negative predictive values of 68.8% and 96.1%, respectively, at the optimal cutoff. MRI-based models demonstrate excellent diagnostic performance for preoperative predicting of FTN and MFTN, potentially guiding clinicians in optimizing therapeutic decision-making.
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Affiliation(s)
- Bin Song
- Department of Radiology, Zhongshan Hospital, Shanghai Medical Imaging Institute, Fudan University, No180, Fenglin Road, Xuhui District, 200032, Shanghai, China
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Tingting Zheng
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Lang Tang
- Department of Ultrasound, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Xiaoli Xie
- Department of Pathology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Qingyin Fu
- Department of Ultrasound, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Weiyan Liu
- Department of General Surgery, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Pu-Yeh Wu
- GE Healthcare, MR Research China, Beijing, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Shanghai Medical Imaging Institute, Fudan University, No180, Fenglin Road, Xuhui District, 200032, Shanghai, China.
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Lin Y, Cheng Y, Zhang Y, Ren X, Li J, Shi H, Li Y, Luo Y, Wang H. The value of Korean, American, and Chinese ultrasound risk stratification systems combined with BRAF(V600E) mutation for detecting papillary thyroid carcinoma in cytologically indeterminate thyroid nodules. Endocrine 2024; 84:549-559. [PMID: 37940765 DOI: 10.1007/s12020-023-03586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE To investigate the value of Korean, American, and Chinese ultrasound risk stratification systems combined with BRAF(V600E) mutation in the detection of papillary thyroid carcinoma (PTC)within cytologically indeterminate thyroid nodules (CITNs). METHODS A single-center retrospective study encompassed 511 CITNs selected from 509 patients between January 2020 and July 2023.Each nodule underwent surgical treatment and was classified according to three distinct systems. Receiver operating characteristic (ROC) curves were plotted using histopathological diagnosis as the reference standard, and diagnostic performance was compared. RESULTS The three ultrasound stratification systems showed an elevated malignant risk with increasing grades (all P for trend2 < 0.001). The cut-off values for Korean, American, and Chinese systems were 5, 5, and 4c, and their respective area under the curves (AUCs) were 0.735, 0.778, and 0.783.The combination of BRAF (V600E) mutation significantly enhanced the diagnostic efficacy for the Korean(0.773vs0.735, P < 0.001), American (0.809vs0.778, P < 0.001) and Chinese (0.815vs0.783, P < 0.001) stratification systems in distinguishing CITNs without compromising specificity. When the three stratification systems were applied individually or combined with BRAF (V600E) mutation, the AUCs of the American and Chinese systems were similar (all P > 0.05), both of which were higher than the AUC of the Korean system (all P < 0.05). The American system exhibited higher specificity compared to the Chinese and Korean systems (all P < 0.001), whereas the Chinese system demonstrated higher sensitivity and accuracy when compared to the American and Korean systems (all P < 0.001). CONCLUSION Korean, American and Chinese stratification systems present potential in the differential diagnosis of CITNs. BRAF (V600E) mutation can significantly improve the detection rate of malignant nodules within CTNs, particularly PTC. Notably, the American and Chinese systems demonstrate superior overall diagnostic performance among these systems.
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Affiliation(s)
- Yu Lin
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yiming Cheng
- Medical School of Chinese PLA, Beijing, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiuyun Ren
- Department of Ultrasound, Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Jie Li
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huaiyin Shi
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuxin Li
- Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Hongwei Wang
- Department of Pathology, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
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Kong Z, Wang J, Ni S, Liu Y, Zhao X, Zhu Y, Li L, Liu S. CT-based quantification of trachea shape to detect invasion by thyroid cancer. Eur Radiol 2024; 34:3141-3150. [PMID: 37926738 DOI: 10.1007/s00330-023-10301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This study aims to develop a CT-based method for quantifying tracheal shape and evaluating its ability to distinguish between cases with or without tracheal invasion in patients with thyroid carcinoma. METHODS A total of 116 quantitative shape features, including 56 geometric moments and 60 bounding shape features, were defined. The tracheal lumen was semi-automatically defined with a CT threshold of less than - 500 HU. Three contiguous slices with the 1st, 2nd, and 3rd smallest trachea lumen areas were contiguously selected, and the appropriate number of slices to be included was determined. Fifty-six patients with differentiated thyroid carcinoma (DTC) invading the trachea and 22 patients with DTC but without invasion were retrospectively included. A receiver operating characteristic (ROC) curve was applied to select the representative shape features and determine the optimal threshold. RESULTS 23.3%, 25.9%, and 24.1% of the features displayed an area under the ROC curve (AUC) ≥ 0.800 when derived from 1, 2, and 3 slices, respectively. Calculating feature values from two slices with the 1st and 2nd smallest tracheal lumen area were considered appropriate. Six final features, including 3 geometric moments and 3 bounding shape features, were selected to determine the tracheal invasion status of DTC and displayed AUCs of 0.875-0.918, accuracies of 0.821-0.891, sensitivities of 0.813-0.893, and specificities of 0.818-0.932, outperforming the visual evaluation results. CONCLUSIONS Geometric moments and bounding shape features can quantify the tracheal shape and are reliable for identifying DTC tracheal invasion. The selected features quantified the extent of tracheal deformity in DTC patients with and without tracheal invasion. CLINICAL RELEVANCE STATEMENT Six geometric features provide a non-invasive, semi-automated evaluation of the tracheal invasion status of thyroid cancer. KEY POINTS • A novel method for quantifying tracheal shape using 56 geometric moments and 60 bounding shape features was developed. • Six features identify tracheal invasion by thyroid carcinoma. • The selected features quantified the extent of tracheal deformity in differentiated thyroid carcinoma patients with and without tracheal invasion.
