Ultrasound Elastography Predicts Thyroid Nodule Volume Reduction Rate After Percutaneous Ethanol Ablation

Diagnostic accuracy of S-Detect in distinguishing benign and malignant thyroid nodules: A meta-analysis

Objectives

In this meta-analysis study, the main objective was to determine the accuracy of S-detect in effectively distinguishing malignant thyroid nodules from benign thyroid nodules.

Methods

We searched the PubMed, Cochrane Library, and CBM databases from inception to August 1, 2021. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 softwares. We calculated summary statistics for sensitivity (Sen), specificity (Spe), positive and negative likelihood ratio (LR⁺/LR⁻), diagnostic odds ratio(DOR), and receiver operating characteristic (SROC) curves. Cochran’s Q-statistic and I² test were used to evaluate potential heterogeneity between studies. A sensitivity analysis was performed to evaluate the influence of single studies on the overall estimate. We also performed meta-regression analyses to investigate the potential sources of heterogeneity.

Results

In this study, a total of 17 studies meeting the requirements of the standard were used. The number of benign and malignant nodules analyzed and evaluated in this paper was 1595 and 1118 respectively. This paper mainly completes the required histological confirmation through s-detect. The pooled Sen and pooled Spe were 0.87 and 0.74, respectively, (95%CI = 0.84–0.89) and (95%CI = 0.66–0.81). Furthermore, the pooled LR⁺ and negative LR⁻ were determined to be 3.37 (95%CI = 2.53–4.50) and 0.18 (95%CI = 0.15–0.21), respectively. The experimental results showed that the pooled DOR of thyroid nodules was 18.83 (95% CI = 13.21–26.84). In addition, area under SROC curve was determined to be 0.89 (SE = 0.0124). It should be pointed out that there is no evidence of bias (i.e. t = 0.25, P = 0.80).

Conclusions

Through this meta-analysis, it can be seen that the accuracy of s-detect is relatively high for the effective distinction between malignant thyroid nodules and benign thyroid nodules.

Efficacy and Safety of Radiofrequency Ablation of Thyroid Nodules: A Multi-institutional Prospective Cohort Study

BACKGROUND

Radiofrequency ablation (RFA) has been recently adopted into the practice of thyroidology in the United States, although its use as an alternative to traditional thyroid surgery in Asia and Europe came near the turn of the 21st century. In the United States, only a few studies with small sample sizes have been published to date. We examined outcomes of benign thyroid nodules treated with RFA from two North American institutions.

METHODOLOGY

We performed a prospective, multi-institutional cohort study of thyroid nodules treated with RFA between July 2019 and January 2022. Demographics, sonographic characteristics of thyroid nodules, thyroid function profiles, procedural details, complications, and nodule volume measurements at 1, 3, 6, and 12 months follow-up were evaluated. Adjusted multivariate logistic regression analysis was performed to identify sonographic features associated with treatment failure.

RESULTS

A total of 233 nodules were included. The median and interquartile range of volume reduction rate (VRR) at 1, 3, 6, and 12 months were 54% (IQR: 36%-73%), 58% (IQR: 37%-80%), 73% (IQR: 51%-90%), and 76% (IQR: 52%-90%), respectively (P<0.001). Four patients presented with toxic adenomas. All patients were confirmed euthyroid at 3-month post-procedure follow-up. Two patients developed temporary hoarseness of voice, but no hematoma or nodular rupture occurred post-procedure. Elastography was significantly associated with VRR. Compared to soft nodules, stiff nodules were more likely to have a lower VRR (OR: 11.64, 95%CI: 3.81-35.53, P<0.05), and mixed elasticity was also more likely to have a lower VRR (OR: 4.9; 95%CI: 1.62-14.85, P<0.05).

CONCLUSION

This is the largest multi-institutional North American study examining thyroid nodule treatment response to RFA. RFA is a safe and effective treatment option that allows preservation of thyroid function with minimal risk of procedural complications.

Malignancy outcomes and the impact of repeat fine needle aspiration of thyroid nodules with Bethesda category III cytology: A multicenter experience

BACKGROUND

The clinical management of Bethesda III category thyroid nodules has some undefined points and differs among centers and conflicting malignancy rates are present in the literature. The aim of this study was to investigate the Bethesda category III thyroid nodule outcomes in our centers, to determine malignancy rates and also to evaluate clinical and sonographic features which may help to predict malignancy.

METHODS

This retrospective study included 333 patients with thyroid nodules who had Bethesda category III on fine needle aspiration (FNA) in three tertiary medical centers of Turkey.

RESULTS

Among 333 patients, 302 had appropriate follow up. Eighteen patients received thyroidectomy after the first FNA, with a malignancy rate of 38.89% (7/18) and 284 patients received a second FNA. After the second FNA, thyroidectomy was performed in 80 patients and 41 patients needed the third FNA. Thirteen thyroidectomies were performed after the third FNA. Totally 111 patients received thyroidectomy with a malignancy rate of 48.65% (54/111) among patients with surgery and the lower bound was detected as 17.88% (54/302). Of these patients the malignancy rates of patients receiving thyroidectomy with two and three FNAs were 47.50% (38/80) and 69.23% (9/13), respectively. Hypoechogenicity, microcalcification, and irregular margin were found as good predictors for malignancy.

CONCLUSION

We demonstrated that the malignancy rate was 48.65% in patients receiving thyroidectomy. We showed a higher malignancy rate than the traditionally rate of 5%-15%. This study showed that repeat FNAs decrease the rate of unnecessary surgery performed for benign lesions by increasing the rate of malignancy detection.