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Dimaano KL, Dib VA, Parnall T, Covington A, Kaji AH, Choi P, Chen KT. The Utility of ACR TI-RADS in Predicting False-Negative Fine Needle Aspiration for Thyroid Cancer. Am Surg 2024; 90:1156-1160. [PMID: 38212274 DOI: 10.1177/00031348241227184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Thyroid nodule fine needle aspiration (FNA) biopsies are associated with a low false-negative rate. There is limited data regarding the predictive value of American College of Radiology Thyroid Imaging Reporting and Data System for false-negative FNA. METHODS This single-center retrospective study evaluated 119 patients who underwent thyroidectomy. The association of TR category, along with other clinical variables, with false-negative FNA was evaluated. RESULTS The overall false-negative rate of FNA was 10.8% (n = 9). False-negative FNAs were associated with younger age (mean 42 years vs 50.6 years, P = .04), larger nodule size (mean 4.4 cm vs 3.2 cm, P = .03), and a lower TR category (median 3 v 4, P = .01). DISCUSSION Lower TR category, younger age, and larger nodule size were associated with false-negative FNA of thyroid nodules. These findings should be taken into context when counseling patients with thyroid nodules who have a benign FNA.
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Affiliation(s)
- Katrina L Dimaano
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Valerie A Dib
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Taylor Parnall
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Audrey Covington
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Patrick Choi
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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2
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Pozdeyev N, Dighe M, Barrio M, Raeburn C, Smith H, Fisher M, Chavan S, Rafaels N, Shortt JA, Lin M, Leu MG, Clark T, Marshall C, Haugen BR, Subramanian D, Crooks K, Gignoux C, Cohen T. Thyroid Cancer Polygenic Risk Score Improves Classification of Thyroid Nodules as Benign or Malignant. J Clin Endocrinol Metab 2024; 109:402-412. [PMID: 37683082 DOI: 10.1210/clinem/dgad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
CONTEXT Thyroid nodule ultrasound-based risk stratification schemas rely on the presence of high-risk sonographic features. However, some malignant thyroid nodules have benign appearance on thyroid ultrasound. New methods for thyroid nodule risk assessment are needed. OBJECTIVE We investigated polygenic risk score (PRS) accounting for inherited thyroid cancer risk combined with ultrasound-based analysis for improved thyroid nodule risk assessment. METHODS The convolutional neural network classifier was trained on thyroid ultrasound still images and cine clips from 621 thyroid nodules. Phenome-wide association study (PheWAS) and PRS PheWAS were used to optimize PRS for distinguishing benign and malignant nodules. PRS was evaluated in 73 346 participants in the Colorado Center for Personalized Medicine Biobank. RESULTS When the deep learning model output was combined with thyroid cancer PRS and genetic ancestry estimates, the area under the receiver operating characteristic curve (AUROC) of the benign vs malignant thyroid nodule classifier increased from 0.83 to 0.89 (DeLong, P value = .007). The combined deep learning and genetic classifier achieved a clinically relevant sensitivity of 0.95, 95% CI [0.88-0.99], specificity of 0.63 [0.55-0.70], and positive and negative predictive values of 0.47 [0.41-0.58] and 0.97 [0.92-0.99], respectively. AUROC improvement was consistent in European ancestry-stratified analysis (0.83 and 0.87 for deep learning and deep learning combined with PRS classifiers, respectively). Elevated PRS was associated with a greater risk of thyroid cancer structural disease recurrence (ordinal logistic regression, P value = .002). CONCLUSION Augmenting ultrasound-based risk assessment with PRS improves diagnostic accuracy.
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Affiliation(s)
- Nikita Pozdeyev
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Division of Endocrinology Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - Martin Barrio
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher Raeburn
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Harry Smith
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Matthew Fisher
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sameer Chavan
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nicholas Rafaels
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jonathan A Shortt
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Meng Lin
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michael G Leu
- Information Technology Services, UW Medicine, Seattle, WA 98195, USA
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
- Division of Hospital Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Toshimasa Clark
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Carrie Marshall
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bryan R Haugen
- Division of Endocrinology Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Kristy Crooks
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher Gignoux
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
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Rho M, Chun SH, Lee E, Lee HS, Yoon JH, Park VY, Han K, Kwak JY. Diagnosis of thyroid micronodules on ultrasound using a deep convolutional neural network. Sci Rep 2023; 13:7231. [PMID: 37142760 PMCID: PMC10160046 DOI: 10.1038/s41598-023-34459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/30/2023] [Indexed: 05/06/2023] Open
Abstract
To assess the performance of deep convolutional neural network (CNN) to discriminate malignant and benign thyroid nodules < 10 mm in size and compare the diagnostic performance of CNN with those of radiologists. Computer-aided diagnosis was implemented with CNN and trained using ultrasound (US) images of 13,560 nodules ≥ 10 mm in size. Between March 2016 and February 2018, US images of nodules < 10 mm were retrospectively collected at the same institution. All nodules were confirmed as malignant or benign from aspirate cytology or surgical histology. Diagnostic performances of CNN and radiologists were assessed and compared for area under curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Subgroup analyses were performed based on nodule size with a cut-off value of 5 mm. Categorization performances of CNN and radiologists were also compared. A total of 370 nodules from 362 consecutive patients were assessed. CNN showed higher negative predictive value (35.3% vs. 22.6%, P = 0.048) and AUC (0.66 vs. 0.57, P = 0.04) than radiologists. CNN also showed better categorization performance than radiologists. In the subgroup of nodules ≤ 5 mm, CNN showed higher AUC (0.63 vs. 0.51, P = 0.08) and specificity (68.2% vs. 9.1%, P < 0.001) than radiologists. Convolutional neural network trained with thyroid nodules ≥ 10 mm in size showed overall better diagnostic performance than radiologists in the diagnosis and categorization of thyroid nodules < 10 mm, especially in nodules ≤ 5 mm.
