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Wang J, Zheng N, Wan H, Yao Q, Jia S, Zhang X, Fu S, Ruan J, He G, Chen X, Li S, Chen R, Lai B, Wang J, Jiang Q, Ouyang N, Zhang Y. Deep learning models for thyroid nodules diagnosis of fine-needle aspiration biopsy: a retrospective, prospective, multicentre study in China. Lancet Digit Health 2024; 6:e458-e469. [PMID: 38849291 DOI: 10.1016/s2589-7500(24)00085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 03/25/2024] [Accepted: 04/17/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Accurately distinguishing between malignant and benign thyroid nodules through fine-needle aspiration cytopathology is crucial for appropriate therapeutic intervention. However, cytopathologic diagnosis is time consuming and hindered by the shortage of experienced cytopathologists. Reliable assistive tools could improve cytopathologic diagnosis efficiency and accuracy. We aimed to develop and test an artificial intelligence (AI)-assistive system for thyroid cytopathologic diagnosis according to the Thyroid Bethesda Reporting System. METHODS 11 254 whole-slide images (WSIs) from 4037 patients were used to train deep learning models. Among the selected WSIs, cell level was manually annotated by cytopathologists according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) guidelines of the second edition (2017 version). A retrospective dataset of 5638 WSIs of 2914 patients from four medical centres was used for validation. 469 patients were recruited for the prospective study of the performance of AI models and their 537 thyroid nodule samples were used. Cohorts for training and validation were enrolled between Jan 1, 2016, and Aug 1, 2022, and the prospective dataset was recruited between Aug 1, 2022, and Jan 1, 2023. The performance of our AI models was estimated as the area under the receiver operating characteristic (AUROC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. The primary outcomes were the prediction sensitivity and specificity of the model to assist cyto-diagnosis of thyroid nodules. FINDINGS The AUROC of TBSRTC III+ (which distinguishes benign from TBSRTC classes III, IV, V, and VI) was 0·930 (95% CI 0·921-0·939) for Sun Yat-sen Memorial Hospital of Sun Yat-sen University (SYSMH) internal validation and 0·944 (0·929 - 0·959), 0·939 (0·924-0·955), 0·971 (0·938-1·000) for The First People's Hospital of Foshan (FPHF), Sichuan Cancer Hospital & Institute (SCHI), and The Third Affiliated Hospital of Guangzhou Medical University (TAHGMU) medical centres, respectively. The AUROC of TBSRTC V+ (which distinguishes benign from TBSRTC classes V and VI) was 0·990 (95% CI 0·986-0·995) for SYSMH internal validation and 0·988 (0·980-0·995), 0·965 (0·953-0·977), and 0·991 (0·972-1·000) for FPHF, SCHI, and TAHGMU medical centres, respectively. For the prospective study at SYSMH, the AUROC of TBSRTC III+ and TBSRTC V+ was 0·977 and 0·981, respectively. With the assistance of AI, the specificity of junior cytopathologists was boosted from 0·887 (95% CI 0·8440-0·922) to 0·993 (0·974-0·999) and the accuracy was improved from 0·877 (0·846-0·904) to 0·948 (0·926-0·965). 186 atypia of undetermined significance samples from 186 patients with BRAF mutation information were collected; 43 of them harbour the BRAFV600E mutation. 91% (39/43) of BRAFV600E-positive atypia of undetermined significance samples were identified as malignant by the AI models. INTERPRETATION In this study, we developed an AI-assisted model named the Thyroid Patch-Oriented WSI Ensemble Recognition (ThyroPower) system, which facilitates rapid and robust cyto-diagnosis of thyroid nodules, potentially enhancing the diagnostic capabilities of cytopathologists. Moreover, it serves as a potential solution to mitigate the scarcity of cytopathologists. FUNDING Guangdong Science and Technology Department. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jue Wang
- Department of Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nafen Zheng
- Department of Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huan Wan
- Department of Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qinyue Yao
- Cells Vision (Guangzhou) Medical Technology, Guangzhou, China
| | - Shijun Jia
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Zhang
- Department of Pathology, The First People's Hospital of Foshan, Foshan, China
| | - Sha Fu
- Department of Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingliang Ruan