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Affiliation(s)
- Ziren Kong
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China
| | - Jian Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China
| | - Song Ni
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China
| | - Yang Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, China
| | - Yiming Zhu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China.
| | - Lin Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, China.
| | - Shaoyan Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China.
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Zhang F, Mei F, Chen W, Zhang Y. Role of Ultrasound and Ultrasound-Based Prediction Model in Differentiating Follicular Thyroid Carcinoma From Follicular Thyroid Adenoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38577871 DOI: 10.1002/jum.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES This study aims to identify distinct ultrasound (US) characteristics for distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA), and construct a user-friendly preoperative risk stratification model for thyroid follicular neoplasms. METHODS In this retrospective study, patients diagnosed with pathologically confirmed FTA or FTC and undergoing US examinations between July 2017 and June 2021 were designated as the training cohort, and those from July 2021 to June 2023 were enrolled as the external validation set. We systematically assessed and compared the sonographic and clinical characteristics of FTC and FTA. Univariable and multivariable logistic regression analyses were used to assess the association of US features with FTC in the training set. A prediction nomogram model, incorporating US features independently associated with FTC, was developed and validated externally to assess its performance. RESULTS A total of 645 patients (FTA/FTC = 530/115) were included in the training set, while 197 patients (FTA/FTC = 165/32) constituted the validation set. In the training set, solid composition, hypo-echogenicity, irregular margin, calcification, protrusion sign, trabecular formation, absent or thick halo, and mainly central hypervascularity were identified as independent factors associated with FTC. The prediction nomogram model constructed using these variables showed good performance in differentiating FTC from FTA with an area under the curve of 0.948 in the training set and 0.915 in the validation set. CONCLUSIONS The preoperative nomogram model constructed based on US features serves as an effective tool for the risk stratification of thyroid follicular neoplasms.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Fang Mei
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yongyue Zhang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
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Zheng T, Wang L, Wang H, Tang L, Xie X, Fu Q, Wu PY, Song B. Prediction model based on MRI morphological features for distinguishing benign and malignant thyroid nodules. BMC Cancer 2024; 24:256. [PMID: 38395783 PMCID: PMC10885392 DOI: 10.1186/s12885-024-11995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The low specificity of Thyroid Imaging Reporting and Data System (TI-RADS) for preoperative benign-malignant diagnosis leads to a large number of unnecessary biopsies. This study developed and validated a predictive model based on MRI morphological features to improve the specificity. METHODS A retrospective analysis was conducted on 825 thyroid nodules pathologically confirmed postoperatively. Univariate and multivariate logistic regression were used to obtain β coefficients, construct predictive models and nomogram incorporating MRI morphological features in the training cohort, and validated in the validation cohort. The discrimination, calibration, and decision curve analysis of the nomogram were performed. The diagnosis efficacy, area under the curve (AUC) and net reclassification index (NRI) were calculated and compared with TI-RADS. RESULTS 572 thyroid nodules were included (training cohort: n = 397, validation cohort: n = 175). Age, low signal intensity on T2WI, restricted diffusion, reversed halo sign in delay phase, cystic degeneration and wash-out pattern were independent predictors of malignancy. The nomogram demonstrated good discrimination and calibration both in the training cohort (AUC = 0.972) and the validation cohort (AUC = 0.968). The accuracy, sensitivity, specificity, PPV, NPV and AUC of MRI-based prediction were 94.4%, 96.0%, 93.4%, 89.9%, 96.5% and 0.947, respectively. The MRI-based prediction model exhibited enhanced accuracy (NRI>0) in comparison to TI-RADSs. CONCLUSIONS The prediction model for diagnosis of benign and malignant thyroid nodules demonstrated a more notable diagnostic efficacy than TI-RADS. Compared with the TI-RADSs, predictive model had better specificity along with a high sensitivity and can reduce overdiagnosis and unnecessary biopsies.
