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Ryu YJ, Kim JW, Park SC, Hur YH, Kim HJ, Kim TH. Differential diagnosis of thyroid nodules using heterogeneity quantification software on ultrasound images: correlation with the Bethesda system and surgical pathology. Sci Rep 2024; 14:10288. [PMID: 38704392 PMCID: PMC11069538 DOI: 10.1038/s41598-024-60881-2] [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: 04/12/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
Ultrasonography (US)-guided fine-needle aspiration cytology (FNAC) is the primary modality for evaluating thyroid nodules. However, in cases of atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS), supplemental tests are necessary for a definitive diagnosis. Accordingly, we aimed to develop a non-invasive quantification software using the heterogeneity scores of thyroid nodules. This cross-sectional study retrospectively enrolled 188 patients who were categorized into four groups according to their diagnostic classification in the Bethesda system and surgical pathology [II-benign (B) (n = 24); III-B (n = 52); III-malignant (M) (n = 54); V/VI-M (n = 58)]. Heterogeneity scores were derived using an image pixel-based heterogeneity index, utilized as a coefficient of variation (CV) value, and analyzed across all US images. Differences in heterogeneity scores were compared using one-way analysis of variance with Tukey's test. Diagnostic accuracy was determined by calculating the area under the receiver operating characteristic (AUROC) curve. The results of this study indicated significant differences in mean heterogeneity scores between benign and malignant thyroid nodules, except in the comparison between III-M and V/VI-M nodules. Among malignant nodules, the Bethesda classification was not observed to be associated with mean heterogeneity scores. Moreover, there was a positive correlation between heterogeneity scores and the combined diagnostic category, which was based on the Bethesda system and surgical cytology grades (R = 0.639, p < 0.001). AUROC for heterogeneity scores showed the highest diagnostic performance (0.818; cut-off: 30.22% CV value) for differentiating the benign group (normal/II-B/III-B) from the malignant group (III-M/V&VI-M), with a diagnostic accuracy of 72.5% (161/122). Quantitative heterogeneity measurement of US images is a valuable non-invasive diagnostic tool for predicting the likelihood of malignancy in thyroid nodules, including AUS or FLUS.
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Affiliation(s)
- Young Jae Ryu
- Department of Surgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University College of Medicine, Chosun University Hospital, Gwangju, 61452, Republic of Korea
| | - Sang Chun Park
- Department of Surgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea
| | - Young Hoe Hur
- Department of Surgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea
| | - Hyung Joong Kim
- Medical Science Research Institute, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Tae-Hoon Kim
- Medical Science Research Institute, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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Ren JY, Lv WZ, Wang L, Zhang W, Ma YY, Huang YZ, Peng YX, Lin JJ, Cui XW. Dual-modal radiomics nomogram based on contrast-enhanced ultrasound to improve differential diagnostic accuracy and reduce unnecessary biopsy rate in ACR TI-RADS 4-5 thyroid nodules. Cancer Imaging 2024; 24:17. [PMID: 38263209 PMCID: PMC10807093 DOI: 10.1186/s40644-024-00661-3] [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: 06/21/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS, TR) 4 and 5 thyroid nodules (TNs) demonstrate much more complicated and overlapping risk characteristics than TR1-3 and have a rather wide range of malignancy possibilities (> 5%), which may cause overdiagnosis or misdiagnosis. This study was designed to establish and validate a dual-modal ultrasound (US) radiomics nomogram integrating B-mode ultrasound (BMUS) and contrast-enhanced ultrasound (CEUS) imaging to improve differential diagnostic accuracy and reduce unnecessary fine needle aspiration biopsy (FNAB) rates in TR 4-5 TNs. METHODS A retrospective dataset of 312 pathologically confirmed TR4-5 TNs from 269 patients was collected for our study. Data were randomly divided into a training dataset of 219 TNs and a validation dataset of 93 TNs. Radiomics characteristics were derived from the BMUS and CEUS images. After feature reduction, the BMUS and CEUS radiomics scores (Rad-score) were built. A multivariate logistic regression analysis was conducted incorporating both Rad-scores and clinical/US data, and a radiomics nomogram was subsequently developed. The performance of the radiomics nomogram was evaluated using calibration, discrimination, and clinical usefulness, and the unnecessary FNAB rate was also calculated. RESULTS BMUS Rad-score, CEUS Rad-score, age, shape, margin, and enhancement direction were significant independent predictors associated with malignant TR4-5 TNs. The radiomics nomogram involving the six variables exhibited excellent calibration and discrimination in the training and validation cohorts, with an AUC of 0.873 (95% CI, 0.821-0.925) and 0.851 (95% CI, 0.764-0.938), respectively. The marked improvements in the net reclassification index and integrated discriminatory improvement suggested that the BMUS and CEUS Rad-scores could be valuable indicators for distinguishing benign from malignant TR4-5 TNs. Decision curve analysis demonstrated that our developed radiomics nomogram was an instrumental tool for clinical decision-making. Using the radiomics nomogram, the unnecessary FNAB rate decreased from 35.3 to 14.5% in the training cohort and from 41.5 to 17.7% in the validation cohorts compared with ACR TI-RADS. CONCLUSION The dual-modal US radiomics nomogram revealed superior discrimination accuracy and considerably decreased unnecessary FNAB rates in benign and malignant TR4-5 TNs. It could guide further examination or treatment options.
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Affiliation(s)
- Jia-Yu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan, China
| | - Liang Wang
- Center of Computer, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying-Ying Ma
- Department of Medical Ultrasound, The First People's Hospital of Qinzhou, Qinzhou, China
| | - Yong-Zhen Huang
- Department of Medical Ultrasound, The First People's Hospital of Qinzhou, Qinzhou, China
| | - Yue-Xiang Peng
- Department of Medical Ultrasound, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Jian-Jun Lin
- Department of Medical Ultrasound, The First People's Hospital of Qinzhou, Qinzhou, China.
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Babajani A, Rahmani S, Raoufi M, Eidgahi ES, Dastjerdi AV, Behfarnia P, Khalili S, Moghaddam NA. Clinico-cytopathological subcategorization in thyroid nodules of atypia of undetermined significance/follicular lesion of undetermined significance using the TIRADS and Bethesda classifications. Front Endocrinol (Lausanne) 2023; 14:1135196. [PMID: 37313444 PMCID: PMC10258349 DOI: 10.3389/fendo.2023.1135196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/28/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction Bethesda category III - atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous class of the Bethesda system for thyroid nodules. In order to clarify the therapeutic road for clinicians, this category was subclassified based on the cytopathological features. In this study, we evaluated the risk of malignancy, surgical outcome, demographic characteristics, and correlation of ultrasound features with the final outcome in patients with thyroid nodules based on AUS/FLUS subclassification. Method After evaluating 867 thyroid nodules from three different centers, 70 (8.07%) were initially diagnosed as AUS/FLUS. The cytopathologists re-interpreted the FNA samples and subclassified them into five subcategories: architectural atypia, cytologic atypia, cytologic and architectural atypia, and Hürthle cell AUS/FLUS, and atypia, which was not specified. Based on the suspicious ultrasound features, an appropriate ACR TI-RADS score was allocated to each nodule. Finally, the malignancy rate, surgical outcomes, and ACR TI-RADS scores were evaluated among Bethesda category III nodules. Results Among the 70 evaluated nodules, 28 (40%) were subclassified as Hürthle cell AUS/FLUS, 22 (31.42%) as cytologic and architectural atypia, 8 (11.42%) as architectural atypia, 7 (10%) as cytologic atypia, and 5 (7.14%) as atypia which was not specified. The overall malignancy rate was 34.28%, and the architectural atypia and Hürthle cell nodules displayed lower malignancy compared to other groups (P-Value<0.05). Utilizing ACR TI-RADS scores showed no statistical significance between Bethesda III subcategorization and ACR TI-RADS scores. However, ACR TI-RADS can be a reliable predictor for Hürthle cell AUS/FLU nodules. Conclusion ACR TI-RADS helps evaluate malignancy only in the Hürthle cell AUS/FLUS subcategory of AUS/FLUS. Besides, cytopathological reporting based on the suggested AUS/FLUS subclassification could help clinicians take appropriate measures to manage thyroid nodules.