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gui He
- Department of Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xulin Chen
- Cells Vision (Guangzhou) Medical Technology, Guangzhou, China
| | - Suiping Li
- Cells Vision (Guangzhou) Medical Technology, Guangzhou, China
| | - Rui Chen
- Cells Vision (Guangzhou) Medical Technology, Guangzhou, China
| | - Boan Lai
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jin Wang
- Cells Vision (Guangzhou) Medical Technology, Guangzhou, China
| | - Qingping Jiang
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Nengtai Ouyang
- Department of Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yin Zhang
- Department of Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Zhou N, Qin W, Zhang JJ, Wang Y, Wen JS, Lim YM. Epidemiological exploration of the impact of bluetooth headset usage on thyroid nodules using Shapley additive explanations method. Sci Rep 2024; 14:14354. [PMID: 38906901 DOI: 10.1038/s41598-024-63653-0] [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: 12/19/2023] [Accepted: 05/30/2024] [Indexed: 06/23/2024] Open
Abstract
With an increasing prevalence of thyroid nodules globally, this study investigates the potential correlation between the use of Bluetooth headsets and the incidence of thyroid nodules, considering the cumulative effects of non-ionizing radiation (NIR) emitted by these devices. In this study, we analyzed 600 valid questionnaires from the WenJuanXing platform using Propensity Score Matching (PSM) and the XGBOOST model, supplemented by SHAP analysis, to assess the risk of thyroid nodules. PSM was utilized to balance baseline characteristic differences, thereby reducing bias. The XGBOOST model was then employed to predict risk factors, with model efficacy measured by the area under the Receiver Operating Characteristic (ROC) curve (AUC). SHAP analysis helped quantify and explain the impact of each feature on the prediction outcomes, identifying key risk factors. Initially, 600 valid questionnaires from the WenJuanXing platform underwent PSM processing, resulting in a matched dataset of 96 cases for modeling analysis. The AUC value of the XGBOOST model reached 0.95, demonstrating high accuracy in differentiating thyroid nodule risks. SHAP analysis revealed age and daily Bluetooth headset usage duration as the two most significant factors affecting thyroid nodule risk. Specifically, longer daily usage durations of Bluetooth headsets were strongly linked to an increased risk of developing thyroid nodules, as indicated by the SHAP analysis outcomes. Our study highlighted a significant impact relationship between prolonged Bluetooth headset use and increased thyroid nodule risk, emphasizing the importance of considering health impacts in the use of modern technology, especially for devices like Bluetooth headsets that are frequently used daily. Through precise model predictions and variable importance analysis, our research provides a scientific basis for the formulation of public health policies and personal health habit choices, suggesting that attention should be paid to the duration of Bluetooth headset use in daily life to reduce the potential risk of thyroid nodules. Future research should further investigate the biological mechanisms of this relationship and consider additional potential influencing factors to offer more comprehensive health guidance and preventive measures.
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Affiliation(s)
- Nan Zhou
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, 43000, Kajang, Selangor, Malaysia
| | - Wei Qin
- Department of Traditional Chinese Medicine and Modern Medicine, The First People's Hospital of Nanning, No. 89, Qixing Road, Nanning, 530000, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Jia-Jin Zhang
- Intervention Department, Dongtai City Traditional Chinese Medicine Hospital, No. 198 Yaju Road, High-Tech Zone, Dongtai, 224200, Jiangsu, People's Republic of China
| | - Yun Wang
- Intervention Department, Dongtai City Traditional Chinese Medicine Hospital, No. 198 Yaju Road, High-Tech Zone, Dongtai, 224200, Jiangsu, People's Republic of China
| | - Jian-Sheng Wen
- Intervention Department, Dongtai City Traditional Chinese Medicine Hospital, No. 198 Yaju Road, High-Tech Zone, Dongtai, 224200, Jiangsu, People's Republic of China.
| | - Yang Mooi Lim
- M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, 43000, Kajang, Selangor, Malaysia.