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Affiliation(s)
- Miribi Rho
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sei Hyun Chun
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eunjung Lee
- School of Mathematics and Computing, Yonsei University, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
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Rano E, Lin L, Molinie V, Sulpicy C, Dorival MJ, Drak Alsibai K, Nacher M, Drame M, Sabbah N. Epidemiological, Clinical, Ultrasonographic and Cytological Characteristics of Thyroid Nodules in an Afro-Caribbean Population: A Series of 420 Patients. Cancers (Basel) 2022; 14:cancers14102365. [PMID: 35625970 PMCID: PMC9139893 DOI: 10.3390/cancers14102365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary This study describes the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and evaluates the value of cytology in the diagnosis of malignancy in an Afro-Caribbean population. Our results revealed that none of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in Afro-Caribbean populations. Bethesda system-based cytology revealed low sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results. Abstract The incidence of thyroid cancer is increasing worldwide. The aim of this study is to describe the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and to evaluate the predictive value of the Bethesda system for thyroid cytology in the diagnosis of malignancy in an Afro-Caribbean population. We conducted a retrospective study in Martinique involving 420 patients with a diagnosis of thyroid nodules between 2011 and 2014. Of the 192/420 (45.7%) patients operated on for thyroid nodules, 9% had thyroid cancer. All patients with thyroid cancer were obese women with a mean age of 50 years. The final histological examination revealed papillary microcarcinomas in 61% of cases and papillary carcinomas in 39% of cases. Thyroid cytology alone had a low sensitivity (22.2%) and positive predictive value (15.4%) for the diagnosis of malignancy, with a good specificity (91.1%) and negative predictive value (94.2%). None of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These epidemiological, clinical and ultrasound results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in an Afro-Caribbean population. Bethesda system-based cytology revealed lower sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results.
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Affiliation(s)
- Elodie Rano
- Department of Endocrinology and Metabolic Diseases, University Hospital Centre Louis Domergues, F-97220 La Trinité, France; (E.R.); (L.L.)
| | - Lucien Lin
- Department of Endocrinology and Metabolic Diseases, University Hospital Centre Louis Domergues, F-97220 La Trinité, France; (E.R.); (L.L.)
| | - Vincent Molinie
- Department of Pathology, University Hospital Centre Pierre Zobda Quitman, F-97261 Fort-de-France, France;
| | | | | | - Kinan Drak Alsibai
- Centre of Biological Resources (CRB Amazonie), Cayenne Hospital Centre, F-97306 Cayenne, French Guiana;
- Clinical Investigation Center Antilles-French Guiana (CIC, INSERM 1424) Cayenne Hospital Centre Andrée Rosemon, F-97306 Cayenne, French Guiana;
| | - Mathieu Nacher
- Clinical Investigation Center Antilles-French Guiana (CIC, INSERM 1424) Cayenne Hospital Centre Andrée Rosemon, F-97306 Cayenne, French Guiana;
| | - Moustafa Drame
- Department of Medical Information, University Hospital Centre Pierre Zobda Quitman, F-97261 Fort-de-France, France;
| | - Nadia Sabbah
- Clinical Investigation Center Antilles-French Guiana (CIC, INSERM 1424) Cayenne Hospital Centre Andrée Rosemon, F-97306 Cayenne, French Guiana;
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Centre Andrée Rosemon, F-97306 Cayenne, French Guiana
- Correspondence: ; Tel.: +(594)-0594395276
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Huang D, Zhang H, Li L, Ge W, Liu W, Dong Z, Gao J, Yao N, Fu W, Huang L, Guo T, Sun Y, Teng X. Proteotypic Differences of Follicular-Patterned Thyroid Neoplasms. Front Endocrinol (Lausanne) 2022; 13:854611. [PMID: 35923625 PMCID: PMC9340356 DOI: 10.3389/fendo.2022.854611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
The diagnosis of follicular-patterned thyroid tumors such as follicular thyroid adenoma (FA), follicular thyroid carcinoma (FTC), and follicular variant of papillary thyroid carcinoma (FvPTC) remains challenging. This study aimed to explore the molecular differences among these three thyroid tumors by proteomic analysis. A pressure cycling technology (PCT)-data-independent acquisition (DIA) mass spectrometry workflow was employed to investigate protein alterations in 52 formalin-fixed paraffin-embedded (FFPE) specimens: 18 FA, 15 FTC, and 19 FvPTC specimens. Immunohistochemical (IHC) analysis of 101 FA, 67 FTC, and 65 FvPTC specimens and parallel reaction monitoring (PRM) analysis of 20 FA, 20 FTC, and 20 FvPTC specimens were performed to validate protein biomarkers. A total of 4107 proteins were quantified from 52 specimens. Pairwise comparisons identified 287 differentially regulated proteins between FTC and FA, and 303 between FvPTC and FA and 88 proteins were co-dysregulated in the two comparisons. However, only 23 discriminatory proteins between FTC and FvPTC were detected. Additionally, the quantitative results for ANXA1 expression based on IHC staining and PRM-MS quantification were consistent with the proteomic results, showing that ANXA1 can be used to distinguish FvPTC from FA and FTC. The differentially regulated proteins found in this study can differentiate FA from FvPTC. In addition, ANXA1 is a promising biomarker for differentiating FvPTC from the other thyroid tumors.
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Affiliation(s)
- Dongdong Huang
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huifang Zhang
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Li
- Westlake Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, China
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Weigang Ge
- Westlake Omics (Hangzhou) Biotechnology Co., Ltd., Hangzhou, China
| | - Wei Liu
- Westlake Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, China
| | - Zhen Dong
- Westlake Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, China
| | - Jinlong Gao
- Westlake Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, China
| | - Nan Yao
- Westlake Omics (Hangzhou) Biotechnology Co., Ltd., Hangzhou, China
| | - Wenxin Fu
- Westlake Omics (Hangzhou) Biotechnology Co., Ltd., Hangzhou, China
| | - Lingling Huang
- Westlake Omics (Hangzhou) Biotechnology Co., Ltd., Hangzhou, China
| | - Tiannan Guo
- Westlake Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, China
| | - Yaoting Sun
- Westlake Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, China
- *Correspondence: Yaoting Sun, ; Xiaodong Teng,
| | - Xiaodong Teng
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Yaoting Sun, ; Xiaodong Teng,
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Jang E, Kim K, Jung CK, Bae JS, Kim JS. Clinicopathological parameters for predicting non-invasive follicular thyroid neoplasm with papillary features (NIFTP). Ther Adv Endocrinol Metab 2021; 12:20420188211000500. [PMID: 33912339 PMCID: PMC8047967 DOI: 10.1177/20420188211000500] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Criteria for the preoperative diagnosis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) have not yet been confirmed. This study aimed to analyze differences in clinicopathological characteristics between follicular variant of papillary thyroid carcinoma (FVPTC) subtypes to determine which parameters are relevant in differentiating NIFTP from other variants. METHODS We retrospectively analyzed the records of 199 patients with a preoperative diagnosis of FVPTC who underwent thyroid surgery at Seoul St. Mary's Hospital (Seoul, Korea) from 2011 to 2015. Clinicopathological features were analyzed retrospectively via a complete review of medical charts and pathology reports of patients. RESULTS The NIFTP and invasive encapsulated FVPTC (EFVPTC) groups showed relatively benign features, with a majority of the patients categorized as Bethesda category III (25.8% and 25.6%, respectively) or IV (34.8% and 30.2%, respectively), while the infiltrative FVPTC group showed more malignant features, with more patients categorized as category V (28.6%) or VI (47.6%) (p < 0.001). BRAF V600E mutations were significantly less prevalent in the NIFTP group (0%) and invasive EFVPTC group (4.7%) compared with the infiltrative FVPTC group (34.9%) (p < 0.001). Multivariate analysis showed that absence of BRAF V600E mutation (OR 20.311, p = 0.004) and lymph node metastasis (odds ratio 10.237, p = 0.004) were significantly associated with NIFTP. CONCLUSION Although Bethesda category was a statistically significant factor in distinguishing FVPTC subtypes, it was not effective in conclusively distinguishing NIFTP and invasive EFVPTC. Absence of BRAF V600E mutation and lymph node metastasis are important features in distinguishing NIFTP from other subtypes.
