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Hamel C, Avard B, Campbell R, Kontolemos M, Murphy A. Canadian Association of Radiologists Head and Neck Imaging Referral Guideline. Can Assoc Radiol J 2024; 75:473-478. [PMID: 38189303 DOI: 10.1177/08465371231217212] [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] [Indexed: 01/09/2024] Open
Abstract
The Canadian Association of Radiologists (CAR) Head and Neck Expert Panel consists of radiologists, a laryngologist and laryngeal surgeon, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 11 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 17 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 26 recommendation statements across the 11 scenarios. This guideline presents the methods of development and the referral recommendations for sinus disease, tinnitus, thyroid and parathyroid disease, neck mass of unknown origin, acute sialadenitis, chronic salivary conditions, and temporomandibular joint dysfunction.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, University of Toronto, Toronto, ON, Canada
| | - Ross Campbell
- Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | | | - Amanda Murphy
- North York General Hospital, University of Toronto, Toronto, ON, Canada
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2
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Li S, Wei X, Wang L, Zhang G, Jiang L, Zhou X, Huang Q. Dual-source dual-energy CT and deep learning for equivocal lymph nodes on CT images for thyroid cancer. Eur Radiol 2024:10.1007/s00330-024-10854-w. [PMID: 38904758 DOI: 10.1007/s00330-024-10854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES This study investigated the diagnostic performance of dual-energy computed tomography (CT) and deep learning for the preoperative classification of equivocal lymph nodes (LNs) on CT images in thyroid cancer patients. METHODS In this prospective study, from October 2020 to March 2021, 375 patients with thyroid disease underwent thin-section dual-energy thyroid CT at a small field of view (FOV) and thyroid surgery. The data of 183 patients with 281 LNs were analyzed. The targeted LNs were negative or equivocal on small FOV CT images. Six deep-learning models were used to classify the LNs on conventional CT images. The performance of all models was compared with pathology reports. RESULTS Of the 281 LNs, 65.5% had a short diameter of less than 4 mm. Multiple quantitative dual-energy CT parameters significantly differed between benign and malignant LNs. Multivariable logistic regression analyses showed that the best combination of parameters had an area under the curve (AUC) of 0.857, with excellent consistency and discrimination, and its diagnostic accuracy and sensitivity were 74.4% and 84.2%, respectively (p < 0.001). The visual geometry group 16 (VGG16) based model achieved the best accuracy (86%) and sensitivity (88%) in differentiating between benign and malignant LNs, with an AUC of 0.89. CONCLUSIONS The VGG16 model based on small FOV CT images showed better diagnostic accuracy and sensitivity than the spectral parameter model. Our study presents a noninvasive and convenient imaging biomarker to predict malignant LNs without suspicious CT features in thyroid cancer patients. CLINICAL RELEVANCE STATEMENT Our study presents a deep-learning-based model to predict malignant lymph nodes in thyroid cancer without suspicious features on conventional CT images, which shows better diagnostic accuracy and sensitivity than the regression model based on spectral parameters. KEY POINTS Many cervical lymph nodes (LNs) do not express suspicious features on conventional computed tomography (CT). Dual-energy CT parameters can distinguish between benign and malignant LNs. Visual geometry group 16 model shows superior diagnostic accuracy and sensitivity for malignant LNs.
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Affiliation(s)
- Sheng Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Guangzhou, 510060, China
| | - Xiaoting Wei
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China
| | - Li Wang
- School of Artificial Intelligence, Optics and Electronics (iOPEN), Northwestern Polytechnical University, Xi'an, 710072, China
| | - Guizhi Zhang
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China
| | - Linling Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Xuhui Zhou
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China.
| | - Qinghua Huang
- School of Artificial Intelligence, Optics and Electronics (iOPEN), Northwestern Polytechnical University, Xi'an, 710072, China.