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Qian Y, Li Z, Fan C, Huang Y. Comparison of ultrasound-guided microwave ablation, laser ablation, and radiofrequency ablation for the treatment of elderly patients with benign thyroid nodules: A meta-analysis. Exp Gerontol 2024; 191:112425. [PMID: 38604254 DOI: 10.1016/j.exger.2024.112425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND A new minimally invasive technique, ultrasound-guided thermal ablation has become one of the treatment methods for benign thyroid nodules. This study aims to evaluate the efficacy and safety of laser ablation (LA), radiofrequency ablation (RFA), and microwave ablation (MWA) in the treatment of elderly patients with benign thyroid nodules. METHODS PubMed, Web of Science, and Cochrane Library were searched for qualified randomized controlled studies (RCTs) issued from establishing databases to March 2022. After screening and evaluating the article quality, the data on nodular volume reduction rate (VRR) and the incidence of complications after thermal ablation were extracted and analyzed by RevMan 5.3 and Stata l4.0. RESULTS The meta-analysis included seven articles with 3055 participants. We found that LA, RFA, and MWA could markedly reduce the volume of benign thyroid nodules. LA was superior to RFA and MWA in reducing the volume of benign thyroid nodules in 6 months of follow-up (all P < 0.05). LA, RFA, and MWA can be safely implemented in patients with benign thyroid nodules. The incidence of significant complications after the RFA group was enhanced compared with that in the MWA (P < 0.05), and the incidence of secondary complications after RFA was slightly higher than that of LA (P < 0.05). CONCLUSION LA, RFA, and MWA can markedly reduce the volume of benign thyroid nodules in elderly patients and can safely treat benign thyroid nodules.
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Affiliation(s)
- Ying Qian
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China
| | - Zheng Li
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China
| | - Chunyun Fan
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China
| | - Yong Huang
- Department of Endocrinology, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China.
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Sciacchitano S, Rugge M, Bartolazzi A. A Review of Thyroid Cancer. JAMA 2024; 331:1863. [PMID: 38709523 DOI: 10.1001/jama.2024.5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Salvatore Sciacchitano
- Department of Life Sciences, Health and Health Professions, Link Campus University, Rome, Italy
| | - Massimo Rugge
- Department of Medicine DIMED Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Armando Bartolazzi
- Pathology Research Laboratory, St Andrea University Hospital, Rome, Italy
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Yandong H, Shiqi Z, Lanting J, Wenxin H, Leyao C, Hejing H. Establishment and preliminary application of personalized three-dimensional reconstruction of thyroid gland with automatic detection of thyroid nodules based on ultrasound videos. J Appl Clin Med Phys 2024; 25:e14332. [PMID: 38528686 PMCID: PMC11163481 DOI: 10.1002/acm2.14332] [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: 09/11/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE A well display of the spatial location of thyroid nodules in the thyroid is important for surgical path planning and surgeon-patient communication. The aim of this study was to establish a three-dimensional (3D) reconstruction method of the thyroid gland, thyroid nodule, and carotid artery with automatic detection based on two-dimensional (2D) ultrasound videos, and to evaluate its clinical value. METHODS Ultrasound videos, including the thyroid gland with nodule, isthmus of thyroid gland, and ipsilateral carotid artery, were recorded. BC-UNet, MTN-Net, and RDPA-U-Net network models were innovatively employed for segmentation of the thyroid glands, the thyroid nodules, and the carotid artery respectively. Marching Cubes algorithm was used for reconstruction, while Laplacian smoothing algorithm was employed to smooth the 3D model surface. Using this model, 20 patients and 15 surgeons completed surveys on the effectiveness of this model for the pre-surgery demonstration of nodule location as well as surgeon-patient communication. RESULTS The thyroid gland with nodule, isthmus of gland, and carotid artery were reconstructed and displayed. With the 3D model, the understanding of the spatial location of thyroid nodules improved in all three surgeon groups, eliminating the influence of professional levels. In the patient survey, the patients' understanding of the thyroid nodule location and procedure for surgery were significantly improved. In addition, with the 3D model, the time for doctors to explain to patients was significantly reduced (16.75 vs. 8.85 min, p = 0.001). CONCLUSION To our knowledge, this is the first report of constructing a 3D thyroid model using a deep learning technique for personalized thyroid segmentation based on 2D ultrasound videos. The preliminary clinical application showed that it was conducive to the comprehension of the location of thyroid nodules for surgeons and patients, with significant improvement on the efficiency of surgeon-patient communication.