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Affiliation(s)
- Amirhesam Babajani
- Oncopathology Research Center, Department of Molecular Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Rahmani
- Oncopathology Research Center, Department of Molecular Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoomeh Raoufi
- Department of Radiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Shaarbaf Eidgahi
- Kidney Transplantation Complication Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Poya Behfarnia
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shayesteh Khalili
- Department of Internal Medicine, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noushin Afshar Moghaddam
- Department of Pathology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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D'Andréa G, Gal J, Mandine L, Dassonville O, Vandersteen C, Guevara N, Castillo L, Poissonnet G, Culié D, Elaldi R, Sarini J, Decotte A, Renaud C, Vergez S, Schiappa R, Chamorey E, Château Y, Bozec A. Application of machine learning methods to guide patient management by predicting the risk of malignancy of Bethesda III-V thyroid nodules. Eur J Endocrinol 2023; 188:7044677. [PMID: 36799885 DOI: 10.1093/ejendo/lvad017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Indeterminate thyroid nodules (ITN) are common and often lead to (sometimes unnecessary) diagnostic surgery. We aimed to evaluate the performance of two machine learning methods (ML), based on routinely available features to predict the risk of malignancy (RM) of ITN. DESIGN Multi-centric diagnostic retrospective cohort study conducted between 2010 and 2020. METHODS Adult patients who underwent surgery for at least one Bethesda III-V thyroid nodule (TN) with fully available medical records were included. Of the 7917 records reviewed, eligibility criteria were met in 1288 patients with 1335 TN. Patients were divided into training (940 TN) and validation cohort (395 TN). The diagnostic performance of a multivariate logistic regression model (LR) and its nomogram, and a random forest model (RF) in predicting the nature and RM of a TN were evaluated. All available clinical, biological, ultrasound, and cytological data of the patients were collected and used to construct the two algorithms. RESULTS There were 253 (19%), 693 (52%), and 389 (29%) TN classified as Bethesda III, IV, and V, respectively, with an overall RM of 35%. Both cohorts were well-balanced for baseline characteristics. Both models were validated on the validation cohort, with performances in terms of specificity, sensitivity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve of 90%, 57.3%, 73.4%, 81.4%, 84% (CI95%: 78.5%-89.5%) for the LR model, and 87.6%, 54.7%, 68.1%, 80%, 82.6% (CI95%: 77.4%-87.9%) for the RF model, respectively. CONCLUSIONS Our ML models performed well in predicting the nature of Bethesda III-V TN. In addition, our freely available online nomogram helped to refine the RM, identifying low-risk TN that may benefit from surveillance in up to a third of ITN, and thus may reduce the number of unnecessary surgeries.
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Affiliation(s)
- Grégoire D'Andréa
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
| | - Jocelyn Gal
- Department of Statistics, Centre Antoine Lacassagne, Nice 06103, France
| | - Loïc Mandine
- Department of Statistics, Centre Antoine Lacassagne, Nice 06103, France
| | - Olivier Dassonville
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
| | - Clair Vandersteen
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
| | - Nicolas Guevara
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
| | - Laurent Castillo
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
| | - Gilles Poissonnet
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
| | - Dorian Culié
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
| | - Roxane Elaldi
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
| | - Jérôme Sarini
- Otorhinolaryngology and Head and Neck Surgery Department, University Cancer Institute of Toulouse-Oncopole, Toulouse 31400, France
| | - Anne Decotte
- Otorhinolaryngology and Head and Neck Surgery Department, Toulouse University Hospital, Hôpital Larrey, Toulouse 31400, France
| | - Claire Renaud
- Thoracic Surgery Department, Toulouse University Hospital, Hôpital Larrey, Toulouse 31400, France
| | - Sébastien Vergez
- Otorhinolaryngology and Head and Neck Surgery Department, University Cancer Institute of Toulouse-Oncopole, Toulouse 31400, France
- Otorhinolaryngology and Head and Neck Surgery Department, Toulouse University Hospital, Hôpital Larrey, Toulouse 31400, France
| | - Renaud Schiappa
- Department of Statistics, Centre Antoine Lacassagne, Nice 06103, France
| | - Emmanuel Chamorey
- Department of Statistics, Centre Antoine Lacassagne, Nice 06103, France
| | - Yann Château
- Department of Statistics, Centre Antoine Lacassagne, Nice 06103, France
| | - Alexandre Bozec
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, GHS Nice University Hospital-Antoine Lacassagne Centre, Côte d'Azur University, Nice 06103, France
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Choi A, Park I, Lee HS, Chung J, Kim MJ, Park YS. Usefulness of complete blood count parameters to predict poor outcomes in cancer patients with febrile neutropenia presenting to the emergency department. Ann Med 2022; 54:599-609. [PMID: 35175159 PMCID: PMC8856028 DOI: 10.1080/07853890.2022.2031271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Febrile neutropenia (FN) is one of the major complications with high mortality rates in cancer patients undergoing chemotherapy. The Multinational Association for Supportive Care in Cancer (MASCC) risk-index score has limited applicability for routine use in the emergency department (ED). This study aimed to develop simplified new nomograms that can predict 28-day mortality and the development of serious medical complications in patients with FN by using a combination of complete blood count (CBC) parameters with quick Sequential Organ Failure Assessment (qSOFA). METHODS In this retrospective observational study, various models comprising qSOFA score and individual CBC parameters (red cell distribution width, delta neutrophil index, mean platelet volume (MPV)) were evaluated for association with outcomes by a multivariate logistic analysis. Subsequently, nomograms were developed for outcome prediction. The primary outcome was mortality at 28 days from ED presentation; the secondary outcome was the development of serious medical complications. RESULTS A total of 378 patients were included. Among the CBC parameters, only MPV was significantly associated with 28-day mortality and serious medical complications in patients with FN. The nomogram developed to predict 28-day mortality and serious medical complications showed good discrimination with area under the receiver-operating characteristic curve (AUC) values of 0.729 and 0.862 (95% CI, 0.780-0.943), respectively, which were not different from those of the MASCC score (0.814, 95% CI, 0.705-0.922; p = .07 and 0.921, 95% CI, 0.863-0.979; p = .11, respectively) in the validation set. The calibration of both nomograms demonstrated good agreement in the validation set. CONCLUSION In this study, a novel prognostic nomogram using qSOFA score and MPV to identify cancer patients with FN with high risk of 28-day mortality and serious medical complications was verified and validated. Prompt management of fatal complications of FN can be possible through early prediction of poor outcomes with these new nomograms.KEY MESSAGESAmong the evaluated CBC parameters, only mean platelet volume was associated with 28-day mortality and serious medical complications in cancer patients with febrile neutropenia.A novel and rapid prognostic nomogram was developed using quick Sequential Organ Failure Assessment score and mean platelet volume to identify cancer patients with febrile neutropenia having high risk of 28-day mortality and serious medical complications.The nomogram developed to predict 28-day mortality and serious medical complications in patients with febrile neutropenia showed good discrimination and provides rapid patient evaluation that is especially applicable in the emergency department.