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Affiliation(s)
- Eunju Jang
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seoul, 06591, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Zhang F, Chen W. Sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and diagnostic performance of the 2017 ACR TI-RADS in FV-PTC. Endocrine 2020; 67:379-386. [PMID: 31919771 DOI: 10.1007/s12020-019-02184-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/29/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To find the sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and evaluate the diagnostic performance of 2017 ACR TI-RADS in FV-PTC. METHODS From June 2017 to June 2019, 104 FV-PTC patients (106 nodules) and 337 classic papillary thyroid carcinoma (C-PTC) patients (343 nodules) with both sonograms and pathologic results were included. Sonographic features of FV-PTC and C-PTC were evaluated and compared, and 2017 ACR TI-RADS scores and levels were calculated. RESULTS Pathologically, the incidence of Hashimoto's thyroiditis and extrathyroidal extension was higher in the FV-PTC group. Most of both the FV-PTC and C-PTC groups were diagnosed as PTC or suspicious PTC by fine-needle aspiration biopsy (FNAB). FV-PTC tended to be isoechoic, while most nodules of C-PTC were hypoechoic or very hypoechoic. Compared with C-PTC, FV-PTC had lower percentages of a taller-than-wide shape (11.3% vs. 46.6%) and lobulated or irregular margin (33.0% vs. 61.8%), and a higher percentage of extrathyroidal extension (20.8% vs. 8.2%). FV-PTC featured macrocalcifications, whereas punctate echogenic foci were more frequently seen in the C-PTC group. Other characteristic US appearances of FV-PTC included uneven hypoechoic halo and peripheral vascularity. The mean TI-RADS score of FV-PTC cases was lower in the FV-PTC group, 11.3%, 44.3%, and 42.5% of which were categorized as TI-RADS 3, 4, and 5, respectively. CONCLUSIONS FV-PTC features isoechoic appearance, macrocalcifications, uneven hypoechoic halo, and peripheral vascularity on US, with lower incidences of microcalcifications and taller-than-wide shape, and tends to have lower TI-RADS scores and levels. For the nodules categorized as TI-RADS 3 or 4, the FNAB criteria should be broaden when these nodules have FV-PTC US features.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, PR China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, PR China.
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Lewiński A, Adamczewski Z, Zygmunt A, Markuszewski L, Karbownik-Lewińska M, Stasiak M. Correlations between Molecular Landscape and Sonographic Image of Different Variants of Papillary Thyroid Carcinoma. J Clin Med 2019; 8:jcm8111916. [PMID: 31717363 PMCID: PMC6912205 DOI: 10.3390/jcm8111916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
Papillary thyroid carcinoma (PTC), the most common thyroid cancer, is predominantly driven by mutations in BRAF (primarily p. V600E) and RAS oncogenes. Ultrasound (US) examination provides significant diagnostic data in the management of thyroid nodules, as many sonographic features of thyroid lesions are correlated with the potential risk of thyroid carcinoma. The aim of the study was to analyze the current literature in regard to the potential associations between genetic landscape and sonographic features of PTC. Based on the current literature, sonographic features of PTCs correlate with their molecular drivers, particularly between tumors harboring BRAFV600E versus activating RAS mutations, although many of these findings appear to be dependent on the tumor variant. Suspicious US findings, such as hypoechogenicity, spiculated/microlobulated margins, non-parallel orientation/taller-than-wide shape, and the presence of microcalcifications, are typical for PTC positive for BRAFV600E mutations. On the contrary, tumors with RAS mutations are most frequently hypo- or isoechoic and ovoid-to-round in shape, with smooth margins and without calcifications. There are also some US features typical for PTCs harboring other mutations, including BRAFK601E, RET/PTC rearrangements, PAX8-PPARγ, CTNNB1, and APC. However, further research is necessary, as some rare PTC variants still cannot be reliably analyzed due to the scarce published data.
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Affiliation(s)
- Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
- Correspondence: or ; Tel.: +48-42-271-1141; Fax: +48-42-271-1140
| | - Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Arkadiusz Zygmunt
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Leszek Markuszewski
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Małgorzata Karbownik-Lewińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
- Chair and Department of Oncological Endocrinology, Medical University of Lodz, 90-752 Lodz, Poland
| | - Magdalena Stasiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
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Lee HS, Lee JW, Park JH, Kim WS, Han HS, Lee SE. Comprehensive analysis for diagnosis of preoperative non-invasive follicular thyroid neoplasm with papillary-like nuclear features. PLoS One 2019; 14:e0218046. [PMID: 31276506 PMCID: PMC6611592 DOI: 10.1371/journal.pone.0218046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/24/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The current paradigm in the treatment of patients with non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a diagnostic lobectomy rather than complete thyroidectomy and postoperative radioiodine treatment. Consequently, preoperative diagnosis of NIFTP is considered to be important. METHODS We performed the comprehensive analysis for diagnosis of preoperative 20 NIFTPs in comparison with 41 invasive encapsulated follicular papillary thyroid carcinomas (I-EFVPTCs) using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and molecular analysis for BRAF and RAS mutations. RESULTS K-TIRADS 3 was identified as the most common sonographic diagnosis in both NIFTP and I-EFVPTC. Unlike I-EFVPTC, K-TIRADS 5 was not identified in NIFTP. AUS/FLUS was the most common cytopathological diagnosis and none of the cases were classified as malignant category in both groups, although the difference in distribution was not significant between the groups. BRAF mutation was not found in NIFTP but was present in 9.8% of cases in I-EFVPTC. The frequency of RAS mutation in I-EFVPTCs was twice as high as that of NIFTP. Wild-type BRAF and RAS in NIFTP was significantly higher than I-EFVPTC. CONCLUSION The existence of overlapping features between the groups was evident, hence conclusive distinction between radiology, cytology and molecular analysis could not be achieved. Apparently, the diagnosis of NIFTP based on comprehensive analysis was not confirmable but could perceive or at least favor the diagnosis of NIFTP.