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Affiliation(s)
- Tingting Zheng
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Lanyun Wang
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Lang Tang
- Department of Ultrasound, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Xiaoli Xie
- Department of Pathology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Qingyin Fu
- Department of Ultrasound, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Pu-Yeh Wu
- GE Healthcare, MR Research China, Beijing, China
| | - Bin Song
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China.
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Song M, Sun W, Liu Q, Wang Z, Zhang H. Global scientific trends on thyroid disease in early 21st century: a bibliometric and visualized analysis. Front Endocrinol (Lausanne) 2024; 14:1306232. [PMID: 38298184 PMCID: PMC10829784 DOI: 10.3389/fendo.2023.1306232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Background Bibliometrics has been used to analyze the literature in the field of thyroid disease studies in the early 21st century, indicating the changes in current international study trends. Methods In this study, a bibliometric analysis of data retrieved from the Web of Science (WoS) database was conducted, and the publication trends and thematic evolution in the field of thyroid disease research from January 1, 2000, to November 16, 2022, were analyzed. A total of 69283 articles related to thyroid diseases were evaluated for their characteristics, including annual publication volume, countries, journals, institutions, authors, keywords, and references. VOSviewer was utilized to perform the analysis of co-authorship, co-citation, co-occurrence and descriptive. Results The annual publication volume of thyroid disease research literature showed a fluctuating upward trend from 2000 to 2021, exceeding 5,000 articles for the first time in 2021. The United States (16120 counts, 678255 cities) ranks first in terms of publication volume and citation. Thyroid (n=3201) and Journal of Clinical Endocrinology&Metabolism (n=140399) are the most prolific and cited journals, respectively. The organization with the highest publication volume and citation frequency is Harvard University (1011 counts, 59429 cities), Miyauchi Akira (n=422), Schlumberger, and Martin (n=24839) possess the highest publication volume and citation frequency, respectively. Co-occurrence analysis of 307 keywords with frequencies of more than 20 resulted in 6 clusters (1): Thyroid dysfunction and diseases (2); mechanism of occurrence and development of thyroid cancer (3); autoimmune thyroiditis (4); scope and postoperative management of thyroid surgery (5); fine needle aspiration of thyroid nodules (6); radioactive iodine therapy for thyroid cancer. Active monitoring, thermal ablation, Lenvatinib, and long noncoding RNA refer to the latest keywords. Discussing the six clusters helps scholars to determine the scope and direction of studies. Conclusion Over the past two decades, the literature related to thyroid diseases has increased year by year, with closer collaboration between countries, institutions, and authors. In this study, the global trends, research hotspots, emerging subjects, and basic knowledge of literature related to thyroid diseases were respectively elucidated, which will facilitate researchers in this field to seek better development.
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Affiliation(s)
- Mingyuan Song
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Qi Liu
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zhongqing Wang
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
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Li Q, Yang L, Yang L, Jiang X, Li S. Utility of Six Ultrasound-Based Risk Stratification Systems in the Diagnosis of AUS/FLUS Thyroid Nodules. Acad Radiol 2024; 31:131-141. [PMID: 37225530 DOI: 10.1016/j.acra.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/22/2023] [Accepted: 04/22/2023] [Indexed: 05/26/2023]
Abstract
RATIONALE AND OBJECTIVES To estimate the diagnostic performance of the currently used ultrasound (US)-based risk stratification systems (RSSs) (American Thyroid Association, American Association of Clinical Endocrinologists, American College of Endocrinology, and Association Medici Endocrinology Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules, European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults [EU-TIRADS], American College of Radiology Thyroid Imaging Reporting and Data System [ACR-TIRADS], Chinese Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules [C-TIRADS], and Thyroid Imaging Reporting and Data System Developed by Kwak et al [Kwak-TIRADS]) for atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) thyroid nodules. MATERIALS AND METHODS This retrospective study included 514 consecutive AUS/FLUS nodules in 481 patients with final diagnosis. The US characteristics were reviewed and classified using the categories defined by each RSS. The diagnostic performance was evaluated and compared using a generalized estimating equation method. RESULTS Of the 514 AUS/FLUS nodules, 148 (28.8%) were malignant and 366 (71.2%) were benign. The calculated malignancy rate increased from the low-risk to high-risk categories for all RSSs (all P < .001). Interobserver correlation for both US features and RSSs showed substantial to almost perfect agreement. The diagnostic efficacy of Kwak-TIRADS (AUC=0.808) and C-TIRADS (AUC=0.804) were similar (P = .721) and higher than those of other RSSs (all P < .05). The EU-TIRADS and Kwak-TIRADS exhibited similar sensitivity (86.5% vs 85.1%, P = .739) and were only higher than that of the C-TIRADS (all P < .05). The specificity of C-TIRADS and ACR-TIRADS were similar (78.1% vs 72.1%, P = .06) and were higher than those of other RSSs (all P < .05). CONCLUSION Currently used RSSs can provide risk stratification for AUS/FLUS nodules. Kwak-TIRADS and C-TIRADS have the highest diagnostic efficacy in identifying malignant AUS/FLUS nodules. A detailed knowledge of the benefits and shortcomings of the various RSSs is essential.