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Affiliation(s)
- Huang Yandong
- Department of UltrasoundSecond Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhang Shiqi
- Department of UltrasoundSecond Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Jia Lanting
- Department of UltrasoundSecond Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Hu Wenxin
- School of Data Science and EngineeringEast China Normal UniversityShanghaiChina
| | - Chen Leyao
- School of Data Science and EngineeringEast China Normal UniversityShanghaiChina
| | - Huang Hejing
- Department of UltrasoundSecond Affiliated Hospital of Naval Medical UniversityShanghaiChina
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Li Y, Yu G, Yao N, Liu S, Wang D, Ma Q, Liu L, Wan H, Shen J. Sex-specific associations between the developmental alterations in the pituitary-thyroid hormone axis and thyroid nodules in Chinese euthyroid adults: a community-based cross-sectional study. Front Endocrinol (Lausanne) 2024; 15:1379103. [PMID: 38800483 PMCID: PMC11116631 DOI: 10.3389/fendo.2024.1379103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background Previous studies have revealed the sex-specific features of pituitary-thyroid hormone (TH) actions and the prevalence of thyroid nodules (TNs) in children and adolescents. However, it was unclear in adults. We aimed to investigate the features of pituitary-TH actions in women and men at different ages, and the associations of thyrotropin (TSH), THs, and central sensitivity to THs indices including the thyroid feedback quantile-based index by FT4 (TFQIFT4) and the thyroid feedback quantile-based index by FT3(TFQIFT3) with of TNs in Chinese euthyroid adults. Methods 8771 euthyroid adults from the communities in China were involved. Demographic, behavioral, and anthropometric data were gathered through the questionnaires. Ultrasound was performed to evaluate the TNs. TSH and THs levels were measured. The multivariable logistic regression and multivariable ordinal logistic regression were conducted. Results TFQIFT3 among both genders, except women aged 43 to 59 years, where it increased slightly. Additionally, there was an age-related decline in TFQIFT4 levels in both women and men at ages < 50 and < 53, respectively, but a marked increase after that. Lower TSH levels were significantly associated with a higher prevalence and lower odds of having fewer TNs using multiple nodules as the base category in both men and women (both P for trend < 0.05). Additionally, lower TFQIFT3 and TFQIFT4 levels were significantly associated with a higher prevalence of TNs in women (both P for trend < 0.05), and lower TFQIFT3 levels were significantly associated with a higher prevalence of TNs in men. Both higher TFQIFT3 and TFQIFT4 levels were significantly associated with higher odds of having fewer TNs using multiple nodules as the base category in women. However, the relationships between TFQIFT4 and the prevalence or number of TNs in men were not found. Conclusions The trends of THs, TSH, TFQIFT4, and TFQIFT3 at different ages were sex-dependent. Both TFQIFT4 and TFQIFT3 levels were negatively associated with the prevalence and number of TNs in women. The present results may lead to a better understanding of the sex-specific relationships between the development of the pituitary-TH axis and the formation of TNs.