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Affiliation(s)
- Arom Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinseok Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Yu B, Li Y, Yu X, Ai Y, Jin J, Zhang J, Zhang Y, Zhu H, Xie C, Shen M, Yang Y, Jin X. Differentiate Thyroid Follicular Adenoma from Carcinoma with Combined Ultrasound Radiomics Features and Clinical Ultrasound Features. J Digit Imaging 2022; 35:1362-1372. [PMID: 35474555 PMCID: PMC9582092 DOI: 10.1007/s10278-022-00639-2] [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: 08/05/2021] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022] Open
Abstract
Noninvasive differentiating thyroid follicular adenoma from carcinoma preoperatively is of great clinical value to decrease the risks resulted from excessive surgery for patients with follicular neoplasm. The purpose of this study is to investigate the accuracy of ultrasound radiomics features integrating with ultrasound features in the differentiation between thyroid follicular carcinoma and adenoma. A total of 129 patients diagnosed as thyroid follicular neoplasm with pathologically confirmed follicular adenoma and carcinoma were enrolled and analyzed retrospectively. Radiomics features were extracted from preoperative ultrasound images with manually contoured targets. Ultrasound features and clinical parameters were also obtained from electronic medical records. Radiomics signature, combined model integrating radiomics features, ultrasound features, and clinical parameters were constructed and validated to differentiate the follicular carcinoma from adenoma. A total of 23 optimal features were selected from 449 extracted radiomics features. Clinical and ultrasound parameters of sex (p = 0.003), interior structure (p = 0.035), edge (p = 0.02), platelets (p = 0.007), and creatinine (p = 0.001) were associated with the differentiation between benign and malignant follicular neoplasm. The values of area under curves (AUCs) of the radiomics signature, clinical model, and combined model were 0.772 (95% CI: 0.707-0.838), 0.792 (95% CI: 0.715-0.869), and 0.861 (95% CI: 0.775-0.909), respectively. A final corrected AUC of 0.844 was achieved for the combined model after internal validation. Radiomics features from ultrasound images combined with ultrasound features and clinical factors are feasible to differentiate thyroid follicular carcinoma from adenoma noninvasive before operation to decrease the unnecessary of diagnostic thyroidectomy for patients with benign follicular adenoma.
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Affiliation(s)
- Bing Yu
- Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, 32500, China
| | - Yanyan Li
- Department of Ultrasound Imaging, Wenzhou Medical University Second Affiliated Hospital, Wenzhou, 32500, China
| | - Xiangle Yu
- Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yao Ai
- Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, 32500, China
| | - Juebin Jin
- Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, 32500, China
| | - Ji Zhang
- Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, 32500, China
| | - YuHua Zhang
- Department of Ultrasound Imaging, Wenzhou Medical University Second Affiliated Hospital, Wenzhou, 32500, China
| | - Hui Zhu
- Department of Ultrasound Imaging, Wenzhou Medical University Second Affiliated Hospital, Wenzhou, 32500, China
| | - Congying Xie
- Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, 32500, China
- Radiation and Medical Oncology, Wenzhou Medical University Second Affiliated Hospital, Wenzhou, 32500, China
| | - Meixiao Shen
- Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Yan Yang
- Department of Ultrasound Imaging, Wenzhou Medical University Second Affiliated Hospital, Wenzhou, 32500, China.
| | - Xiance Jin
- Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, 32500, China.
- School of Basic Medical Science, Wenzhou Medical University, Wenzhou, 325000, China.
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Alshahrani AS, Alamri AS, Balkhoyor AH, Mahzari MM, Alshieban SS, Majed PM. The Prediction of Malignancy Risk in Thyroid Nodules Classified as Bethesda System Category III (AUS/FLUS) and the Role of Ultrasound Finding for Prediction of Malignancy Risk. Cureus 2021; 13:e17924. [PMID: 34660116 PMCID: PMC8512574 DOI: 10.7759/cureus.17924] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/31/2022] Open
Abstract
Objective To predict the risk of malignancy in category III of the Bethesda System for Reporting Thyroid Cytopathology "Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS)" at King Abdulaziz Medical City, Riyadh, Saudi Arabia. It also intends to determine other possible contributing predictors of malignancy in thyroid nodules such as age, sex, and ultrasound (US) findings. Method This retrospectively designed study included 187 patients (mean age, 43.9 ± 14.1 years) with thyroid nodules, which were diagnosed as AUS/FLUS and all patients included had total thyroidectomy or lobectomy between January 2013 and December 2018 at King Abdulaziz Medical City in Riyadh, Saudi Arabia. The electronic medical records, US images, and final cytopathology and histopathology reports were reviewed and analyzed. Result The overall incidence of AUS/FLUS was (46.5%). Multivariate analysis of US features revealed that malignancy was significantly associated with nodules with irregular margins, microcalcification, multiple numbers (P < 0.001), and hypoechogenicity (P 0.04). Conclusion Despite the high rate of malignancy of nodules AUS/FLUS, it is still consistent with previously reported studies. The highly suspicious ultrasound features (irregular margins, microcalcification, multiple nodules, and hypoechogenicity) could be helpful in the diagnosis of thyroid cancer.
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Affiliation(s)
- Awad S Alshahrani
- Department of Adult Endocrinology, King Abdulaziz Medical City, Riyadh, SAU.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | - Moeber M Mahzari
- Department of Adult Endocrinology, King Abdulaziz Medical City, Riyadh, SAU.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Population Health Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Saeed S Alshieban
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, SAU.,College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU.,Population Health Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Pharaon M Majed
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, SAU
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The Prognostic Usefulness of the Lactate/Albumin Ratio for Predicting Clinical Outcomes in Out-of-Hospital Cardiac Arrest: a Prospective, Multicenter Observational Study (koCARC) Study. Shock 2021; 53:442-451. [PMID: 31306348 DOI: 10.1097/shk.0000000000001405] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the lactate/albumin ratio (LAR) to identify its significance as a prognostic marker for favorable neurologic outcome and survival in patients with return of spontaneous circulation after out-of-hospital cardiac arrest (OHCA). Based on the LAR and multiple parameters, we developed new nomograms and externally validated the tools. METHODS We conducted an observational study using a prospective, multicenter registry of out-of-cardiac arrest resuscitation provided by the Korean Cardiac Arrest Research Consortium registry from October 2015 to June 2017. RESULTS A total of 524 patients were included in this study. An increased LAR was significantly associated with decreased favorable neurologic outcomes (odds ratio [OR] 0.787; 95% confidence interval [CI], 0.630-0.983; P = 0.035) and survival at discharge (OR 0.744; 95% CI, 0.638-0.867; P < 0.001). The areas under the curve (AUCs) for predicting neurologic outcome and survival to discharge using the LAR were 0.824 (P < 0.001) and 0.781 (P < 0.001), respectively. An LAR value of more than the optimal cutoff values of 2.82 and 3.62 could significantly improve prediction of decreased favorable neurologic outcome and survival to discharge, respectively. We constructed nomograms based on the multivariate logistic model. The model for predicting favorable neurologic outcomes and survival discharge had AUCs of 0.927 (P < 0.001) and 0.872 (P < 0.001), respectively. CONCLUSION The prognostic performance of the LAR was superior to a single measurement of lactate for predicting favorable neurologic outcomes and survival to discharge after OHCA. The newly developed nomograms can provide rapid prediction of probability of clinical outcomes.
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Liu Y, Zhao Y, Fu J, Liu S. Ultrasonographic differentiation and Ultrasound-based management of partially cystic thyroid nodules. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:336-341. [PMID: 33939910 DOI: 10.20945/2359-3997000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To determine sonographic features of malignancy in partially cystic thyroid nodules and assess the diagnostic efficacy of these features for differentiating between benign and malignant lesions in the nodules with indeterminate cytology. Methods From January 2016 to December 2017, a total of 91 patients with 94 partially cystic thyroid nodules who had undergone ultrasound-guided fine-needle aspiration biopsy and thyroid surgery in our hospital were included in this study. The sonographic features of the thyroid nodules were analyzed to identify the predictive features of malignancy and assess the diagnostic efficacy of these features. Results The features of hypoechogenicity, microcalcification, composition, and an eccentric solid component with an acute angle had statistically significant associations with malignant nodule (p<005) by univariable analysis. Binary logistic regression analysis showed that microcalcification and hypoechogenicity were significantly associated with malignancy. Using the combination of microcalcification, hypoechogenicity, and a solid component comprising of greater than or equal to 50% of the total volume, the diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 97.6%, 32.7%, 53.9%, and 94.4%, respectively. In these nodules with indeterminate cytology, this combination also exhibited a high sensitivity of 92.3% and an NPV of 83.3%. Conclusion This study demonstrated that microcalcification and hypoechogenicity were independently associated with malignancy in partially cystic thyroid nodules. The combination of microcalcification, hypoechogenicity, and a solid portion that is greater than or equal to 50% of the total volume will help guide clinical decisions in mixed cystic solid nodules.