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Affiliation(s)
- Qiang Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.)
| | - Lu Yang
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.)
| | - Liming Yang
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.)
| | - Xianfeng Jiang
- Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China (X.J.)
| | - Shiyan Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.).
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Li J, Li C, Zhou X, Huang J, Yang P, Cang Y, Zhai H, Huang R, Mu Y, Gou X, Zhang Y, Yu J, Liang P. US Risk Stratification System for Follicular Thyroid Neoplasms. Radiology 2023; 309:e230949. [PMID: 37987664 DOI: 10.1148/radiol.230949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Preoperative assessment of follicular thyroid neoplasms is challenging using the current US risk stratification systems (RSSs) that are applicable to papillary thyroid neoplasms. Purpose To develop a US feature-based RSS for differentiating between follicular thyroid adenoma (FTA) and follicular thyroid carcinoma (FTC) in biopsy-proven follicular neoplasm and compare it with existing RSSs. Materials and Methods This retrospective multicenter study included consecutive adult patients who underwent conventional US and received a final diagnosis of follicular thyroid neoplasm from seven centers between January 2018 and December 2022. US images from a pretraining data set were used to improve readers' understanding of the US characteristics of the FTC and FTA. Univariable and multivariable logistic regression analyses were used to assess the association of qualitative US features with FTC in a training data set. Features with P < .05 were used to construct a prediction model (follicular tumor model, referred to as F model) and RSS for follicular neoplasms using the Thyroid Imaging Reporting and Data System (TI-RADS). Area under the receiver operating characteristic curve (AUC) was compared between follicular TI-RADS (hereafter, F-TI-RADS) and existing RSS (American College of Radiology [ACR] TI-RADS, Korean Society of Thyroid Radiology and Korean Society of Radiology TI-RADS [hereafter, referred to as K-TI-RADS], and Chinese TI-RADS [hereafter, referred to as C-TI-RADS]) in a validation data set. Results The pretraining, training, and validation data sets included 30 (mean age, 47.6 years ± 16.0 [SD]; 16 male patients; FTCs, 30 of 60 [50.0%]), 703 (mean age, 47.9 years ± 14.5; 530 female patients; FTCs, 188 of 703 [26.7%]), and 155 (mean age, 49.9 years ± 13.3 [SD]; 155 female patients; FTCs, 43 of 155 [27.7%]) patients. In the validation data set, the F-TI-RADS showed improved performance for differentiating between FTA and FTC (AUC, 0.81; 95% CI: 0.71, 0.86) compared with ACR TI-RADS (AUC, 0.74; 95% CI: 0.66, 0.80; P = .02), K-TI-RADS (AUC, 0.69; 95% CI: 0.61, 0.76; P = .002), and C-TI-RADS (AUC, 0.68; 95% CI: 0.60, 0.75; P = .002). Conclusion F-TI-RADS outperformed existing RSSs for differentiating between FTC and FTA. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Baumgarten in this issue.
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Affiliation(s)
- Jianming Li
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Chao Li
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - XiaoHui Zhou
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - JiuPing Huang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Peipei Yang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Yuancheng Cang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Hongyan Zhai
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - RenXiang Huang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Yang Mu
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Xiangnan Gou
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Yang Zhang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Jie Yu
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
| | - Ping Liang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China (J.L., J.Y., P.L.); Department of Ultrasound, The First Affiliated Hospital of Henan University of CM, Henan, China (C.L.); Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hunan, China (X.Z.); Department of Ultrasound, Peking University Third Hospital, Beijing, China (J.H.); Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China (P.Y.); Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China (Y.C.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (H.Z.); Department of Otolaryngology-Head & Neck Surgery, The Second Affiliated Hospital of Guilin Medical University, Guangxi, China (R.H.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang, Xinjiang, China (Y.M.); Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China (X.G.); and Department of Pathology, Affiliated Hospital of Hebei Engineering University, Hebei, China (Y.Z.)