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Affiliation(s)
- Ying Li
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Genfeng Yu
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Nanfang Yao
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Siyang Liu
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Dongmei Wang
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Qintao Ma
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Lan Liu
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Heng Wan
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
| | - Jie Shen
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, Guangdong, China
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Alexis M, Ginzberg SP, Soegaard Ballester JM, Mandel SJ, Langer JE, Kelz RR, Wachtel H. Assessing the Frequency of Deferrable Thyroid Nodule Biopsies to De-escalate Low-Value Care. Endocr Pract 2024; 30:305-310. [PMID: 38160939 PMCID: PMC10990838 DOI: 10.1016/j.eprac.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Thyroid nodules are common, yet fewer than 1 in 10 harbors malignancy. When present, thyroid cancer is typically indolent with excellent survival. Therefore, patients who are not candidates for thyroid cancer treatment due to comorbid disease may not require further thyroid nodule evaluation. The goal of this study was to determine the rate of deferrable thyroid nodule biopsies in patients with limited life expectancy. METHODS We identified patients who underwent thyroid fine needle aspiration (FNA) between 2015 and 2018 at our institution. The primary outcome was the number of deferrable FNAs, defined as FNAs performed in patients who died within 2 years after biopsy. Secondary outcomes included cytologic Bethesda score, procedure costs, and final diagnosis on surgical pathology. Multivariable logistic and Cox proportional hazards regressions were used to evaluate factors associated with FNA in patients with limited life expectancy. RESULTS A total of 2565 FNAs were performed. Most patients were female (79%), and 37 (1.5%) patients died within 2 years. Nonthyroid specialists were significantly more likely to order deferrable FNAs (odds ratio 4.13, P < .001). Of the patients who died within 2 years, most (78%) had a concomitant diagnosis of nonthyroid cancer, and 4 went on to have thyroid surgery (Bethesda scores: 3, 4, 4, and 6). Spending associated with deferrable FNAs and subsequent surgery totaled over $98 000. CONCLUSIONS Overall, the rate of deferrable thyroid nodule biopsies was low. However, there is an opportunity to reduce low-value biopsies in patients with a concurrent nonthyroid cancer by partnering with oncology providers.
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Affiliation(s)
- Maya Alexis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara P Ginzberg
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Susan J Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jill E Langer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Battistella E, Mirabella M, Pomba L, Toniato R, Giacomini F, Magni G, Toniato A. Uni- and Multivariate Analyses of Cancer Risk in Cytologically Indeterminate Thyroid Nodules: A Single-Center Experience. Cancers (Basel) 2024; 16:875. [PMID: 38473241 DOI: 10.3390/cancers16050875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Every year in Italy, about 60,000 new cases of nodular thyroid pathology are diagnosed, of which almost 30% are cytologically indeterminate (TIR3A/3B). The risk of malignancy reported in the literature on thyroid nodules ranges from 5% to 15% for TIR3A and from 15% to 30% for TIR3B. It is suspected that these percentages are higher in practice. We performed univariate and multivariate analyses of clinical risk factors. The medical records of 291 patients who underwent surgery for cytologically indeterminate nodular thyroid disease were retrospectively reviewed. Clinical parameters and preoperative serum markers were then compared between the benign nodular thyroid disease and thyroid cancer groups. For each patient, clinical characteristics, comorbidities, neck ultrasonographic features, and histological reports were statistically analyzed using Chi-squared and Fisher's exact tests. A total of 134 malignant neoplasms were found (46%), divided into 55 cases (35%) in the TIR3A group and 79 cases (59%) in the TIR3B group. Statistical analysis was not significant in both populations for both sex and age (TIR3A p-value = 0.5097 and p-value = 0.1430, TIR3B p-value = 0.5191 p-value = 0.3384), while it was statistically significant in patients with TIR3A nodules associated with thyroiditis (p-value = 0.0009). In addition, the patients with TIR3A and 3B nodules were stratified by ultrasound risk for the prediction of malignancy and it was significant (p = 0.0004 and p < 0.0001). In light of these results, it emerges that surgical treatment of nodular thyroid pathology with indeterminate cytology TIR3A should always be considered, and surgery for TIR3B is mandatory.