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Affiliation(s)
- Yanjun Liu
- Department of Endocrinology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Yanru Zhao
- Department of Endocrinology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Jiao Fu
- Department of Endocrinology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Shu Liu
- Department of Endocrinology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China,
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Yousefi E, Sura GH, Somma J. The gray zone of thyroid nodules: Using a nomogram to provide malignancy risk assessment and guide patient management. Cancer Med 2021; 10:2723-2731. [PMID: 33763983 PMCID: PMC8026948 DOI: 10.1002/cam4.3866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/04/2021] [Accepted: 03/13/2021] [Indexed: 01/21/2023] Open
Abstract
Background Thyroid nodules have a low prevalence of malignancy and most proven cancers do not behave aggressively. Thus, risk‐stratification of nodules is a critical step to avoid surgical overtreatment. We hypothesized that a risk management system superior to those currently in use could be created to reduce the number of clinically indeterminate nodules (i.e., the “gray zone”) by concurrently considering the malignancy risks conferred by clinical, ultrasonographic, and cytologic variables. Methods Thyroidectomy cases were reviewed from three institutions. Their benign versus malignant outcome was used to evaluate the variables for correlation. A binary logistic regression model was trained and, using indeterminate nodules with Bethesda III and IV results, validated. A scoring nomogram was designed to demonstrate the application of the model in clinical practice. Results One hundred thirty thyroidectomies (28% malignant) met inclusion criteria. The final logistic regression model included difficulty in swallowing, hypothyroidism, echogenicity, hypervascularity, margins, calcification, and cytology diagnosis as input parameters. The model was highly successful in determining the outcome (p value: 0.001) with a R2(Nagelkerke) score of 0.93. The area under the curve as determined by receiver operating characteristics was 0.91. The accuracy of the model on the training dataset was 93% (sensitivity and specificity 92% and 96%, respectively) and, on the validation dataset, 80% (sensitivity and specificity 91% and 67%, respectively). Conclusions We report a model for risk assessment of thyroid nodules that has the potential to significantly reduce indeterminates and surgical overtreatment. We illustrate its application via a straightforward nomogram, which integrates clinical, ultrasonographic, and cytologic data, and can be used to create clear, evidence‐based management plans for patients.
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Affiliation(s)
- Elham Yousefi
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Gloria H Sura
- Department of Pathology, LSU Health Sciences Center, New Orleans, LA, USA
| | - Jonathan Somma
- Department of Pathology, LSU Health Sciences Center, New Orleans, LA, USA
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Yoon J, Lee E, Kang SW, Han K, Park VY, Kwak JY. Implications of US radiomics signature for predicting malignancy in thyroid nodules with indeterminate cytology. Eur Radiol 2021; 31:5059-5067. [PMID: 33459858 DOI: 10.1007/s00330-020-07670-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/16/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the role of the radiomics score using US images to predict malignancy in AUS/FLUS and FN/SFN nodules. METHODS One hundred fifty-five indeterminate thyroid nodules in 154 patients who received initial US-guided FNA for diagnostic purposes were included in this retrospective study. A representative US image of each tumor was acquired, and square ROIs covering the whole nodule were drawn using the Paint program of Windows 7. Texture features were extracted by in-house texture analysis algorithms implemented in MATLAB 2019b. The LASSO logistic regression model was used to choose the most useful predictive features, and ten-fold cross-validation was performed. Two prediction models were constructed using multivariable logistic regression analysis: one based on clinical variables, and the other based on clinical variables with the radiomics score. Predictability of the two models was assessed with the AUC of the ROC curves. RESULTS Clinical characteristics did not significantly differ between malignant and benign nodules, except for mean nodule size. Among 730 candidate texture features generated from a single US image, 15 features were selected. Radiomics signatures were constructed with a radiomics score, using selected features. In multivariable logistic regression analysis, higher radiomics score was associated with malignancy (OR = 10.923; p < 0.001). The AUC of the malignancy prediction model composed of clinical variables with the radiomics score was significantly higher than the model composed of clinical variables alone (0.839 vs 0.583). CONCLUSIONS Quantitative US radiomics features can help predict malignancy in thyroid nodules with indeterminate cytology.
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Affiliation(s)
- Jiyoung Yoon
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunjung Lee
- Department of Computational Science and Engineering, Yonsei University, Seoul, South Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University, College of Medicine, Seoul, South Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Vivian Youngjean Park
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea.
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12
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Suh YJ, Choi YJ. Strategy to reduce unnecessary surgeries in thyroid nodules with cytology of Bethesda category III (AUS/FLUS): a retrospective analysis of 667 patients diagnosed by surgery. Endocrine 2020; 69:578-586. [PMID: 32297204 DOI: 10.1007/s12020-020-02300-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Fine-needle aspiration (FNA) is widely used for the diagnosis of thyroid nodules detected by ultrasonography. However, the cytology of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) often leads to unnecessary thyroid surgery. This study aimed to identify a strategy to reduce unnecessary surgeries in patients with AUS/FLUS nodules. METHODS Medical records of 667 patients with the cytology of AUS/FLUS who underwent surgery from January 2007 to December 2017 were retrospectively reviewed. Clinicopathological data were analyzed to identify malignant factors in thyroid nodules with AUS/FLUS. Factors were compared between patients with thyroid cancer and those with benign thyroid nodules, using stepwise multivariate logistic regression and decision tree model. RESULTS Pathological thyroid cancer was identified in 193 (43.3%) patients. There was a significant difference in malignancy incidence with respect to family history, number of nodules, number of FNAs, ultrasonographic finding, lymphocytic thyroiditis, and BRAFV600E mutation. Multivariate analysis showed that ultrasonography (K-TIRADS 5) was the most influential independent predictor of malignancy in AUS/FLUS (odds ratio = 11.02, p < 0.001), followed by possessing BRAFV600E mutation (odds ratio = 4.54, p < 0.001). This strategy enabled 226 (89.3%) patients to avoid unnecessary surgeries based on the decision tree model. There was no node of repeated FNA in the decision tree model, which reduced the risk of malignancy (odds ratio = 0.35, p = 0.029). CONCLUSION K-TIRADS 5 and BRAFV600E mutation were predictive of malignancy in nodules of AUS/FLUS. These factors should be considered in strategies to reduce unnecessary surgeries for AUS/FLUS.
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Affiliation(s)
- Yong Joon Suh
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang, 14068, Republic of Korea.
| | - Yeon Ju Choi
- Research Cooperation Center, Hallym University, Chuncheon, 24252, Republic of Korea
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Lee DH, Yoon CS, Lim BJ, Lee HS, Kim S, Choi AL, Kim S. Ultrasound Feature-Based Diagnostic Model Focusing on the "Submarine Sign" for Epidermal Cysts among Superficial Soft Tissue Lesions. Korean J Radiol 2020; 20:1409-1421. [PMID: 31544366 PMCID: PMC6757000 DOI: 10.3348/kjr.2019.0241] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/23/2019] [Indexed: 02/05/2023] Open
Abstract
Objective To develop a diagnostic model for superficial soft tissue lesions to differentiate epidermal cyst (EC) from other lesions based on ultrasound (US) features. Materials and Methods This retrospective study included 205 patients who had undergone US examinations for superficial soft tissue lesions and subsequent surgical excision. The study population was divided into the derivation set (n = 112) and validation set (n = 93) according to the imaging date. The following US features were analyzed to determine those that could discriminate EC from other lesions: more-than-half-depth involvement of the dermal layer, “submarine sign” (focal projection of the hypoechoic portion to the epidermis), posterior acoustic enhancement, posterior wall enhancement, morphology, shape, echogenicity, vascularity, and perilesional fat change. Using multivariable logistic regression, a diagnostic model was constructed and visualized as a nomogram. The performance of the diagnostic model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curve and calibration plot in both the derivation and validation sets. Results More-than-half-depth involvement of the dermal layer (odds ratio [OR] = 3.35; p = 0.051), “submarine sign” (OR = 12.2; p < 0.001), and morphology (OR = 5.44; p = 0.002) were features that outweighed the others when diagnosing EC. The diagnostic model based on these features showed good discrimination ability in both the derivation set (AUC = 0.888, 95% confidence interval [95% CI] = 0.825–0.950) and validation set (AUC = 0.902, 95% CI = 0.832–0.972). Conclusion More-than-half-depth of involvement of the dermal layer, “submarine sign,” and morphology are relatively better US features than the others for diagnosing EC.