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Affiliation(s)
- Hye Seung Lee
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae-Wook Lee
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Park
- Department of Hemato-Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Wan-Seop Kim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seung Eun Lee
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Automatic thyroid nodule recognition and diagnosis in ultrasound imaging with the YOLOv2 neural network. World J Surg Oncol 2019; 17:12. [PMID: 30621704 PMCID: PMC6325802 DOI: 10.1186/s12957-019-1558-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, images of 2450 benign thyroid nodules and 2557 malignant thyroid nodules were collected and labeled, and an automatic image recognition and diagnosis system was established by deep learning using the YOLOv2 neural network. The performance of the system in the diagnosis of thyroid nodules was evaluated, and the application value of artificial intelligence in clinical practice was investigated. METHODS The ultrasound images of 276 patients were retrospectively selected. The diagnoses of the radiologists were determined according to the Thyroid Imaging Reporting and Data System; the images were automatically recognized and diagnosed by the established artificial intelligence system. Pathological diagnosis was the gold standard for the final diagnosis. The performances of the established system and the radiologists in diagnosing the benign and malignant thyroid nodules were compared. RESULTS The artificial intelligence diagnosis system correctly identified the lesion area, with an area under the receiver operating characteristic (ROC) curve of 0.902, which is higher than that of the radiologists (0.859). This finding indicates a higher diagnostic accuracy (p = 0.0434). The sensitivity, positive predictive value, negative predictive value, and accuracy of the artificial intelligence diagnosis system for the diagnosis of malignant thyroid nodules were 90.5%, 95.22%, 80.99%, and 90.31%, respectively, and the performance did not significantly differ from that of the radiologists (p > 0.05). The artificial intelligence diagnosis system had a higher specificity (89.91% vs 77.98%, p = 0.026). CONCLUSIONS Compared with the performance of experienced radiologists, the artificial intelligence system has comparable sensitivity and accuracy for the diagnosis of malignant thyroid nodules and better diagnostic ability for benign thyroid nodules. As an auxiliary tool, this artificial intelligence diagnosis system can provide radiologists with sufficient assistance in the diagnosis of benign and malignant thyroid nodules.
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Pigac B, Masic S, Hutinec Z, Masic V. Rare Occurrence of Incidental Finding of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features in Hürthle Cell Adenoma. Med Arch 2018; 72:367-370. [PMID: 30524171 PMCID: PMC6282913 DOI: 10.5455/medarh.2018.72.367-370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/19/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Hürthle cell adenoma is a rare benign lesion of the thyroid gland, however, controversies about its potential malignant behavior still remain. Among thyroid neoplasms, papillary carcinoma is the most common variant with great variety of histological subtypes demonstrating different biological behavior. AIM To raise the awareness of possible coexistence of these two lesions and discussion about possible therapeutic approaches. CASE REPORT A 42 year old female patient was examined because of the pain in the thyroid area. Cytological examination suggested Hürthle cell adenoma. Subsequently, right thyroid lobectomy was performed. Intraoperative frozen sections confirmed the diagnosis, yet final histological analysis revealed encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), now reclassified as noninvasive follicular thyroid neoplasm with papillary- like nuclear features (NIFTP) within the adenoma, which was not noticed through scintigraphy, ultrasound, cytological and frozen section analysis. CONCLUSIONS Problems concerning both diagnostic and therapeutic approach to these lesions are being discussed, since opinions reported in the literature are divided, posing great challenge for the clinician in determining adequate therapeutic procedures.
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Affiliation(s)
- Biserka Pigac
- Pathology, Cytology and Forensic Medicine Unit, Varazdin General Hospital, Varazdin, Croatia
| | - Silvija Masic
- Clinical Department of Pathology and Cytology “Ljudevit Jurak”, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Zdenka Hutinec
- Department of Pathology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Valentina Masic
- Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
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12
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Chaigneau E, Russ G, Royer B, Bigorgne C, Bienvenu-Perrard M, Rouxel A, Leenhardt L, Belin L, Buffet C. TIRADS score is of limited clinical value for risk stratification of indeterminate cytological results. Eur J Endocrinol 2018; 179:13-20. [PMID: 29703794 DOI: 10.1530/eje-18-0078] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/27/2018] [Indexed: 02/05/2023]
Abstract
CONTEXT Thyroid nodules with cytological indeterminate results represent a daily and recurrent issue for patient management. OBJECTIVE The primary aim of our study was to determine if TIRADS (Thyroid Imaging Reporting and Data System) could be used to stratify the malignancy risk of these nodules and to help in their clinical management. Secondary objective was to estimate if this risk stratification would change after reclassification of encapsulated non-invasive follicular variant of papillary carcinomas (FVPTC) as non-invasive follicular thyroid neoplasm (NIFTP). PATIENTS AND METHODS Single-center retrospective study of a cohort of 602 patients who were referred for ultrasound-guided fine-needle aspiration from January 2010 to December 2016 with an indeterminate cytological result and in whom histological results after surgery were available. TIRADS score was prospectively determined for all patients included. Nodules that had been classified as FVPTC were submitted to a rereading of histological report and reclassified as NIFTP when judged relevant. A table of malignancy risk crossing Bethesda and TIRADS results was built before and after this reclassification. RESULTS The study included 602 cytologically indeterminate nodules. TIRADS score was positively correlated with the malignancy rate (P < 0.0001). Risk stratification with TIRADS was significant only in Bethesda V nodules (P = 0.0004). However, the risk of malignancy in this Bethesda V category was always above 45%, whatever the TIRADS score. CONCLUSION For a clinician facing an indeterminate cytological result for a thyroid nodule, return to TIRADS score is of limited value in most conditions to rule in or rule out malignancy and to guide subsequent management of patients.