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9
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Torshizian A, Hashemi F, Khoshhal N, Ghodsi A, Rastegar H, Mousavi Z, Dadgar Moghadam M, Mohebbi M. Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review. Diagnostics (Basel) 2023; 13:2972. [PMID: 37761339 PMCID: PMC10527732 DOI: 10.3390/diagnostics13182972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
AIM This study sought to compare two common risk stratification systems in terms of their diagnostic performance for the evaluation of thyroid malignancy. METHODS The American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) guidelines were compared among 571 thyroid nodules with definitive fine needle aspiration (FNA) cytology or postoperative histopathology. Ultrasound characteristics such as composition, echogenicity, shape, margin, size, and vascularity were assessed for each thyroid nodule. Diagnostic performance measures were determined and compared through receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). RESULTS Of 571 nodules, 65 (11.4%) were malignant. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value were 0.691, 49.2%, 84.9%, 29.6%, and 92.8% for ATA guideline, and 0.776, 72.3%, 79.2%, 30.9%, and 95.7%, for ACR TI-RADS, respectively. ACR TI-RADS was more sensitive (p = 0.003), while the ATA guideline was more specific (p < 0.001). DCA demonstrated that the ACR TI-RADS provided a greater net benefit than the ATA guideline. In addition, the net reduction in unnecessary biopsies is higher for ACR TI-RADS than ATA guidelines. The total number of indicated biopsies and unnecessary FNA rates were lower in ACR TI-RADS compared to ATA guideline (293 vs. 527 and 80.2 vs. 87.8). ACR TI-RADS presented no biopsy indication in seven malignant nodules (all categorized as TR2), whereas ATA guideline missed one. Hypoechogenicity was the most significant predictor of malignancy (OR = 8.34, 95% CI: 3.75-19.45), followed by a taller-than-wide shape (OR = 6.73, 95% CI: 3.07-14.77). CONCLUSIONS Our findings suggest that each system has particular advantages in the evaluation of thyroid nodules. ACR TI-RADS reduces unnecessary FNA rates, however, malignant nodules categorized as TR2 might be missed using this system. Further evaluation of this group of nodules using Doppler and other ultrasound modalities is recommended.
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Affiliation(s)
- Ashkan Torshizian
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Fatemeh Hashemi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Nastaran Khoshhal
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Houra Rastegar
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Zohreh Mousavi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Maliheh Dadgar Moghadam
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Masoud Mohebbi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
- Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Sq., Mashhad 13944-91388, Iran
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10
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Kim DH, Kim SW, Basurrah MA, Lee J, Hwang SH. Diagnostic Performance of Six Ultrasound Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Network Meta-Analysis. AJR Am J Roentgenol 2023; 220:791-803. [PMID: 36752367 DOI: 10.2214/ajr.22.28556] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND. Risk stratification systems for evaluating thyroid nodules on ultrasound use varying approaches to classify levels of suspicion for malignancy, leading to variable performance. OBJECTIVE. The purpose of this study was to perform a network meta-analysis comparing six risk stratification systems used to evaluate thyroid nodules on ultrasound in terms of their diagnostic performance for the detection of thyroid cancer. EVIDENCE ACQUISITION. Five bibliometric databases were searched for studies published through August 31, 2022, that compared at least two of six ultrasound risk stratification systems (the American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi [AACE/ACE/AME] system; American College of Radiology Thyroid Imaging Reporting and Data System [ACR TI-RADS]; the American Thyroid Association [ATA] risk stratification system; European Thyroid Association Thyroid Imaging Reporting and Data System [EU-TIRADS]; the Korean Thyroid Imaging Reporting and Data System [K-TIRADS] endorsed by the Korean Thyroid Association and the Korean Society of Thyroid Radiology; and the Thyroid Imaging Reporting and Data System developed by Kwak et al. [Kwak TIRADS]) in terms of their diagnostic performance for the detection of thyroid cancer, with cytologic or histologic evaluation used as a reference standard. The studies' risk of bias was evaluated using the Newcastle-Ottawa Scale. A meta-analysis of each system was performed to identify the risk category threshold that had the highest accuracy as well as the highest sensitivity and specificity at this threshold. Network meta-analysis was used to perform hierarchic ranking and identify the systems having the highest sensitivities and specificities at each system's most accurate threshold. EVIDENCE SYNTHESIS. The analysis included 39 studies with 49,661 patients. All studies were of fair (n = 17) or good (n = 22) quality. The most accurate risk category thresholds were class 3 (high risk) for the AACE/ACE/AME system, TR5 (highly suspicious) for ACR TI-RADS, EU-TIRADS 5 (high risk) for EU-TIRADS, 4c (moderate concern but not classic for malignancy) for Kwak TIRADS, K-TIRADS 5 (high suspicion) for K-TIRADS, and high suspicion for the ATA system. At these thresholds, the systems had sensitivity of 64-77% and specificity of 82-90%. Network meta-analysis identified the highest sensitivity and highest specificity for ACR TI-RADS, followed by K-TIRADS. CONCLUSION. Of six risk stratification systems, ACR TI-RADS had the highest diagnostic performance for the detection of thyroid nodules on ultrasound. CLINICAL IMPACT. This network meta-analysis can inform decisions regarding implementation of the risk stratification systems and can aid future system updates.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Jueun Lee