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Affiliation(s)
- Da Hyun Lee
- Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Choon Sik Yoon
- Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Jin Lim
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Sinae Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - A Lam Choi
- Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
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Li F, Pan D, Wu Y, Peng J, Li Q, Gui X, Ma W, Yang H, He Y, Chen J. Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule. Diagn Cytopathol 2019; 47:881-889. [PMID: 31211509 PMCID: PMC6772092 DOI: 10.1002/dc.24248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022]
Abstract
Background This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. Methods We reviewed patient records in which the results of ultrasound‐guided fine‐needle aspiration (US‐FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. Results Fifty‐nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta‐analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34‐7.14, P < .001), 2.18 (95% CI: 1.39‐3.42, P = .001), 2.02 (95% CI: 1.35‐3.01, P = .001), 3.21 (95% CI: 2.26‐4.56, P < .001), and 4.35 (95% CI: 3.07‐6.15, P < .001), respectively. Conclusion As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC‐type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non‐PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.
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Affiliation(s)
- Fu Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Denghua Pan
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yuquan Wu
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Jinbo Peng
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Qing Li
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xiaolong Gui
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Wei Ma
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Hong Yang
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yun He
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Junqiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
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Öcal B, Korkmaz MH, Yılmazer D, Taşkın Türkmenoğlu T, Bayır Ö, Saylam G, Çadallı Tatar E, Karahan S, Çakal E. The Malignancy Risk Assessment of Cytologically Indeterminate Thyroid Nodules Improves Markedly by Using a Predictive Model. Eur Thyroid J 2019; 8:83-89. [PMID: 31192147 PMCID: PMC6514482 DOI: 10.1159/000494720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/15/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The majority of thyroid nodules are discovered incidentally, and the management may be a challenge if the fine needle aspiration specimen yields indeterminate findings. Our aim was to develop an individualized risk prediction model to provide an accurate estimate of cancer risk in patients with cytologically indeterminate thyroid nodules. MATERIALS AND METHODS Clinical records, ultrasound images, and cytopathology reports of patients who underwent thyroidectomy were retrospectively reviewed. Logistic regression analysis was used to identify the predictive ability of each variable for malignancy, and a nomogram was built by integrating patients' age, multiplicity of nodules, cytology results, and suspicious ultrasound features, such as microcalcifications and irregular margins. RESULTS For the 233 indeterminate nodules according to the Bethesda System for Reporting Thyroid Cytopathology, the malignancy rates of the subgroups "atypia of undetermined significance," "suspicious follicular neoplasia," and "suspicious for malignancy" were 44.3, 47.7, and 88.0%, respectively. It was found that the Bethesda category "suspicious for malignancy," microcalcifications, and irregular margins were independent risk factors for malignancy. The area under the receiver operating characteristics curve was 0.784, which suggested that the presented nomogram had considerable discriminative performance. CONCLUSIONS The nomogram developed in our study accurately predicts the malignancy risk of thyroid nodules with indeterminate cytology by using clinical, cytological, and ultrasonographic features.
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Affiliation(s)
- Bülent Öcal
- Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
- *Bülent Öcal, Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım, Beyazıt Training and Research Hospital, 20 Irfan Bastug St. Altindag, TR–06110 Ankara (Turkey), E-Mail
| | - Mehmet Hakan Korkmaz
- Department of Otolaryngology, Yıldırım Beyazıt University Medical School, Ankara, Turkey
| | - Demet Yılmazer
- Department of Pathology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Tuğba Taşkın Türkmenoğlu
- Department of Pathology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ömer Bayır
- Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erman Çakal
- Department of Endocrinology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Clinical Parameter for Deciding the BRAFV600E Mutation Test in Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance Thyroid Nodules: US Features According to TIRADS. Ultrasound Q 2018; 33:284-288. [PMID: 28877096 DOI: 10.1097/ruq.0000000000000313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the usefulness of a thyroid imaging reporting and data system (TIRADS) to select thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytology for additional BRAF mutation testing. Three hundred three thyroid nodules were included. Statistical analysis was performed at both patient and nodule levels according to BRAF mutation positivity and clinical factors. Univariate and multivariate logistic regression analyses were performed to assess independent associations between BRAF mutation positivity and clinical factors. Of 303 AUS/FLUS nodules, 16 (5.3%) of 303 nodules had the BRAF mutation. The frequency of the BRAF mutation according to the TIRADS was 35.7% for category 5, 10.8% for category 4c, 2.5% for category 4b, 1.1% for category 4a, and 0% for category 3 nodules (P < 0.001). On multivariate analysis, BRAF mutation positivity was significantly associated with high suspicion on the TIRADS (odds ratio, 15.247; P < 0.001). In conclusion, the ultrasonography patterns of the TIRADS can be used as a clinical parameter for deciding the BRAF mutation test in thyroid nodules with AUS/FLUS cytology.
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17
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Giusti M, Massa B, Balestra M, Calamaro P, Gay S, Schiaffino S, Turtulici G, Zupo S, Monti E, Ansaldo G. Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes. J Zhejiang Univ Sci B 2018; 18:555-566. [PMID: 28681580 DOI: 10.1631/jzus.b1600075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The cytology of 130 indeterminate nodules (Thy 3) was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a (atypical features) and Thy 3f (follicular lesion) categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonography (US), semi-quantitative elastography-US (USE), contrast-enhanced US (CEUS), and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgically-treated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a (26%) and Thy 3f (14%) nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f (29%) than in Thy 3a (3%) nodules (P=0.01). The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules (P=0.04). Receiver-operating characteristic (ROC) analysis was used to obtain cut-off values from US (score), USE (ELX 2/1 strain index), and CEUS (time-to-peak index and peak index) data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is >2, ELX 1/2 strain index >1, time-to-peak index >1, and peak index <1. In a sub-group of 24 revised nodules (12 Thy 3a and 12 Thy 3f) with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values (83% and 100%, respectively) for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.
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Affiliation(s)
- Massimo Giusti
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Barbara Massa
- Cytopathology and Pathology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | | | - Paola Calamaro
- Cytopathology and Pathology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Stefano Gay
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | | | | | - Simonetta Zupo
- Molecular Diagnostic Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Eleonora Monti
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Gianluca Ansaldo
- Endocrinology Surgery Unit, San Martino University Hospital, I-16100 Genoa, Italy
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Valderrabano P, McIver B. Evaluation and Management of Indeterminate Thyroid Nodules: The Revolution of Risk Stratification Beyond Cytological Diagnosis. Cancer Control 2018; 24:1073274817729231. [PMID: 28975825 PMCID: PMC5937245 DOI: 10.1177/1073274817729231] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In accordance with National Guidelines, we currently follow a linear approach to the diagnosis of thyroid nodules, with management decision based primarily on a cytological diagnosis following fine-needle aspiration biopsy. However, 25% of these biopsies render an indeterminate cytology, leaving uncertainty regarding appropriate management. Individualizing the risk of malignancy of these nodules could improve their management significantly. We summarize the current evidence on the relevance of clinical information, radiological features, cytological features, and molecular markers tests results and describe how these can be integrated to personalize the management of thyroid nodules with indeterminate cytology. Several factors can be used to stratify the risk of malignancy in thyroid nodules with indeterminate cytology. Male gender, large tumors (>4 cm), suspicious sonographic patterns, and the presence of nuclear atypia on the cytology are all associated with an increased cancer prevalence. The added value of current molecular markers in the risk stratification process needs further study because their performance seems compromised in some clinical settings and remains to be validated in others. Risk stratification is possible in thyroid nodules with indeterminate cytology using data that are often underused by current guidelines. Future guidelines should integrate these factors and personalize the recommended diagnostic and therapeutic approaches accordingly.