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Gule-Monroe MK, Calle S, Policeni B, Juliano AF, Agarwal M, Chow LQM, Dubey P, Friedman ER, Hagiwara M, Hanrahan KD, Jain V, Rath TJ, Smith RB, Subramaniam RM, Taheri MR, Yom SS, Zander D, Burns J. ACR Appropriateness Criteria® Staging and Post-Therapy Assessment of Head and Neck Cancer. J Am Coll Radiol 2023; 20:S521-S564. [PMID: 38040469 DOI: 10.1016/j.jacr.2023.08.008] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Susana Calle
- Research Author, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Q M Chow
- University of Texas at Austin, Dell Medical School, Austin, Texas; American Society of Clinical Oncology
| | | | | | - Mari Hagiwara
- New York University Langone Health, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio
| | | | - Russell B Smith
- Baptist Medical Center, Jacksonville, Florida; American Academy of Otolaryngology-Head and Neck Surgery
| | - Rathan M Subramaniam
- University of Otago, Dunedin, Otepoti, New Zealand; Commission on Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | - Sue S Yom
- University of California, San Francisco, San Francisco, California
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Abstract
PURPOSE OF REVIEW Thyroid ultrasound (TUS) is a common diagnostic test that can help guide the management of patients with thyroid conditions. Yet, inappropriate use of TUS can lead to harmful unintended consequences. This review aims to describe trends in the use and appropriateness of TUS in practice, drivers and consequences of inappropriate use, and potential solutions to decrease overuse. RECENT FINDINGS TUS use has increased in the U.S. and is associated with increased diagnosis of thyroid cancer. Between 10-50% of TUSs may be ordered outside of clinical practice recommendations. Patients who receive an inappropriate TUS and are incidentally found to have a thyroid nodule may experience unnecessary worry, diagnostic interventions, and potential overdiagnosis of thyroid cancer. The drivers of inappropriate TUS use are not yet fully understood, but it is likely that a combination of clinician, patient, and healthcare system factors contribute to this problem. SUMMARY Inappropriate TUS is a factor leading to the overdiagnosis of thyroid nodules and thyroid cancer, resulting in increased healthcare costs and potential harm to patients. To effectively address the overuse of this diagnostic test, it is necessary to gain a deeper understanding of the frequency of inappropriate TUS use in clinical practice and the factors that contribute to it. With this knowledge, interventions can be developed to reduce the inappropriate use of TUS, leading to improved patient outcomes and more efficient use of healthcare resources.
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Affiliation(s)
- Gonzalo J. Acosta
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
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Langdon J, Gupta A, Sharbidre K, Czeyda-Pommersheim F, Revzin M. Thyroid cancer in pregnancy: diagnosis, management, and treatment. Abdom Radiol (NY) 2023; 48:1724-1739. [PMID: 36719426 DOI: 10.1007/s00261-023-03808-1] [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: 10/20/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
The evaluation and management of cancer during pregnancy requires special care to assure the health and safety of both the mother and fetus. The diagnosis and treatment of thyroid cancer in the non-pregnant patient often involves radioactive iodine exposure. However, radioactive iodine is contraindicated in pregnancy and surgical interventions pose risks to both the mother and fetus. Thus, the management of thyroid cancer during pregnancy is a unique clinical challenge. In this review, we discuss the imaging of thyroid nodules during pregnancy, including the role of CT, MRI, and nuclear Imaging, as well as that of Ultrasound and FNA. The staging and prognosis are discussed along with the management, treatment, and surveillance of thyroid cancer in pregnancy. Finally, the risks to the fetus through treatment are examined. Case examples are provided with an emphasis on the appropriate direction of care from a radiologist's perspective.
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Affiliation(s)
- Jonathan Langdon
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Akshya Gupta
- Department of Radiology and Imaging Science, University of Rochester, Rochester, NY, USA
| | - Kedar Sharbidre
- Department of Radiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Margarita Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
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Do Cao C, Haissaguerre M, Lussey-Lepoutre C, Donatini G, Raverot V, Russ G. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules: Initial work-up for thyroid nodules. ANNALES D'ENDOCRINOLOGIE 2022; 83:380-388. [PMID: 36280193 DOI: 10.1016/j.ando.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons, but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This section deals with the initial work-up for thyroid nodules in adult patients, including clinical and biological evaluation, standardized ultrasound characterization and EU-TIRADS-based nodule selection for fine-needle aspiration biopsy. Indications for thyroid core-biopsies or open surgical biopsies and for cross-sectional imaging of the neck and upper chest are also mentioned.
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Affiliation(s)
- Christine Do Cao
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, CHU Lille, Lille, France.
| | - Magalie Haissaguerre
- Department of Endocrinology and Endocrine Oncology, Haut Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Charlotte Lussey-Lepoutre
- Department of Nuclear Medicine, Sorbonne University, Pitié-Salpêtrière Hospital APHP, Inserm U970, Paris, France
| | - Gianluca Donatini
- Department of General and Endocrine Surgery, University of Poitiers, CHU Poitiers, Poitiers, France
| | - Véronique Raverot
- Laboratory of Hormonology, East Center for Biology and Pathology, East Hospital Group, Civil Hospices of Lyon, 59 Boulevard Pinel, Bron, France
| | - Gilles Russ
- Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital APHP, Institute of Cancer IUC Sorbonne University, Paris, France; Centre de Pathologie et d'Imagerie, 14 Avenue René Coty, 75014 Paris, France
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Fiori T, Lisewski D, Flukes S, Wood C, Gibson D. Lessons learnt from the global iodinated contrast media shortage in head and neck imaging. J Med Imaging Radiat Oncol 2022; 66:1073-1083. [PMID: 36125131 DOI: 10.1111/1754-9485.13472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
A recent shortage in the global supply of iodinated contrast media (ICM) has required health service providers to review their contrast administration policies and implement strategies to conserve inventory. This article will review the current best practices in head and neck imaging for a variety of common presentations and provide examples where alternative imaging can be considered due to the recent ICM shortage. Ultrasound and MRI techniques can feature heavily in many diagnostic processes in head and neck pathology, and a variety of common presentations can be appropriately investigated through clinical evaluation or naso-endoscopy. In many instances, for the routine assessment of non-acute adult and paediatric head and neck presentations, the use of contrast-enhanced CT can be safely minimised to conserve ICM if required.