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Gyeonggi-do 14647, Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Gyeonggi-do 14647, Korea
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11
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Kim JS, Kim BG, Stybayeva G, Hwang SH. Diagnostic Performance of Various Ultrasound Risk Stratification Systems for Benign and Malignant Thyroid Nodules: A Meta-Analysis. Cancers (Basel) 2023; 15:cancers15020424. [PMID: 36672373 PMCID: PMC9857194 DOI: 10.3390/cancers15020424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To evaluate the diagnostic performance of ultrasound risk-stratification systems for the discrimination of benign and malignant thyroid nodules and to determine the optimal cutoff values of individual risk-stratification systems. METHODS PubMed, Embase, SCOPUS, Web of Science, and Cochrane library databases were searched up to August 2022. Sensitivity and specificity data were collected along with the characteristics of each study related to ultrasound risk stratification systems. RESULTS Sixty-seven studies involving 76,512 thyroid nodules were included in this research. The sensitivity, specificity, diagnostic odds ratios, and area under the curves by K-TIRADS (4), ACR-TIRADS (TR5), ATA (high suspicion), EU-TIRADS (5), and Kwak-TIRADS (4b) for malignancy risk stratification of thyroid nodules were 92.5%, 63.5%, 69.8%, 70.6%, and 95.8%, respectively; 62.8%, 89.6%, 87.2%, 83.9%, and 63.8%, respectively; 20.7111, 16.8442, 15.7398, 12.2986, and 38.0578, respectively; and 0.792, 0.882, 0.859, 0.843, and 0.929, respectively. CONCLUSION All ultrasound-based risk-stratification systems had good diagnostic performance. Although this study determined the best cutoff values in individual risk-stratification systems based on statistical assessment, clinicians could adjust or alter cutoff values based on the clinical purpose of the ultrasound and the reciprocal changes in sensitivity and specificity.
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Affiliation(s)
- Ji-Sun Kim
- Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Byung Guk Kim
- Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55902, USA
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: ; Tel.: +82-32-340-7044
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12
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Zhang G, Yu J, Lei YM, Hu JR, Hu HM, Harput S, Guo ZZ, Cui XW, Ye HR. Ultrasound super-resolution imaging for the differential diagnosis of thyroid nodules: A pilot study. Front Oncol 2022; 12:978164. [PMID: 36387122 PMCID: PMC9647016 DOI: 10.3389/fonc.2022.978164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/12/2022] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Ultrasound imaging provides a fast and safe examination of thyroid nodules. Recently, the introduction of super-resolution imaging technique shows the capability of breaking the Ultrasound diffraction limit in imaging the micro-vessels. The aim of this study was to evaluate its feasibility and value for the differentiation of thyroid nodules. METHODS In this study, B-mode, contrast-enhanced ultrasound, and color Doppler flow imaging examinations were performed on thyroid nodules in 24 patients. Super-resolution imaging was performed to visualize the microvasculature with finer details. Microvascular flow rate (MFR) and micro-vessel density (MVD) within thyroid nodules were computed. The MFR and MVD were used to differentiate the benign and malignant thyroid nodules with pathological results as a gold standard. RESULTS Super-resolution imaging (SRI) technique can be successfully applied on human thyroid nodules to visualize the microvasculature with finer details and obtain the useful clinical information MVD and MFR to help differential diagnosis. The results suggested that the mean value of the MFR within benign thyroid nodule was 16.76 ± 6.82 mm/s whereas that within malignant thyroid was 9.86 ± 4.54 mm/s. The mean value of the MVD within benign thyroid was 0.78 while the value for malignant thyroid region was 0.59. MFR and MVD within the benign thyroid nodules were significantly higher than those within the malignant thyroid nodules respectively (p < 0.01). CONCLUSIONS This study demonstrates the feasibility of ultrasound super-resolution imaging to show micro-vessels of human thyroid nodules via a clinical ultrasound platform. The important imaging markers, such as MVD and MFR, can be derived from SRI to provide more useful clinical information. It has the potential to be a new tool for aiding differential diagnosis of thyroid nodules.