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Affiliation(s)
- E Chaigneau
- Department of Endocrinology and Cardiovascular Prevention, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
| | - G Russ
- Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
| | - B Royer
- Centre of Pathology and Radiology, Paris, France
| | - C Bigorgne
- Centre of Pathology and Radiology, Paris, France
| | | | - A Rouxel
- Centre of Pathology and Radiology, Paris, France
| | - L Leenhardt
- Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
| | - L Belin
- Department of Biostatistics, Public Health, and Medical Information, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
| | - C Buffet
- Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
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Ng SC, Kuo SF, Hua CC, Huang BY, Chiang KC, Chu YY, Hsueh C, Lin JD. Differentiation of the Follicular Variant of Papillary Thyroid Carcinoma From Classic Papillary Thyroid Carcinoma: An Ultrasound Analysis and Complement to Fine-Needle Aspiration Cytology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:667-674. [PMID: 28880405 DOI: 10.1002/jum.14377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES It is difficult to establish a diagnosis of the follicular variant of papillary thyroid carcinoma (PTC) using fine-needle aspiration cytology (FNAC). Preoperative features on ultrasound (US) imaging are different between follicular PTC and classic PTC. This study developed a risk score system to differentiate follicular PTC from classic PTC and to correlate the risk score of follicular PTC with its FNAC categories and pathologic features. METHODS The US features, FNAC results, and pathologic reports of 156 follicular PTC nodules and 152 classic PTC nodules from 296 patients with PTC along with their clinical characteristics were reviewed retrospectively. A risk score system based on US features was developed by multivariate logistic regression to differentiate classic PTC from follicular PTC nodules. The risk scores were then correlated with the FNAC category and pathologic features of the nodules. RESULTS The US risk score (5 × echogenicity + 3 × calcifications + 3 × marginal regularity) had an area under the receiver operating characteristic curve of 0.85 and a cutoff value of 8.0, with specificity of 87% and sensitivity of 69% for predicting a classic PTC nodule. The follicular PTC nodules with low Bethesda categorization (I-III) had a median US risk score of 6 (range, 0-11), which was higher than that of nodules with high categorization (IV-VI; median, 3; range, 0-11). CONCLUSIONS The US risk score may be useful in differentiating classic PTC from follicular PTC and complementary to FNAC in identifying follicular PTC.
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Affiliation(s)
- Soh-Ching Ng
- Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Sheng-Fong Kuo
- Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Chung-Ching Hua
- Departments of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Bie-Yu Huang
- Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Kun-Chun Chiang
- Departments of General Surgery, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Yin-Yi Chu
- Departments of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Chuen Hsueh
- Departments of Pathology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Jen-Der Lin
- Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Hsien, Taiwan
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Kwon MR, Shin JH, Hahn SY, Oh YL, Kwak JY, Lee E, Lim Y. Histogram analysis of greyscale sonograms to differentiate between the subtypes of follicular variant of papillary thyroid cancer. Clin Radiol 2018; 73:591.e1-591.e7. [PMID: 29317047 DOI: 10.1016/j.crad.2017.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the diagnostic value of histogram analysis using ultrasound (US) to differentiate between the subtypes of follicular variant of papillary thyroid carcinoma (FVPTC). MATERIALS AND METHODS The present study included 151 patients with surgically confirmed FVPTC diagnosed between January 2014 and May 2016. Their preoperative US features were reviewed retrospectively. Histogram parameters (mean, maximum, minimum, range, root mean square, skewness, kurtosis, energy, entropy, and correlation) were obtained for each nodule. RESULTS The 152 nodules in 151 patients comprised 48 non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs; 31.6%), 60 invasive encapsulated FVPTCs (EFVPTCs; 39.5%), and 44 infiltrative FVPTCs (28.9%). The US features differed significantly between the subtypes of FVPTC. Discrimination was achieved between NIFTPs and infiltrative FVPTC, and between invasive EFVPTC and infiltrative FVPTC using histogram parameters; however, the parameters were not significantly different between NIFTP and invasive EFVPTC. CONCLUSION It is feasible to use greyscale histogram analysis to differentiate between NIFTP and infiltrative FVPTC, but not between NIFTP and invasive EFVPTC. Histograms can be used as a supplementary tool to differentiate the subtypes of FVPTC.
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Affiliation(s)
- M-R Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J H Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - S Y Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Y L Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J Y Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - E Lee
- Department of Computational Science and Engineering, Yonsei University, Seoul, South Korea
| | - Y Lim
- Department of Applied Statistics, Chung-Ang University, 221, Heukseok-dong, Dongjak-gu, Seoul 156-756, South Korea
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15
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You SH, Lee KE, Yoo RE, Choi HJ, Jung KC, Won JK, Kang KM, Yoon TJ, Choi SH, Sohn CH, Kim JH. Prevention of total thyroidectomy in noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) based on combined interpretation of ultrasonographic and cytopathologic results. Clin Endocrinol (Oxf) 2018; 88:114-122. [PMID: 28898488 DOI: 10.1111/cen.13473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To explore the potential preoperative ultrasonography (US) and cytopathological features to avoid total thyroidectomy in NIFTP. CONTEXT Recently, it has been proposed that that noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) be classified as tumours, rather than cancer. PATIENTS A total of 142 surgically proven follicular variant papillary thyroid carcinomas (FVPTCs; 45 NIFTP, 97 non-NIFTP; mean size: 20.4±11.0 mm, range: 10.0-65.0 mm) from 142 patients were included in this study. MEASUREMENTS Three preoperative features of thyroid nodules (each US finding, US and Bethesda category) were compared in NIFTP and non-NIFTP groups. The preoperative decision-making process to avoid total thyroidectomy in NIFTP was evaluated based on combination of those features. RESULTS In each US finding, there was only significantly less macrocalcification in the NIFTP group than in the non-NIFTP group (8.8% [4/45] vs 32.0% [31/97], P = .006). In US category, all of the NIFTP nodules were a low or intermediate suspicion (100% [45/45]). In Bethesda category, 26.7% [12/45] of the NIFTP was diagnosed as either suspicious malignancy or malignant, which increased the risk of a total thyroidectomy. In our study, a total thyroidectomy might be avoided in all of the NIFTP cases if lobectomy was selected for the nodules classified as a low or intermediate suspicion in US, despite being classified as a suspicious malignancy or malignant by cytopathology. CONCLUSIONS Combining the US and cytopathological results could sensitively reduce total thyroidectomy in cases of NIFTP.
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Affiliation(s)
- Sung-Hye You
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Jeong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyeong Cheon Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Kyung Won
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jin Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Girardi FM, Silva LMD, Flores CD. A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features. Braz J Otorhinolaryngol 2017; 85:24-31. [PMID: 29162407 PMCID: PMC9442819 DOI: 10.1016/j.bjorl.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 07/26/2017] [Accepted: 10/02/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains. Objective The purpose of this study was to create a statistical prediction model for thyroid nodules management. Methods Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case. Results In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%. Conclusions The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.