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Affiliation(s)
- Timothy Fiori
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dean Lisewski
- Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Stephanie Flukes
- Department of Otolaryngology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Chris Wood
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Daren Gibson
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Lee JY, Yoo RE, Rhim JH, Lee KH, Choi KS, Hwang I, Kang KM, Kim JH. Validation of Ultrasound Risk Stratification Systems for Cervical Lymph Node Metastasis in Patients with Thyroid Cancer. Cancers (Basel) 2022; 14:cancers14092106. [PMID: 35565235 PMCID: PMC9105025 DOI: 10.3390/cancers14092106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Ultrasound (US) malignancy risk stratification systems (RSS) for cervical lymph nodes (LNs) have not been fully established in patients with thyroid cancer. In this study, we assessed the malignancy risks of each US feature and risk category from the Korean Society of Thyroid Radiology (KSThR) and the European Thyroid Association (ETA). Both systems effectively classified malignancy risks; however, 15.1% of LNs were unclassifiable in ETA RSS. Suspicious US features of hyperechogenicity, cystic change, echogenic foci, and abnormal vascularity were independently associated with metastasis. When the primary tumor characteristics were assessed, tumor multiplicity was associated with metastasis in the indeterminate LN group. We refined this system and proposed an RSS based on the KSThR system for cervical LNs in patients with thyroid cancer. Abstract A malignancy risk stratification system (RSS) for cervical lymph nodes (LNs) has not been fully established. This study aimed to validate the current RSS for the diagnosis of cervical LN metastasis in thyroid cancer. In total, 346 LNs from 282 consecutive patients between December 2006 and June 2015 were included. We determined the malignancy risk of each ultrasound (US) feature and performed univariable and multivariable logistic regression analyses. Each risk category from the Korean Society of Thyroid Radiology (KSThR) and the European Thyroid Association (ETA) was applied to calculate malignancy risks. The effects of size, number of suspicious features, and primary tumor characteristics were analyzed to refine the current RSS. Suspicious features including echogenic foci, cystic change, hyperechogenicity, and abnormal vascularity were independently predictive of malignancy (p ≤ 0.045). The malignancy risks of probably benign, indeterminate, and suspicious categories were 2.2–2.5%, 26.8–29.0%, and 85.8–87.4%, respectively, according to the KSThR and ETA criteria. According to the ETA criteria, 15.1% of LNs were unclassifiable. In indeterminate LNs, multiplicity of the primary tumor was significantly associated with malignancy (odds ratio, 6.53; p = 0.004). We refined the KSThR system and proposed a US RSS for LNs in patients with thyroid cancer.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Jung Hyo Rhim
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156707, Korea;
| | - Kyung Hoon Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Kyu Sung Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea; (J.Y.L.); (R.-E.Y.); (K.H.L.); (K.S.C.); (I.H.); (K.M.K.)