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Affiliation(s)
- Pablo Valderrabano
- 1 Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Bryan McIver
- 1 Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Choi YJ, Baek JH, Shin JH, Shim WH, Kim SO, Lee WH, Song DE, Kim TY, Chung KW, Lee JH. Web-based thyroid imaging reporting and data system: Malignancy risk of atypia of undetermined significance or follicular lesion of undetermined significance thyroid nodules calculated by a combination of ultrasonography features and biopsy results. Head Neck 2018; 40:1917-1925. [PMID: 29756265 DOI: 10.1002/hed.25173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/03/2017] [Accepted: 02/15/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to construct a web-based predictive model using ultrasound characteristics and subcategorized biopsy results for thyroid nodules of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) to stratify the risk of malignancy. METHODS Data included 672 thyroid nodules from 656 patients from a historical cohort. We analyzed ultrasound images of thyroid nodules and biopsy results according to nuclear atypia and architectural atypia. Multivariate logistic regression analysis was performed to predict whether nodules were diagnosed as malignant or benign. RESULTS The ultrasound features, including spiculated margin, marked hypoechogenicity, calcifications, biopsy results, and cytologic atypia, showed significant differences between groups. A 13-point risk scoring system was developed, and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the development and validation sets were 0.837 and 0.830, respectively (http://www.gap.kr/thyroidnodule_b3.php). CONCLUSION We devised a web-based predictive model using the combined information of ultrasound characteristics and biopsy results for AUS/FLUS thyroid nodules to stratify the malignant risk.
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Affiliation(s)
- Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Won-Hong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Kim JY, Jeon KJ, Kim MG, Park KH, Huh JK. A nomogram for classification of temporomandibular joint disk perforation based on magnetic resonance imaging. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:682-692. [PMID: 29574057 DOI: 10.1016/j.oooo.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to analyze risk factors and establish a prediction model for temporomandibular joint (TMJ) disk perforation by constructing a nomogram. STUDY DESIGN The study included a total of 282 joints in 274 patients. All patients underwent open TMJ surgery after obtaining magnetic resonance imaging (MRI), from 2005 to 2015. The presence or absence of disk perforation was confirmed during the operation. Patients were classified into 2 groups: perforation and nonperforation groups. We investigated demographic data and the characteristics of the disk, joint space, and bone on MRI. A logistic regression analysis was performed to analyze risk factors. A nomogram was constructed and validated internally and externally. RESULTS Risk factors for disk perforation were increased age, disk shape (eyeglass or amorphous), low bone marrow signal, abnormal joint space, and 2 or more bony changes in the condyle and fossa. The area under the receiver operating characteristic curve of the nomogram was 0.908 (95% confidence interval [CI] 0.869-0.946) in the internal validation and 0.889 (95% CI 0.804-0.973) in the external validation with good suitability. CONCLUSIONS We were able to predict the probability of disk perforation with analyzed risk factors and constructed a nomogram, which may be helpful in proper diagnosis and treatment.
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Affiliation(s)
- Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kug-Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yongin Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Myeong-Gyun Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Kwang-Ho Park
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Republic of Korea.
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22
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Turkyilmaz S, Ulusahin M, Celebi B, Cekic AB, Mungan S, Kucuktulu U, Tasdelen A, Guner A, Cinel A. Thyroid nodules classified as atypia or follicular lesions of undetermined significance deserve further research: Analysis of 305 surgically confirmed nodules. Cytopathology 2017; 28:391-399. [PMID: 28714532 DOI: 10.1111/cyt.12438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of the present study was to determine the malignancy risk for nodules categorised as atypia or follicular lesions of undetermined significance atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and to investigate the predictors of malignancy. METHODS All nodules diagnosed as AUS/FLUS on fine needle aspiration (FNAs) performed between January 2011 and December 2015 were retrospectively reviewed. Clinical data, ultrasonographic features, follow-up data and the final pathological results were recorded. After further exclusion, only nodules that underwent surgical excision were included in the final analysis. The malignancy rate and the range of malignancy rates were calculated. Clinical and ultrasound features were examined to determine the predictors of malignancy. RESULTS During the study period, FNA was performed on 9938 nodules, and 1019 (10.2%) nodules were diagnosed as AUS/FLUS. After further exclusion, 976 nodules were evaluated. After the initial diagnosis of AUS/FLUS, 139 (14.2%) patients underwent surgery, 518 (53.1%) had repeated FNAs. A total of 305 (31%) had undergone surgical excision at different time points. For surgically confirmed nodules, the malignancy rate after the initial FNA was 34.5% (the lower and upper thresholds for the malignancy rate were 19.3% and 66.3%, respectively), and 37.9% after the repeated FNA. No ultrasound feature was determined as a predictor, whereas age (>55 years) was a predictor for malignancy. CONCLUSIONS The overall malignancy rate for nodules diagnosed as AUS/FLUS and the malignancy rate for nodules that underwent repeated FNA after AUS/FLUS were higher than the expected malignancy rates of the National Cancer Institute. It is, therefore, suggested that the current recommendations should be reconsidered.
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Affiliation(s)
- S Turkyilmaz
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - M Ulusahin
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - B Celebi
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - A B Cekic
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - S Mungan
- Department of Pathology, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - U Kucuktulu
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - A Tasdelen
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - A Guner
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - A Cinel
- Department of General Surgery, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
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23
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Gao LY, Wang Y, Jiang YX, Yang X, Liu RY, Xi XH, Zhu SL, Zhao RN, Lai XJ, Zhang XY, Zhang B. Ultrasound is helpful to differentiate Bethesda class III thyroid nodules: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6564. [PMID: 28422844 PMCID: PMC5406060 DOI: 10.1097/md.0000000000006564] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fine-needle aspiration (FNA) is the most dependable tool to triage thyroid nodules for medical or surgical management. However, Bethesda class III cytology, namely "follicular lesion of undetermined significance" (FLUS) or "atypia of undetermined significance" (AUS), is a major limitation of the US-FNA in assessing thyroid nodules. As the most important imaging method, ultrasound (US) has a high efficacy in diagnosing thyroid nodules. This meta-analysis aimed to assess the role of US in evaluating Bethesda class III thyroid nodules. METHODS With keywords "Undetermined Significance," "Bethesda Category III," "Bethesda system," "Cytological Subcategory," "AUS/FLUS," "Atypia of Undetermined Significance," and "Ultrasound/US," papers in PubMed, Cochrane Library, Medline, Web of Science, Embase, and Google Scholar from inception to December 2016 were searched. A meta-analysis of these trials was then performed for evaluating the diagnostic value of thyroid ultrasound in Bethesda Category III thyroid nodules. RESULTS Fourteen studies including 2405 nodules were analyzed. According to the criteria for US diagnosis of thyroid nodules in each article, with any one of suspicious features as indictors of malignancy, US had a pooled sensitivity of 0.75 (95% CI 0.72-0.78) and a pooled specificity of 0.48 (95% CI 0.45-0.50) in evaluating Bethesda Class III Nodules. The pooled diagnostic odds ratio was 10.92 (95% CI 6.04-19.74). The overall area under the curve was 0.84 and the Q* index was 0.77. With any 2 or 3 of US suspicious features as indictors of malignancy, the sensitivity and specificity were 0.77 (95% CI 0.71-0.83) and 0.54 (95% CI 0.51-0.58), 0.66 (95% CI 0.59-0.73) and 0.71 (95% CI 0.68-0.74), respectively. CONCLUSIONS US was helpful for differentiating benign and malignant Bethesda class III thyroid nodules, with the more suspicious features, the more likely to be malignant.