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Affiliation(s)
- Enrico Battistella
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Marica Mirabella
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Luca Pomba
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Riccardo Toniato
- School of Medicine, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Francesca Giacomini
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Giovanna Magni
- Clinical Research Unit, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Antonio Toniato
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
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Cong P, Wang XM, Zhang YF. Comparison of artificial intelligence, elastic imaging, and the thyroid imaging reporting and data system in the differential diagnosis of suspicious nodules. Quant Imaging Med Surg 2024; 14:711-721. [PMID: 38223033 PMCID: PMC10784040 DOI: 10.21037/qims-23-788] [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: 06/01/2023] [Accepted: 11/16/2023] [Indexed: 01/16/2024]
Abstract
Background Ultrasound is widely used for detecting thyroid nodules in clinical practice. This retrospective study aimed to assess the diagnostic efficacy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS), S-Detect, and elastography of the carotid artery for suspicious thyroid nodules and to determine the complementary value of artificial intelligence and elastography. Methods Between January 2021 and November 2021, 101 consecutive patients with 138 thyroid nodules were enrolled in The First Hospital of China Medical University. All nodules were evaluated using ACR-TIRADS categories (TR), S-Detect, and elastography, and then the diagnostic performance of the different methods and the combined assessment were compared. The inclusion criteria were the following: (I) TR3, TR4, and TR5 nodules, which were defined as "suspicious nodules"; (II) patients who had surgical or cytopathological results after ultrasound examination; and (III) voluntary enrollment in this study. Meanwhile, the exclusion criteria were the following: (I) TR1 and TR2 nodules, (II) patients who had undergone fine-needle aspiration before ultrasound examination, and (III) inconclusive cytologic findings. Results A total of 71 patients (12 men and 59 women) with 94 suspicious thyroid nodules (42 benign nodules and 52 malignant nodules) were finally included in this study. S-Detect had a significantly better sensitivity than did ACR-TIRADS [S-Detect: 98.1%, 95% confidence interval (CI): 89.7-100.0%; ACR-TIRADS: 84.6%, 95% CI: 71.9-93.1%; P=0.036], but its specificity was much lower (S-Detect: 19.0%; 95% CI: 8.6-34.1%; ACR-TIRADS: 40.5%, 95% CI: 25.6-56.7%; P=0.032). The accuracy was not significantly different between S-Detect (62.8%; 95% CI: 52.2-72.5%) and ACR-TIRADS (64.9%; 95% CI: 54.4-74.5%) (P=0.761). The elasticity contrast index (ECI) was not definitively useful in identifying suspicious thyroid nodules (P=0.592). Compared with the use of ACR-TIRADS and S-Detect alone, the specificity (45.2%; 95% CI: 29.8-61.3%), positive predictive value (65.2%; 95% CI: 52.4-76.5%), accuracy (66.0%; 95% CI: 55.5-75.4%), and the area under the receiver operating characteristic curve (0.640; 95% CI: 0.534-0.736) of their combination were higher but not significantly so. Conclusions At present, S-Detect cannot replace manual diagnosis, and the value of elastography of the carotid artery in diagnosing suspected thyroid nodules remains unclear.