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Affiliation(s)
- Ge Zhang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of science and technology, Wuhan, China
| | - Jing Yu
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Yu-Meng Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Jun-Rui Hu
- Department of Chemistry and Chemical Engineering, Queen’s University Belfast, Belfast, United Kingdom
| | - Hai-Man Hu
- Department of Electrical and Electronic Engineering, Hubei University of Technology, Wuhan, China
| | - Sevan Harput
- Department of Electrical and Electronic Engineering, London South Bank University, London, United Kingdom
| | - Zhen-Zhong Guo
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of science and technology, Wuhan, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Rong Ye
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
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13
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Yang J, Sun Y, Li X, Zhao Y, Han X, Chen G, Ding W, Li R, Wang J, Xiao F, Liu C, Xu S. Diagnostic performance of six ultrasound-based risk stratification systems in thyroid follicular neoplasm: A retrospective multi-center study. Front Oncol 2022; 12:1013410. [PMID: 36338713 PMCID: PMC9632336 DOI: 10.3389/fonc.2022.1013410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/06/2022] [Indexed: 12/07/2022] Open
Abstract
This study aimed to compare the diagnostic performances of six commonly used ultrasound-based risk stratification systems for distinguishing follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC), including the American Thyroid Association Sonographic Pattern System (ATASPS), ultrasound classification systems proposed by American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinology (AACE/ACE/AME), Korean thyroid imaging reporting and data system (K-TIRADS), European Thyroid Association for the imaging reporting and data system (EU-TIRADS), American College of Radiology for the imaging reporting and data system (ACR-TIRADS), and 2020 Chinese Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules (C-TIRADS). A total of 225 FTA or FTC patients were retrospectively analyzed, involving 251 thyroid nodules diagnosed by postoperative pathological examinations in three centers from January 2013 to October 2021. The diagnostic performances of six ultrasound-based risk stratification systems for distinguishing FTA from FTC were assessed by plotting the receiver operating characteristic (ROC) curves and compared at different cut-off values. A total of 205 (81.67%) cases of FTA and 46 (18.33%) cases of FTC were involved in the present study. Compared with those of FTA, FTC presented more typical ultrasound features of solid component, hypoechoic, irregular margin and sonographic halo (all P<0.001). There were no significant differences in ultrasound features of calcification, shape and comet-tail artifacts between cases of FTA and FTC. There was a significant difference in the category of thyroid nodules assessed by the six ultrasound-based risk stratification systems (P<0.001). The areas under the curve (AUCs) of ATASPS, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS in distinguishing FTA from FTC were 0.645, 0.729, 0.766, 0.635, 0.783 and 0.798, respectively. Our study demonstrated that all the six ultrasound-based risk stratification systems present potential in the differential diagnosis of FTA and FTC. Specifically, C-TIRADS exerts the best diagnostic performance among the Chinese patients. ATASPS possesses a high sensitivity, while K-TIRADS possesses a high specificity in distinguishing FTA from FTC.
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Affiliation(s)
- Jingjing Yang
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Sun
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Endocrinology and Metabolism, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Xingjia Li
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory of Traditional Chinese Medicine (TCM) Syndrome and Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yueting Zhao
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xue Han
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory of Traditional Chinese Medicine (TCM) Syndrome and Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Wenbo Ding
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruiping Li
- Department of Pathology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianhua Wang
- Department of General Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Fangsen Xiao
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Shuhang Xu, ; Fangsen Xiao,
| | - Chao Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Key Laboratory of Traditional Chinese Medicine (TCM) Syndrome and Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Shuhang Xu, ; Fangsen Xiao,
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Wang J, Zhanghuang C, Jin L, Zhang Z, Tan X, Mi T, Liu J, Li M, Wu X, Tian X, He D. Development and validation of a nomogram to predict cancer-specific survival in elderly patients with papillary thyroid carcinoma: a population-based study. BMC Geriatr 2022; 22:736. [PMID: 36076163 PMCID: PMC9454205 DOI: 10.1186/s12877-022-03430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Thyroid carcinoma (TC) is the most common endocrine tumor in the human body. Papillary thyroid carcinoma (PTC) accounts for more than 80% of thyroid cancers. Accurate prediction of elderly PTC can help reduce the mortality of patients. We aimed to construct a nomogram predicting cancer-specific survival (CSS) in elderly patients with PTC. Methods Patient information was downloaded from the Surveillance, Epidemiology, and End Results (SEER) program. Univariate and multivariate Cox regression models were used to screen the independent risk factors for patients with PTC. The nomogram of elderly patients with PTC was constructed based on the multivariate Cox regression model. We used the concordance index (C-index), the area under the receiver operating characteristic curve (AUC) and the calibration curve to test the accuracy and discrimination of the prediction model. Decision curve analysis (DCA) was used to test the clinical value of the model. Results A total of 14,138 elderly patients with PTC were included in this study. Patients from 2004 to 2015 were randomly divided into a training set (N = 7379) and a validation set (N = 3141), and data from 2016 to 2018 were divided into an external validation set (N = 3618). Proportional sub-distribution hazard model showed that age, sex, tumor size, histological grade, TNM stage, surgery and chemotherapy were independent risk factors for prognosis. In the training set, validation set and external validation set, the C-index was 0.87(95%CI: 0.852–0.888), 0.891(95%CI: 0.866–0.916) and 0.931(95%CI:0.894–0.968), respectively, indicating that the nomogram had good discrimination. Calibration curves and AUC suggest that the prediction model has good discrimination and accuracy. Conclusions We constructed a new nomogram to predict CSS in elderly patients with PTC. Internal cross-validation and external validation indicate that the model has good discrimination and accuracy. The predictive model can help doctors and patients make clinical decisions.