- Correspondence: ; Tel.: +82-2-2072-3280
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9
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Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, Park JS, Yoo RE, Baek JH, Baek SM, Cho SW, Choi YJ, Hahn SY, Jung SL, Kim JH, Kim SK, Kim SJ, Lee CY, Lee HK, Lee JH, Lee YH, Lim HK, Shin JH, Sim JS, Sung JY, Yoon JH, Choi M. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2021; 22:2094-2123. [PMID: 34719893 PMCID: PMC8628155 DOI: 10.3348/kjr.2021.0713] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital, Gimpo, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyu Lee
- Department of Radiology, Jeju National University, Jeju, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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10
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Lee JY, Baek JH, Ha EJ, Sung JY, Shin JH, Kim JH, Lee MK, Jung SL, Lee YH, Ahn HS, Yoon JH, Choi YJ, Park JS, Lee YJ, Choi M, Na DG. 2020 Imaging Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer: Korean Society of Thyroid Radiology. Korean J Radiol 2021; 22:840-860. [PMID: 33660459 PMCID: PMC8076832 DOI: 10.3348/kjr.2020.0578] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Eun Ju Ha
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoung Lee
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chungang University Hospital, Chungang University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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He X, Guo BJ, Lei Y, Tian S, Wang T, Curran WJ, Zhang LJ, Liu T, Yang X. Thyroid gland delineation in noncontrast-enhanced CTs using deep convolutional neural networks. Phys Med Biol 2021; 66:055007. [PMID: 33590826 DOI: 10.1088/1361-6560/abc5a6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The purpose of this study is to develop a deep learning method for thyroid delineation with high accuracy, efficiency, and robustness in noncontrast-enhanced head and neck CTs. The cross-sectional analysis consisted of six tests, including randomized cross-validation and hold-out experiments, tests of prediction accuracy between cancer and benign and cross-gender analysis were performed to evaluate the proposed deep-learning-based performance method. CT images of 1977 patients with suspected thyroid carcinoma were retrospectively investigated. The automatically segmented thyroid gland volume was compared against physician-approved clinical contours using metrics, the Pearson correlation and Bland-Altman analysis. Quantitative metrics included: the Dice similarity coefficient (DSC), sensitivity, specificity, Jaccard index (JAC), Hausdorff distance (HD), mean surface distance (MSD), residual mean square distance (RMSD) and the center of mass distance (CMD). The robustness of the proposed method was further tested using the nonparametric Kruskal-Wallis test to assess the equality of distribution of DSC values. The proposed method's accuracy remained high through all the tests, with the median DSC, JAC, sensitivity and specificity higher than 0.913, 0.839, 0.856 and 0.979, respectively. The proposed method also resulted in median MSD, RMSD, HD and CMD, of less than 0.31 mm, 0.48 mm, 2.06 mm and 0.50 mm, respectively. The MSD and RMSD were 0.40 ± 0.29 mm and 0.70 ± 0.46 mm, respectively. Concurrent testing of the proposed method with 3D U-Net and V-Net showed that the proposed method had significantly improved performance. The proposed deep-learning method achieved accurate and robust performance through six cross-sectional analysis tests.
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Affiliation(s)
- Xiuxiu He
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States of America
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Alswat K, Assiri SA, Althaqafi RMM, Alsufyani A, Althagafi A, Alrebaiee S, Alsukhayri N. Scintigraphy evaluation of hyperthyroidism and its correlation with clinical and biochemical profiles. BMC Res Notes 2020; 13:324. [PMID: 32631402 PMCID: PMC7339512 DOI: 10.1186/s13104-020-05164-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/27/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Hyperthyroidism is the excessive synthesis of thyroid hormones. Thyroid uptake scans and ultrasonography provide an accurate diagnosis of hyperthyroidism, especially when thyroid receptor antibody (TRAb) measurement is not readily available. This study explored the prevalence of various hyperthyroidism causes using retrospective scintigraphy results and evaluated their relationship with clinical, biochemical, and sonographic imaging parameters from patients who underwent 99mTc-pertechnetate thyroid scans between 2016 and 2019 in Taif, Saudi Arabia, where literature is insufficient. Furthermore, the inappropriate use of thyroid scanning in different thyroid diseases was evaluated. Results The study enrolled 207 patients (mean age: 42.5 ± 14.7 years). The mean free T4, T3, antithyroid peroxidase antibody, antithyroglobulin antibody, C-reactive protein, and erythrocyte sedimentation rate levels were high. Graves’ disease was the most common diagnosis. Compared to toxic solitary/multinodular goiter, patients with Graves’ disease were usually younger, used carbimazole during both the uptake and the scan, had an enlarged thyroid gland, and had higher FT4 and FT3 levels. Inappropriate thyroid uptake and scan use was reported in approximately 10% of patients, and 25% of the patients used carbimazole during the uptake and scan. Thus, better patient education is needed to avoid misinterpreting the scan results.
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Abstract
Over the past several years, there has been an increase in the discovery of thyroid cancers, likely because of the marked increased utilization of computed tomography (CT) and MR imaging. Despite the increase in number of thyroid cancers, the overall mortality remains unchanged because most of these cancers are the differentiated type and have a more indolent behavior. CT and MR imaging are important in the preoperative evaluation of thyroid goiters and thyroid cancer. This article discusses the imaging characteristics of benign and malignant thyroid diseases, and the important information that needs to be relayed to the surgeon.
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Affiliation(s)
- Katie Suzanne Traylor
- Neuroradiology Division, Department of Radiology, University of Pittsburgh Medical Center Presbyterian, 200 Lothrop Street, South Tower, 2nd Floor, Suite 200, Pittsburgh, PA 15213, USA.
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Positron Emission Tomography and Molecular Imaging of Head and Neck Malignancies. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00366-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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