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Affiliation(s)
- Peng Cong
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xue-Mei Wang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
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Song S, Jia C, Li C, Ma Y. The causal association between thyroid disease and gout: A Mendelian randomization study. Medicine (Baltimore) 2023; 102:e35817. [PMID: 37932979 PMCID: PMC10627627 DOI: 10.1097/md.0000000000035817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
Observational studies have reported some associations between thyroid disease and gout, but the causal relationship between the 2 is not clear. We used Mendelian randomization (MR) Analysis to investigate the causal association between some thyroid diseases (autoimmune hypothyroidism, autoimmune hyperthyroidism, thyroid nodules, and thyroid cancer) and gout. GWAS data were used for analysis. The exposure factors were autoimmune hypothyroidism, autoimmune hyperthyroidism, thyroid nodules and thyroid cancer, and the outcome variables were gout. IVW, MR-Egger, Weighted median and Weighted mode were used for MR analysis. Cochran Q test MR-PRESSO and MR-Egger intercept analysis were used to detect heterogeneity and multi directivity. Autoimmune hypothyroidism has a causal effect on gout, IVW results show (OR = 1.13, 95% CI = 1.03-1.21, PFDR = 0.0336); Autoimmune hyperthyroidism has a causal effect on gout, IVW results show (OR = 1.07, 95% CI = 1.01-1.12, PFDR = 0.0314); Thyroid cancer has no causal effect on gout, IVW results show (OR = 1.03, 95% CI = 0.98-1.09, PFDR = 0.297); Thyroid nodules has no causal effect on gout, IVW results show (OR = 1.03, 95% CI = 0.98-1.08, PFDR = 0.225); Reverse MR Studies show that gout have no causal effect on the above thyroid diseases. Autoimmune hypothyroidism and autoimmune hyperthyroidism increase the risk of gout.
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Affiliation(s)
- Shuai Song
- Department of Traditional Chinese Medicine External Treatment Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Congcong Jia
- Department of Nephrology, Shandong First Medical University Affiliated Occupational Disease Hospital, Jinan, Shandong, China
| | - ChunJing Li
- College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuxia Ma
- College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Pak SJ, Kwon D, Kim BC, Cho JW, Kim WW, Lee YM, Sung TY, Baek JH, Kim WG, Kim WB, Chung KW. Contralateral Low-to-Intermediate Suspicion Nodule Is Not a Contraindication for Lobectomy in Patients with Papillary Thyroid Carcinoma. Thyroid 2023; 33:1339-1348. [PMID: 37624735 DOI: 10.1089/thy.2023.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Background: The optimal extent of surgery for unilateral papillary thyroid carcinoma (PTC) with contralateral nodules remains unclear. This study evaluated the long-term outcomes in a large cohort of patients with unilateral PTC and contralateral low-to-intermediate suspicious nodules who underwent lobectomy. Methods: This retrospective cohort study included patients with unilateral PTC who underwent lobectomy between January 2016 and December 2017 at Asan Medical Center in Korea. Patients were divided into two groups, those with and without contralateral nodules at the time of lobectomy: the Present group and the Absent group. All contralateral nodules observed at the time of surgery and during follow-up were evaluated. Results: The study cohort consisted of 1761 patients (1879 nodules), including 700 (39.8%) with and 1061 (60.2%) without contralateral nodules. The median size of the contralateral nodules was 0.5 cm. After a median follow-up of 59 months, the median growth of the contralateral nodules in the Present group was 0.1 cm (range, -3.4 to 4.7 cm). Of the contralateral nodules present at the time of lobectomy, 54.7% remained unchanged, decreased in size, or disappeared; whereas 14.8% increased ≥0.3 cm. Of the 700 patients with contralateral nodules, 20 (2.9%) were diagnosed with contralateral PTC. The 5-year contralateral PTC disease-free survival rates in patients with and without contralateral nodules were 98.2% and 99.3% (p = 0.003), respectively, whereas the 5-year recurrence-free survival rates did not differ significantly in these two groups. Of the 39 patients who underwent completion thyroidectomy, 2 (5.1%) experienced permanent hypocalcemia. Conclusions: Lobectomy may be a safe and feasible initial treatment option for patients with unilateral low-risk PTC and contralateral low-to-intermediate suspicious nodules.