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Affiliation(s)
- Lu-Ying Gao
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
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Choi YJ, Baek JH, Suh CH, Shim WH, Jeong B, Kim JK, Song DE, Kim TY, Chung KW, Lee JH. Core-needle biopsy versus repeat fine-needle aspiration for thyroid nodules initially read as atypia/follicular lesion of undetermined significance. Head Neck 2016; 39:361-369. [PMID: 27704650 DOI: 10.1002/hed.24597] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the role of core-needle biopsy (CNB) by comparing the results of CNB and repeat fine-needle aspiration (FNA) for thyroid nodules that are initially read as atypia/follicular lesion of undetermined significance (AUS/FLUS) on FNA. METHODS Among 2631 initial AUS/FLUS FNA results, 505 consecutive nodules (295 repeat FNAs and 210 CNBs) were retrospectively analyzed. The primary outcome was inconclusive (ie, nondiagnostic or AUS/FLUS). The secondary outcomes included inconclusive results of the subcategory, risk factors for inconclusive results, and diagnostic performance. RESULTS CNB demonstrated significantly fewer inconclusive results than repeat FNA for the overall nodules (40.9% vs 63%; p < .001). Repeat FNA and group FLUS were significant risk factors for inconclusive results (odds ratio = 1.92; p =.001 and odds ratio = 2.08; p <.001, respectively). All diagnostic performances using CNB were higher than repeat FNAs. CONCLUSION CNB is more useful than repeat FNAs for reducing inconclusive results and improving the diagnostic performance of thyroid nodules with initial AUS/FLUS FNA results. © 2016 Wiley Periodicals, Inc. Head Neck 39: 361-369, 2017.
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Affiliation(s)
- Young Jun Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Woo Hyun Shim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Boseul Jeong
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea
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Yoon JH, Kwon HJ, Kim EK, Moon HJ, Kwak JY. Subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS): a study applying Thyroid Imaging Reporting and Data System (TIRADS). Clin Endocrinol (Oxf) 2016; 85:275-82. [PMID: 26639612 DOI: 10.1111/cen.12987] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/01/2015] [Accepted: 11/25/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the clinical significance and compare the imaging features according to the Thyroid Image Reporting and Data System (TIRADS) between atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) subcategories. DESIGN & PATIENTS A total of 192 thyroid nodules in 188 patients (mean age: 50·2 ± 11·8 years) that had been initially diagnosed as AUS/FLUS on US-guided fine needle aspiration (US-FNA) were included. One cytopathologist retrospectively reviewed the cytology slides, subcategorizing cytology results into AUS and FLUS. A TIRADS category was assigned to each thyroid nodule according to the number of suspicious US features. Clinical, US features and malignancy rates were compared between the two subcategories. RESULTS Of the 192 AUS/FLUS lesions, 149 (77·6%) were subcategorized as AUS and 43 (22·4%) as FLUS. Of the 192 AUS/FLUS nodules, 82 (42·7%) were malignant. The malignancy rates between AUS and FLUS subcategories were not significantly different, 45·6% to 32·6%, respectively (P = 0·127). When applying TIRADS, significant differences were seen in TIRADS category between benign and malignant nodules in the AUS subcategory (P < 0·001), but not in the FLUS subcategory (P = 0·414). The malignancy rates in TIRADS categories 3, 4a, 4b, 4c and 5 were 15·4%, 22·2%, 33·3%, 57·1% and 80·0% (P < 0·001) in AUS nodules and 40·0%, 50·0%, 23·5%, 22·2% and 0·0% (P = 0·414) in FLUS nodules, respectively. CONCLUSION Suspicious US features are useful in predicting malignancy among AUS subcategories but not in FLUS subcategories. Subcategorization into AUS and FLUS cytology may be helpful in deciding upon treatment or management of thyroid nodules.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Seoul, Korea
| | - Hyeong Ju Kwon
- Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea
- Department of Pathology, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Seoul, Korea
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Jang EK, Kim WG, Kim EY, Kwon H, Choi YM, Jeon MJ, Baek JH, Lee JH, Kim TY, Shong YK, Choi J, Song DE, Kim WB. Usefulness of NRAS codon 61 mutation analysis and core needle biopsy for the diagnosis of thyroid nodules previously diagnosed as atypia of undetermined significance. Endocrine 2016; 52:305-12. [PMID: 26547216 DOI: 10.1007/s12020-015-0773-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/08/2015] [Indexed: 12/11/2022]
Abstract
A repeat fine needle aspiration (FNA) is recommended for thyroid nodules diagnosed as atypia of undetermined significance (AUS) in a previous cytology. We evaluated the utility of NRAS codon 61 (NRAS61) mutation analysis and core needle biopsy (CNB) for the diagnosis of thyroid nodules previously diagnosed as AUS. This study enrolled 236 patients who underwent both NRAS61 mutation analysis and CNB of thyroid nodules previously diagnosed as AUS at cytology. The NRAS61 mutation was detected in 36 nodules and was more frequently detected in the AUS and follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) categories, as determined by histological analysis of CNB, than in the benign group (p = 0.005). Sixty-one patients underwent surgery, and 29 nodules were finally diagnosed as malignant after surgery. Among 61 patients who underwent surgery, nodules with the NRAS61 mutation (42-65 %) had a significantly higher malignancy rate than nodules with wild-type NRAS61 (7-37 %, p = 0.038). The association between malignancy and the NRAS61 mutation was significant after adjusting for age, sex, nodule size, and histological diagnosis of CNB (p = 0.01). NRAS61 mutation analysis together with CNB could be helpful for arriving at a clinical decision in patients with thyroid nodules showing AUS in a previous cytology.
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Affiliation(s)
- Eun Kyung Jang
- Department of Endocrinology, Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil Songpa-gu, Seoul, 138-736, Korea
| | - Eui Young Kim
- Department of Endocrinology, Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, Korea
| | - Hyemi Kwon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil Songpa-gu, Seoul, 138-736, Korea
| | - Yun Mi Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil Songpa-gu, Seoul, 138-736, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil Songpa-gu, Seoul, 138-736, Korea
| | - Jung Hwan Baek
- Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea
| | - Jeong Hyun Lee
- Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil Songpa-gu, Seoul, 138-736, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil Songpa-gu, Seoul, 138-736, Korea
| | - Jene Choi
- Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea
| | - Dong Eun Song
- Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea.
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil Songpa-gu, Seoul, 138-736, Korea.
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Koh J, Kim EK, Kwak JY, Yoon JH, Moon HJ. Repeat fine-needle aspiration can be performed at 6 months or more after initial atypia of undetermined significance or follicular lesion of undetermined significance results for thyroid nodules 10 mm or larger. Eur Radiol 2016; 26:4442-4448. [PMID: 26965502 DOI: 10.1007/s00330-016-4311-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate whether repeat ultrasound-guided fine-needle aspiration (US-FNA) in initial atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) results could be performed 6 months after or more. METHODS A total of 221 AUS/FLUS ≥10 mm with any follow-up were grouped according to the first follow-up interval at less than 6 months (group 1, n = 87) and 6 months or more (group 2, n = 134). Clinical features, final assessment of ultrasound (US) or the Thyroid Imaging Reporting and Data System (TIRADS), tumour size, extrathyroidal extension and lymph node metastasis in malignancies were compared. RESULTS Thirty-four (15.4 %) were malignant. Age, gender, size, final assessment, TIRADS and malignancy rate were not significantly different between the two groups (p = 0.660, 0.691, 0.502, 0.237, 0.819 and 0.420). Tumour size, extrathyroidal extension and lymph node metastasis were not significantly different between the two malignancy groups (p = 0.770, 0.611 and 0.068). Two of 10 nodules with increased size were malignancies found at 7.1 and 25.0 months. None of 33 nodules (14.9 %) with decreased size at a median 10 months were malignant. CONCLUSIONS Repeat US-FNA performed on nodules ≥10 mm at 6 months or more after initial AUS/FLUS results can reduce unnecessary repeat US-FNAs without progression of malignancy. KEY POINTS • Follow-up intervals of AUS/FLUS did not affect the malignancy rate • Tumour stage was not different according to the follow-up intervals • None of the nodules with decreased size were malignant • Repeat US-FNA can be performed at ≥6 months after initial AUS/FLUS.