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Affiliation(s)
- Fábio Muradás Girardi
- Complexo Hospitalar Santa Casa, Hospital Santa Rita, Departamento de Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil.
| | | | - Cecilia Dias Flores
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Informática, Porto Alegre, RS, Brazil
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Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology? PLoS One 2017; 12:e0186242. [PMID: 29023564 PMCID: PMC5638398 DOI: 10.1371/journal.pone.0186242] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/27/2017] [Indexed: 11/22/2022] Open
Abstract
Background There is controversy about the accuracy of the fine-needle aspiration (FNA) cytology results in large sized thyroid nodules. Our aim was to evaluate the false-negative rate of FNA for large thyroid nodules and the usefulness of the Thyroid Imaging Reporting and Data System (TIRADS) in predicting false-negative cytology for large thyroid nodules with benign cytology. Methods 632 thyroid nodules larger than or equal to 3cm in size with subsequent benign cytology on US-guided FNA were included. US features of internal composition, echogenicity, margin, calcifications, and shape were evaluated, and nodules were classified according to TIRADS. TIRADS category 3 included nodules without any of the following suspicious features:solidity, hypoechogenicity or marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. Category 4a, 4b, 4c, and 5 were assigned to nodules showing one, two, three or four, or five suspicious US features, respectively. US features associated with malignancy for these lesions were analyzed and malignancy risk according to TIRADS was calculated. Results Of the 632 lesions, 23 lesions(3.6%) were malignant and 609(96.4%) were benign, suggesting a 3.6% false-negative rate for FNA cytology. Of the 23 malignant lesions, final pathology was mainly follicular carcinoma minimally invasive(65.2%, 15/23) and the follicular variant of papillary carcinoma(26.1%, 6/23). The malignancy risks of categories 3, 4a, 4b, and 4c nodules were 0.9%, 4.6%, 10.0%, and 11.8%, respectively. Conclusion Large thyroid nodules with benign cytology had a relatively high false-negative risk of 3.6% and TIRADS was helpful in predicting false-negative cytology for these lesions.
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18
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Hahn SY, Shin JH, Oh YL, Kim TH, Lim Y, Choi JS. Role of Ultrasound in Predicting Tumor Invasiveness in Follicular Variant of Papillary Thyroid Carcinoma. Thyroid 2017; 27:1177-1184. [PMID: 28699414 DOI: 10.1089/thy.2016.0677] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Follicular variant of papillary thyroid carcinoma (FVPTC) is traditionally divided into infiltrative and encapsulated types. Adding to this classification, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) represents a reclassification of a subset of cases (encapsulated tumors without lymphovascular or capsular invasion). The purpose of this study was to assess the role of ultrasound (US) in predicting tumor invasiveness in FVPTC. METHODS From January 2014 to May 2016, preoperative US examinations were performed on 151 patients with 152 FVPTCs who underwent surgery. Based on a pathologic analysis, the FVPTCs were categorized into three groups: NIFTP, invasive encapsulated FVPTC (iE-FVPTC), or infiltrative FVPTC (I-FVPTC). Each nodule was categorized based on the US pattern according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the American Thyroid Association (ATA) guidelines. The correlation between tumor invasiveness and the K-TIRADS or ATA category was investigated using Spearman's rank correlation coefficient. RESULTS Among the 152 FVPTCs, there were 48 (31.6%) NIFTPs, 60 (39.5%) iE-FVPTCs, and 44 (28.9%) I-FVPTCs. US characteristics of the FVPTCs differed significantly according to tumor invasiveness (p ≤ 0.030). Tumor invasiveness showed a significant positive correlation with K-TIRADS (tumors of all sizes: r = 0.591, p < 0.001; tumors ≥1.0 cm: r = 0.427, p < 0.001) and ATA categories (tumors of all sizes: r = 0.532, p < 0.001; tumors ≥1.0 cm: r = 0.466, p < 0.001). According to both K-TIRADS and ATA guidelines for all-sized tumors, the most common subtype was NIFTP in low-suspicion nodules (52.6% and 51.6%), iE-FVPTC in intermediate-suspicion nodules (52.7% and 54.2%), and I-FVPTC in high-suspicion nodules (82.5% and 69.4%). After surgery, lymph node metastases were confirmed in two (4.2%) NIFTP cases, three (5.0%) iE-FVPTC cases, and eight (18.2%) I-FVPTC cases (p = 0.001). The results of the BRAF mutation analysis were not significantly different between the groups (p = 0.507). CONCLUSIONS Increasing tumor invasiveness from NIFTP to iE-FVPTC to I-FVPTC is positively correlated with the level of suspicion on US using both K-TIRADS and ATA guidelines.
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MESH Headings
- Adolescent
- Adult
- Aged
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/secondary
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/diagnostic imaging
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/secondary
- Carcinoma, Papillary, Follicular/surgery
- Female
- Humans
- Lymphatic Metastasis
- Male
- Middle Aged
- Neoplasm Invasiveness/diagnostic imaging
- Neoplasm Invasiveness/pathology
- Practice Guidelines as Topic
- Retrospective Studies
- Seoul
- Tertiary Care Centers
- Thyroid Cancer, Papillary
- Thyroid Gland/diagnostic imaging
- Thyroid Gland/pathology
- Thyroid Gland/surgery
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/secondary
- Thyroid Neoplasms/surgery
- Thyroid Nodule/diagnostic imaging
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Tumor Burden
- Ultrasonography
- Ultrasonography, Doppler
- Young Adult
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Affiliation(s)
- Soo Yeon Hahn
- 1 Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jung Hee Shin
- 1 Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Young Lyun Oh
- 2 Department of Pathology, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Tae Hyuk Kim
- 3 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Yaeji Lim
- 4 Department of Statistics, Pukyong National University , Busan, Korea
| | - Ji Soo Choi
- 1 Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
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19
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Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017; 6:225-237. [PMID: 29167761 PMCID: PMC5652895 DOI: 10.1159/000478927] [Citation(s) in RCA: 632] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/17/2017] [Indexed: 01/04/2023] Open
Abstract
Thyroid ultrasound (US) is a key examination for the management of thyroid nodules. Thyroid US is easily accessible, noninvasive, and cost-effective, and is a mandatory step in the workup of thyroid nodules. The main disadvantage of the method is that it is operator dependent. Thyroid US assessment of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. Due to the pivotal role of thyroid US in the management of patients with nodules, the European Thyroid Association convened a panel of international experts to set up European guidelines on US risk stratification of thyroid nodules. Based on a review of the literature and on the American Association of Clinical Endocrinologists, American Thyroid Association, and Korean guidelines, the panel created the novel European Thyroid Imaging and Reporting Data System, called EU-TIRADS. This comprises a thyroid US lexicon; a standardized report; definitions of benign and low-, intermediate-, and high-risk nodules, with the estimated risks of malignancy in each category; and indications for FNA. Illustrated by numerous US images, the EU-TIRADS aims to serve physicians in their clinical practice, to enhance the interobserver reproducibility of descriptions, and to simplify communication of the results.