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Affiliation(s)
- Shin Jeong Pak
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Douk Kwon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung-Chang Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Woong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Fan H, Ren Q, Sheng Z, Deng G, Li L. The role of the thyroid in polycystic ovary syndrome. Front Endocrinol (Lausanne) 2023; 14:1242050. [PMID: 37867519 PMCID: PMC10585146 DOI: 10.3389/fendo.2023.1242050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/14/2023] [Indexed: 10/24/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disease in women of childbearing age and can cause metabolic disorder, infertility, and increased anxiety and depression; as a result, it can seriously affect the physical and mental health of fertile women. PCOS is a highly clinically heterogeneous disease with unclear etiology and pathogenesis, which increases the difficulty of treatment. The thyroid gland has complex regulatory effects on metabolism, reproduction, and emotion, and produces hormones that act on almost all cells of the human body. The clinical manifestations of PCOS are similar to some thyroid diseases. Furthermore, some thyroid diseases, such as subclinical hypothyroidism (SCH), not only increase the incidence rate of PCOS, but also exacerbate its associated metabolic abnormalities and reproductive disorders. Interestingly, PCOS also increases the incidence of some thyroid diseases. However, the role of the thyroid in PCOS remains unclear. This review is intended to thoroughly explore the critical role of the thyroid in PCOS by summarizing the comorbidity of PCOS and thyroid diseases and their combined role in metabolic disorders, related metabolic diseases, and reproductive disorders; and by analyzing the potential mechanism through which the thyroid influences the development and progression of PCOS and its symptoms. We hope this review will provide a valuable reference for the role of the thyroid in PCOS.
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Affiliation(s)
- Huanhuan Fan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qingling Ren
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhejin Sheng
- School of Life Science and Technology, Tongji University, Shanghai, China
| | - Ganxiu Deng
- Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Tongji University, Shanghai, China
| | - Limei Li
- Research Center for Translational Medicine, Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Bogdanovski AK, Sturgeon C, James BC. Financial toxicity in thyroid cancer survivors. Curr Opin Endocrinol Diabetes Obes 2023; 30:238-243. [PMID: 37470486 DOI: 10.1097/med.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW Financial burden and distress are high in patients with thyroid cancer. However, little has been done to evaluate potential interventions to mitigate financial toxicity in survivors. This review will cover current data on the impact of financial toxicity on quality of life and clinical outcomes in patients with thyroid cancer and highlight areas for future study. RECENT FINDINGS Thyroid cancer incidence has nearly tripled in the past decades, and cost of treatment is predicted to rise more than other cancers over the next decade. With mean age of diagnosis at 51 years, most patients begin treatment while still working, do not qualify for Medicare or Social Security, and are susceptible to higher financial burden. Though thyroid cancer has high survival rates, some studies suggest patients have worse quality of life and higher financial burden than more morbid cancers. SUMMARY Thyroid cancer survivors have high rates of financial toxicity, and there remains need for longitudinal studies to evaluate how financial burden may change during the treatment process while also assessing potential tools to mitigate this burden.
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Affiliation(s)
- Anastasia K Bogdanovski
- Harvard Medical School
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Cord Sturgeon
- Northwestern University Feinberg School of Medicine
- Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Benjamin C James
- Harvard Medical School
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Garber JR, Patkar V. Computer-interpretable guidelines: electronic tools to enhance the utility of thyroid nodule clinical practice guidelines and risk stratification tools. Front Endocrinol (Lausanne) 2023; 14:1228834. [PMID: 37654563 PMCID: PMC10465787 DOI: 10.3389/fendo.2023.1228834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/11/2023] [Indexed: 09/02/2023] Open
Abstract
Clinicians seeking guidance for evaluating and managing thyroid nodules currently have several resources. The principal ones are narrative clinical guidelines and clinical risk calculators. This paper will review the strengths and weaknesses of both. The paper will introduce a concept of computer interpretable guideline, a novel way of transforming narrative guidelines in to a clinical decision support tool that can provide patient specific recommendations at the point of care. The paper then describes an experience of developing an interactive web based computer interpretable guideline for thyroid nodule management, called Thyroid Nodule Management App (TNAPP). The advantages of this approach and the potential barriers for widespread adaptation are discussed.
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Affiliation(s)
- Jeffrey R. Garber
- Atrius Health, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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