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Affiliation(s)
- Jinkui Wang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chenghao Zhanghuang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Department of Urology, Kunming Children's Hospital, Yunnan Provincial Key Research Laboratory of Pediatric Major Diseases, Kunming, 650228, China
| | - Liming Jin
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhaoxia Zhang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaojun Tan
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Tao Mi
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jiayan Liu
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Mujie Li
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xin Wu
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaomao Tian
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Dawei He
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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Lee JH, Ha EJ, Lee DH, Han M, Park JH, Kim JH. Clinicoradiological Characteristics in the Differential Diagnosis of Follicular-Patterned Lesions of the Thyroid: A Multicenter Cohort Study. Korean J Radiol 2022; 23:763-772. [PMID: 35695317 PMCID: PMC9240300 DOI: 10.3348/kjr.2022.0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Preoperative differential diagnosis of follicular-patterned lesions is challenging. This multicenter cohort study investigated the clinicoradiological characteristics relevant to the differential diagnosis of such lesions. MATERIALS AND METHODS From June to September 2015, 4787 thyroid nodules (≥ 1.0 cm) with a final diagnosis of benign follicular nodule (BN, n = 4461), follicular adenoma (FA, n = 136), follicular carcinoma (FC, n = 62), or follicular variant of papillary thyroid carcinoma (FVPTC, n = 128) collected from 26 institutions were analyzed. The clinicoradiological characteristics of the lesions were compared among the different histological types using multivariable logistic regression analyses. The relative importance of the characteristics that distinguished histological types was determined using a random forest algorithm. RESULTS Compared to BN (as the control group), the distinguishing features of follicular-patterned neoplasms (FA, FC, and FVPTC) were patient's age (odds ratio [OR], 0.969 per 1-year increase), lesion diameter (OR, 1.054 per 1-mm increase), presence of solid composition (OR, 2.255), presence of hypoechogenicity (OR, 2.181), and presence of halo (OR, 1.761) (all p < 0.05). Compared to FA (as the control), FC differed with respect to lesion diameter (OR, 1.040 per 1-mm increase) and rim calcifications (OR, 17.054), while FVPTC differed with respect to patient age (OR, 0.966 per 1-year increase), lesion diameter (OR, 0.975 per 1-mm increase), macrocalcifications (OR, 3.647), and non-smooth margins (OR, 2.538) (all p < 0.05). The five important features for the differential diagnosis of follicular-patterned neoplasms (FA, FC, and FVPTC) from BN are maximal lesion diameter, composition, echogenicity, orientation, and patient's age. The most important features distinguishing FC and FVPTC from FA are rim calcifications and macrocalcifications, respectively. CONCLUSION Although follicular-patterned lesions have overlapping clinical and radiological features, the distinguishing features identified in our large clinical cohort may provide valuable information for preoperative distinction between them and decision-making regarding their management.
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Affiliation(s)
- Jeong Hoon Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
| | - Da Hyun Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Miran Han
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hyun Park
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Hu Y, Xu S, Zhan W. Diagnostic performance of C-TIRADS in malignancy risk stratification of thyroid nodules: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:938961. [PMID: 36157473 PMCID: PMC9492922 DOI: 10.3389/fendo.2022.938961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chinese thyroid imaging reports and data systems (C-TIRADS) is a novel malignancy risk stratification used for thyroid nodule diagnosis and guiding thyroid fine needle aspiration (FNA). In this review, we aim to assess the performance of C-TIRADS in malignancy risk stratification of thyroid nodules. METHODS PubMed, Medline, Web of Science, Embase, CNKI, and Wanfang databases were searched until 1 April 2022. Original articles reporting data about C-TIRADS and setting FNA or histology as reference standards were included. C-TIRADS 4A, 4B, and 4C were set as thresholds, respectively, to obtain pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and the area under the curve (AUC). Integrated nested Laplace approximation was used for Bayesian bivariate meta-analysis of diagnostic tests. RESULTS Sixteen studies were included, evaluating 11,506 thyroid nodules. The rate of malignancy in each risk classification is comparable with that in C-TIRADS. C-TIRADS 4B appeared to have better diagnostic performance than C-TIRADS 4A and 4C. The pooled sensitivity, specificity, LR+, LR-, and DOR of C-TI-RADS 4B were 0.94 (95% CI: 0.89-0.97), 0.70 (95% CI: 0.60-0.79), 3.20 (95% CI: 2.28-4.39), 0.09 (95% CI: 0.05-0.15), and 33.71 (95% CI: 25.51-42.40), respectively. The area under the summary ROC curve was 0.94 (95% CI: 0.90-0.96). CONCLUSION C-TIRADS performed well in malignancy risk stratification of thyroid nodules. C-TIRADS 4B showed strong evidence of detecting malignancy.
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