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Affiliation(s)
- Gilles Russ
- Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
| | - Steen J. Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Murat Faik Erdogan
- Department of Endocrinology and Metabolism, University of Ankara School of Medicine, İbni Sina Hastanesi, Ankara, Turkey
| | - Cosimo Durante
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Rose Ngu
- Head Neck and Thyroid Imaging, Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
- *Laurence Leenhardt, MD, PhD, Thyroid and Endocrine Tumors Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 83 Bd de l'Hôpital, FR–75651 Paris Cedex 13 (France), E-Mail
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20
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Tang AL, Falciglia M, Yang H, Mark JR, Steward DL. Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration. Thyroid 2017; 27:1077-1082. [PMID: 28657511 DOI: 10.1089/thy.2016.0555] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this study was to validate the American Thyroid Association (ATA) sonographic risk assessment of thyroid nodules. METHODS The ATA sonographic risk assessment was prospectively applied to 206 thyroid nodules selected for ultrasound-guided fine-needle aspiration (US-FNA), and analyzed with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), as well as surgical pathology for the subset undergoing surgical excision. RESULTS The analysis included 206 thyroid nodules averaging 2.4 cm (range 1-7 cm; standard error of the mean 0.07). Using the ATA US pattern risk assessment, nodules were classified as high (4%), intermediate (31%), low (38%), and very low (26%) risk of malignancy. Nodule size was inversely correlated with sonographic risk assessment, as lower risk nodules were larger on average (p < 0.0001). Malignancy rates determined by cytology/surgical pathology were high 100%, intermediate 11%, low 8%, and very low 2%, which were closely aligned with ATA malignancy risk estimates (high 70-90%, intermediate 10-20%, low 5-10%, and very low 3%). ATA US pattern risk assessment also appropriately predicted the proportion of nodules classified as malignant or suspicious for malignancy through TBSRTC classification-high (77%), intermediate (6%), low (1%), and very low 0%-as well as benign TBSRTC classification-high (0%), intermediate (47%), low (61%), and very low (70%) (p < 0.0001). Malignancy rates of surgically excised, cytologically indeterminate nodules followed ATA sonographic risk stratification (high 100%, intermediate 21%, low 17%, and very low 12%; p = 0.003). CONCLUSION This prospective study supports the new ATA sonographic pattern risk assessment for selection of thyroid nodules for US-FNA based upon TBSRTC and surgical pathology results. In the setting of indeterminate cytopathology, nodules categorized as atypia of undetermined significance/follicular lesion of undetermined significance with ATA high-risk sonographic patterns have a high likelihood of being malignant.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adenoma, Oxyphilic/diagnostic imaging
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/surgery
- Adult
- Biopsy, Fine-Needle
- Calcinosis/diagnostic imaging
- Calcinosis/pathology
- Calcinosis/surgery
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Diagnosis, Differential
- Female
- Hospitals, Teaching
- Humans
- Male
- Ohio
- Practice Guidelines as Topic
- Prospective Studies
- Risk Assessment
- Societies, Scientific
- Thyroid Cancer, Papillary
- Thyroid Gland/diagnostic imaging
- Thyroid Gland/pathology
- Thyroid Gland/surgery
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Nodule/diagnostic imaging
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Tumor Burden
- Ultrasonography
- United States
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Affiliation(s)
- Alice L Tang
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Mercedes Falciglia
- 2 Division of Endocrinology, Department of Medicine, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Huaitao Yang
- 3 Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Jonathan R Mark
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - David L Steward
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio
- 2 Division of Endocrinology, Department of Medicine, University of Cincinnati College of Medicine , Cincinnati, Ohio
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Choi YJ, Baek JH, Park HS, Shim WH, Kim TY, Shong YK, Lee JH. A Computer-Aided Diagnosis System Using Artificial Intelligence for the Diagnosis and Characterization of Thyroid Nodules on Ultrasound: Initial Clinical Assessment. Thyroid 2017; 27:546-552. [PMID: 28071987 DOI: 10.1089/thy.2016.0372] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND An initial clinical assessment is described of a new, commercially available, computer-aided diagnosis (CAD) system using artificial intelligence (AI) for thyroid ultrasound, and its performance is evaluated in the diagnosis of malignant thyroid nodules and categorization of nodule characteristics. METHODS Patients with thyroid nodules with decisive diagnosis, whether benign or malignant, were consecutively enrolled from November 2015 to February 2016. An experienced radiologist reviewed the ultrasound image characteristics of the thyroid nodules, while another radiologist assessed the same thyroid nodules using the CAD system, providing ultrasound characteristics and a diagnosis of whether nodules were benign or malignant. The diagnostic performance and agreement of US characteristics between the experienced radiologist and the CAD system were compared. RESULTS In total, 102 thyroid nodules from 89 patients were included; 59 (57.8%) were benign and 43 (42.2%) were malignant. The CAD system showed a similar sensitivity as the experienced radiologist (90.7% vs. 88.4%, p > 0.99), but a lower specificity and a lower area under the receiver operating characteristic (AUROC) curve (specificity: 74.6% vs. 94.9%, p = 0.002; AUROC: 0.83 vs. 0.92, p = 0.021). Classifications of the ultrasound characteristics (composition, orientation, echogenicity, and spongiform) between radiologist and CAD system were in substantial agreement (κ = 0.659, 0.740, 0.733, and 0.658, respectively), while the margin showed a fair agreement (κ = 0.239). CONCLUSION The sensitivity of the CAD system using AI for malignant thyroid nodules was as good as that of the experienced radiologist, while specificity and accuracy were lower than those of the experienced radiologist. The CAD system showed an acceptable agreement with the experienced radiologist for characterization of thyroid nodules.