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Affiliation(s)
- Jieun Koh
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea, 120-752
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea, 120-752
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea, 120-752
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea, 120-752
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea, 120-752.
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28
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Kim YH, Kwon HJ, Kim EK, Kwak JY, Moon HJ, Yoon JH. Applying Ultrasound-Guided Core Needle Biopsy for Diagnosis of Thyroid Masses: Preliminary Results From a Single Institution. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1801-8. [PMID: 26324755 DOI: 10.7863/ultra.15.14.12028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/10/2015] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the level of conclusive results obtained with ultrasound (US)-guided core needle biopsy (CNB) and how this method should be applied for diagnosis of thyroid nodules. METHODS From January 2013 to November 2014, US-guided CNB was performed in 84 thyroid lesions of 83 patients. Based on CNB pathologic reports, thyroid nodules were divided into 2 categories: conclusive (nodules reaching a definite pathologic diagnosis suggesting benignity or malignancy) and inconclusive (nodules that were not able to reach a definite diagnosis because of ambiguous results). Medical records and US examinations were reviewed and compared. RESULTS The mean age of the 83 patients ± SD was 49.7 ± 14.1 years. Of the 84 thyroid nodules, 73 (86.9%) were diagnosed as benign or malignant and 11 (13.1%) as inconclusive by CNB pathologic analysis. Among the 11 nodules with inconclusive results, the possibility of a follicular neoplasm was suggested in 8 nodules (72.7%). No significant difference was seen in tumor size and US features when comparing the nodules with conclusive and inconclusive results (all P >.05). CONCLUSIONS Ultrasound-guided CNB may have supplemental roles in addition to US-guided fine-needle aspiration for diagnosis of selected cases. A considerable proportion of inconclusive results are seen on US-guided CNB, especially for diagnosis of follicular lesions, which must be considered when using this method for diagnosis of thyroid nodules.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Hyeong Ju Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.)
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea (Y.H.K., E.-K.K., J.Y.K., H.J.M., J.H.Y.); and Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea (H.J.K.).
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Kwon HJ, Kim EK, Kwak JY. Cytomorphologic features in thyroid nodules read as "suspicious for malignancy" on cytology may predict thyroid cancers with the BRAF mutation. Pathol Res Pract 2015; 211:671-6. [PMID: 26187369 DOI: 10.1016/j.prp.2015.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/26/2015] [Accepted: 06/22/2015] [Indexed: 01/24/2023]
Abstract
Some morphologic parameters have been studied to help predict the BRAF(V600E) mutation using cytopathologic specimens, which can indicate which nodules should undergo further testing. The aim of this study was to investigate the value of cytomorphologic parameters to predict the BRAF(V600E) mutation in nodules read as "suspicious for malignancy" on cytology. This study included 142 resected nodules which were diagnosed as "suspicious for malignancy" on cytology in 142 patients. At our institution, BRAF(V600E) mutation analysis was performed at the request of the referring clinicians based on the clinical features of the patients, or the judgment of the radiologists performing US-FNA because suspicious US features were observed on the targeted nodule during this study period. Cytology smears were re-reviewed to assess the presence and amount of polygonal eosinophilic (plump) cells and microfollicles, and the presence of intranuclear pseudoinclusions, irregular nuclear membranes, nuclear grooves, sickles cells, psammoma bodies, and cystic changes. We evaluated the diagnostic performances of the cytomorphologic features to predict the BRAF(V600E) mutation. Polygonal eosinophilic (plump) cells, microfollicles, intranuclear pseudoinclusions, sickle cells, and cystic changes were significantly associated with the BRAF(V600E) mutation. The mutation was not present in all 6 thyroid nodules with microfollicles larger than 20% on cytology. Additionally, polygonal eosinophilic (plump) cells larger than 20%, cystic changes, and sickle cells on cytology had a high specificity of 95%, 96.7%, and 81.7%, respectively. Excluding 6 nodules with microfollicles larger than 20% on cytology, there were 82 (60.3%) nodules with the BRAF(V600E) mutation among the 136 nodules. Among the 136 nodules, there were 95 nodules with polygonal eosinophilic (plump) cells larger than 20%, cystic changes, or sickle cells on cytology. Of the 95 nodules, 69 (72.6%) had the mutation. Cytomorphologic features can help select nodules for the BRAF(V600E) mutation test among nodules read as "suspicious for malignancy" on cytology.
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Affiliation(s)
- Hyeong Ju Kwon
- Department of Pathology, Yonsei University, College of Medicine, Republic of Korea; Department of Pathology, Yonsei University Wonju College of Medicine, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Republic of Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Republic of Korea.
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Yoon JH, Lee HS, Kim EK, Moon HJ, Kwak JY. Thyroid Nodules: Nondiagnostic Cytologic Results according to Thyroid Imaging Reporting and Data System before and after Application of the Bethesda System. Radiology 2015; 276:579-87. [PMID: 25848904 DOI: 10.1148/radiol.15142308] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare the malignancy rates and the effectiveness of the Thyroid Imaging Reporting and Data System (TIRADS) for risk stratification of nodules with nondiagnostic results classified before and after application of the Bethesda System for Reporting Thyroid Cytopathology. MATERIALS AND METHODS This retrospective study was approved by an institutional review board, with waiver of informed consent. A total of 763 patients with 790 thyroid nodules and nondiagnostic cytologic results were included (mean age ± standard deviation, 52.3 years ± 11.5), 485 nodules from the pre-Bethesda period (from March 2007 to December 2008) and 305 nodules from the post-Bethesda period (from May 2011 to May 2012). A TIRADS category was assigned to each thyroid nodule on the basis of the number of features that appeared suspicious for cancer at ultrasonography (US). Malignancy rates and TIRADS categories during the two periods were compared. Correlation between TIRADS category and malignancy risk between the two periods was evaluated and compared. RESULTS The malignancy rates of nodules with nondiagnostic cytologic results were not significantly different between the two periods (P = .148). Malignancy risk of TIRADS category 3, 4a, 4b, 4c, and 5 was 1.8%, 5.7%, 4.1%, 29.8%, and 16.7%, for the pre-Bethesda period, and 1.6%, 3.0%, 7.1%, 16.3%, and 25.0% for the post-Bethesda period, respectively. Near-perfect correlation was seen between the TIRADS category and malignancy risk in the post-Bethesda period (r = 0.961, P = .009), while no significant correlation was found in the pre-Bethesda period (r = 0.731, P = .161). CONCLUSION Malignancy risk stratification with TIRADS was more effective for nodules with nondiagnostic cytologic results classified according to the Bethesda System. When these Bethesda-classified nodules with nondiagnostic results are evaluated as TIRADS category 3 or 4a, they may be treated conservatively with follow-up US, but when other cytologic classifications are applied, follow-up US and fine- needle aspiration must be considered for nodules showing one or more features suspicious for cancer at US.
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Affiliation(s)
- Jung Hyun Yoon
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
| | - Hye Sun Lee
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
| | - Eun-Kyung Kim
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
| | - Hee Jung Moon
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
| | - Jin Young Kwak
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (J.H.Y., E.K.K., H.J.M., J.Y.K.), and Biostastistics Collaboration Unit, Medical Research Center (H.S.L.), Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752 Seoul, Korea
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