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Affiliation(s)
- Young Jun Choi
- 1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jung Hwan Baek
- 1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hye Sun Park
- 1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Woo Hyun Shim
- 1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Tae Yong Kim
- 2 Department of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Young Kee Shong
- 2 Department of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jeong Hyun Lee
- 1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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Hahn SY, Shin JH, Lim HK, Jung SL, Oh YL, Choi IH, Jung CK. Preoperative differentiation between noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and non-NIFTP. Clin Endocrinol (Oxf) 2017; 86:444-450. [PMID: 27761926 DOI: 10.1111/cen.13263] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/27/2016] [Accepted: 10/16/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND A recent concept was proposed that the noninvasive encapsulated follicular variant of papillary thyroid carcinoma reclassified as "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)" is benign. Our aim was to identify the differences between NIFTP and non-NIFTP preoperatively. METHODS This retrospective study included a total of 208 patients with 208 follicular variant of papillary thyroid carcinomas (FVPTC) that were surgically confirmed at three university hospitals from 2008 to 2014. Clinical factors, the biopsy techniques and ultrasonography (US) imaging characteristics were compared between the NIFTP and non-NIFTP groups. RESULTS A total of 34 NIFTP (16·3%) and 174 non-NIFTP (83·7%) were observed. For NIFTPs, the need for surgery was indicated by ultrasonography-guided fine needle aspiration (US-FNA) in 54·3% and by ultrasonography-guided core needle biopsy (US-CNB) in 100% (P = 0·008). For non-NIFTP, no significant difference was noted in the rates of surgical indication between US-FNA and US-CNB (62·6% vs 78·9%, P = 0·054). The most common biopsy diagnosis of NIFTP was Bethesda category V (28·6%) in the US-FNA group and category IV (45·5%) in the US-CNB group. US diagnosis of NIFTP had a significantly lower rate of the high suspicion of malignancy than that of non-NIFTP (14·7% vs 37·9%, P = 0·024). Central nodal metastasis was found in only one case (2·9%) of NIFTP patients, but none had distance metastasis or recurrence. CONCLUSION Noninvasive follicular thyroid neoplasm with papillary-like nuclear features lacks malignant US features and is better triaged using US-CNB than using US-FNA to facilitate the surgical management. US evaluation is pivotal in determining the next step of FVPTC management.
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Affiliation(s)
- Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Ho Choi
- Department of Pathology, Soonchunhyang University Hospital, Seoul, Korea
| | - Chan Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Korea
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23
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Shin JH. Ultrasonographic imaging of papillary thyroid carcinoma variants. Ultrasonography 2017; 36:103-110. [PMID: 28222584 PMCID: PMC5381844 DOI: 10.14366/usg.16048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/20/2022] Open
Abstract
Ultrasonography (US) is routinely used to evaluate thyroid nodules. The US features of papillary thyroid carcinoma (PTC), the most common thyroid malignancy, include hypoechogenicity, spiculated/microlobulated margins, microcalcifications, and a nonparallel orientation. However, many PTC variants have been identified, some of which differ from the classic type of PTC in terms of biological behavior and clinical outcomes. This review describes the US features and clinical implications of the variants of PTC. With the introduction of active surveillance replacing immediate biopsy or surgical treatment of indolent, small PTCs, an understanding of the US characteristics of PTC variants will facilitate the individualized management of patients with PTC.
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Affiliation(s)
- Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Koh J, Kim EK, Kim JY, Kwak JY, Yoon JH, Moon HJ. Comparison of Ultrasound, Pathologic and Prognostic Characteristics of the Follicular Variant of Papillary Thyroid Cancer According to Fine-Needle Aspiration Cytology. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2864-2872. [PMID: 27658752 DOI: 10.1016/j.ultrasmedbio.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
The aim of the study described here was to compare ultrasound features, pathologic characteristics and prognoses of the follicular variant of papillary thyroid carcinoma (FVPTC) according to cytology results. Eighty-seven FVPTCs were classified according to the first cytology results as the surgery group (n = 66, follicular neoplasm/Hürthle cell neoplasm, suspicious for malignancy and malignancy) and the indeterminate group (n = 21, non-diagnostic and benign), for whom the management was follow-up. The indeterminate group had a longer mean interval to surgery (p = 0.020) and larger tumor size (p = 0.018). More tumors were assessed as probably benign in the indeterminate group than in the surgery group (p < 0.001). Extrathyroidal extension and lymph node metastasis did not significantly differ between the two groups, and no patient had a recurrence (mean follow-up interval: 54.9 ± 16.9 mo). The indeterminate group exhibited more probably benign features and larger size on ultrasound, with surgery being performed at a later date. However, aggressive pathologic characteristics and tumor recurrence did not significantly differ between the two groups.
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Affiliation(s)
- Jieun Koh
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Ye Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Baser H, Topaloglu O, Tam AA, Alkan A, Kilicarslan A, Ersoy R, Cakir B. Comparing Clinicopathologic and Radiographic Findings Between TT-UMP, Classical, and Non-Encapsulated Follicular Variants of Papillary Thyroid Carcinomas. Endocr Pathol 2016; 27:233-42. [PMID: 27256097 DOI: 10.1007/s12022-016-9437-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Thyroid tumors of uncertain malignant potential (TT-UMP) comprise an accepted subgroup of follicular-patterned thyroid tumors for which benignancy or malignancy cannot be precisely assessed. We aimed to evaluate the demographic characteristics, ultrasound (US) findings, and cytological results of patients with TT-UMP and compare these findings to a classical variant of papillary thyroid carcinoma (CV-PTC) and non-encapsulated follicular variant of PTC (NEFV-PTC) patients; we also evaluated the immunohistochemical characteristics of patients with TT-UMP. Twenty-four patients with TT-UMP, 672 with CV-PTC, and 132 with NEFV-PTC were included in the study. Mean longitudinal nodule size and median nodule volume were higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p < 0.001 and p < 0.001 for CV-PTC; p < 0.001 and p = 0.008 for NEFV-PTC). The presence of halo and peripheral vascularization was observed more frequently in the TT-UMP group than in the CV-PTC group (p = 0.002 and p = 0.024). Benign and follicular neoplasm/suspicious for follicular neoplasm cytological results were higher in the TT-UMP group than in the CV-PTC group (p = 0.030 and p = 0.001). US findings were similar between TT-UMP and NEFV-PTC groups (all, p > 0.05). However, none of the patients with TT-UMP were called malignant; 105 patients (31.2 %) of CV-PTC and 11 patients (9.5 %) of NEFV-PTC (infiltrative FV) were classified as malignant cytologically. Tumor size was higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p < 0.001 and p = 0.006). In the TT-UMP group, positive expression of HBME-1, CK-19, and Gal-3 was found in 50, 33.3, and 25 % of patients, respectively. This study demonstrated that none of the TT-UMP patients were evaluated as malignant in preoperative cytology. However, patients with TT-UMP had higher nodule and tumor sizes than CV-PTC and NEFV-PTC patients; US features were similar between NEFV-PTC and TT-UMP patients.
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Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey.
| | - Oya Topaloglu
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Abbas Ali Tam
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Afra Alkan
- Faculty of Medicine, Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey
| | - Aydan Kilicarslan
- Faculty of Medicine, Department of Pathology, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
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Ultrasonographic risk factors of malignancy in thyroid nodules. Langenbecks Arch Surg 2016; 401:839-49. [DOI: 10.1007/s00423-016-1451-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/17/2016] [Indexed: 12/18/2022]
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