1
|
Chen J, Ye D, Lv S, Li X, Ye F, Huang Y, Su Z, Lin Y, Xie T, Wen X. Benign thyroid nodules classified as ACR TI-RADS 4 or 5: Imaging and histological features. Eur J Radiol 2023; 175:111261. [PMID: 38493559 DOI: 10.1016/j.ejrad.2023.111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/15/2023] [Accepted: 12/09/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) being most widely applied in clinical practice, there is an overlap in US imaging manifestations between benign and malignant thyroid nodules. OBJECTIVES To analyze the imaging and histological characteristics of pathological benign thyroid nodules categorized as American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) 4 or 5, and to explore the correlation between the suspicious sonographic signs resulting in the misdiagnoses and the histopathological features. MATERIALS AND METHODS Overall, 227 benign thyroid nodules (215 patients) in ACR TI-RADS 4 or 5 sampled through surgical excision were analyzed between December 2020 and August 2022. We retrospectively reread the ultrasound (US) images of the pathological discordant cases, after which we performed a systematic analysis focusing on the histopathological characteristics of thyroid lesions and recorded the findings. Qualitative US features and pathological significance of the thyroid nodules were analyzed using the chi-square and Fisher's exact tests. RESULTS The pathological type of 227 thyroid nodules (n = 103 in ACR TI-RADS 4 and n = 124 in ACR TI-RADS 5) was nodular goiter together with other histopathological features, namely, fibrosis (n = 103, 45.4 %), calcification (n = 70, 30.8 %), adenomatous hyperplasia (n = 31, 13.7 %), follicular epithelial hyperplasia (n = 23, 10.1 %), Hashimoto's thyroiditis (n = 18, 7.9 %), and cystic degeneration (n = 16, 7.1 %). Fibrosis was the most common histopathological feature in both ACR TI-RADS 4 (n = 42, 40.8 %) and 5 (n = 61, 49.2 %) categories of benign thyroid nodules. Thyroid nodules with fibrosis demonstrated sonographic features of "taller than wide" (p < 0.05), while lesions with follicular epithelial hyperplasia were likely to be detected with irregular and/or lobulated margins and very hypoechoic on US (p < 0.05 for both). CONCLUSION Benign thyroid nodules with histopathological findings such as fibrosis are associated with suspicious US features, which may give inappropriately higher TIRADS stratification.
Collapse
Affiliation(s)
- Jiamin Chen
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China.
| | - Dalin Ye
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China
| | - Shuhui Lv
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China
| | - Xuefeng Li
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China
| | - Feile Ye
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China
| | - Yongquan Huang
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China.
| | - Zhongzhen Su
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China.
| | - Yuhong Lin
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China.
| | - Ting Xie
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China.
| | - Xin Wen
- The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, China.
| |
Collapse
|
2
|
Liu Y, Chen C, Wang K, Zhang M, Yan Y, Sui L, Yao J, Zhu X, Wang H, Pan Q, Wang Y, Liang P, Xu D. The auxiliary diagnosis of thyroid echogenic foci based on a deep learning segmentation model: A two-center study. Eur J Radiol 2023; 167:111033. [PMID: 37595399 DOI: 10.1016/j.ejrad.2023.111033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/18/2023] [Accepted: 08/10/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE The aim of this study is to develop AI-assisted software incorporating a deep learning (DL) model based on static ultrasound images. The software aims to aid physicians in distinguishing between malignant and benign thyroid nodules with echogenic foci and to investigate how the AI-assisted DL model can enhance radiologists' diagnostic performance. METHODS For this retrospective study, a total of 2724 ultrasound (US) scans were collected from two independent institutions, encompassing 1038 echogenic foci nodules. All echogenic foci were confirmed by pathology. Three DL segmentation models (DeepLabV3+, U-Net, and PSPNet) were developed, with each model using two different backbones to extract features from the nodular regions with echogenic foci. Evaluation indexes such as Mean Intersection over Union (MIoU), Mean Pixel Accuracy (MPA), and Dice coefficients were employed to assess the performance of the segmentation model. The model demonstrating the best performance was selected to develop the AI-assisted diagnostic software, enabling radiologists to benefit from AI-assisted diagnosis. The diagnostic performance of radiologists with varying levels of seniority and beginner radiologists in assessing high-echo nodules was then compared, both with and without the use of auxiliary strategies. The area under the receiver operating characteristic curve (AUROC) was used as the primary evaluation index, both with and without the use of auxiliary strategies. RESULTS In the analysis of Institution 2, the DeepLabV3+ (backbone is MobileNetV2 exhibited optimal segmentation performance, with MIoU = 0.891, MPA = 0.945, and Dice = 0.919. The combined AUROC (0.693 [95% CI 0.595-0.791]) of radiology beginners using AI-assisted strategies was significantly higher than those without such strategies (0.551 [0.445-0.657]). Additionally, the combined AUROC of junior physicians employing adjuvant strategies improved from 0.674 [0.574-0.774] to 0.757 [0.666-0.848]. Similarly, the combined AUROC of senior physicians increased slightly, rising from 0.745 [0.652-0.838] to 0.813 [0.730-0.896]. With the implementation of AI-assisted strategies, the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both senior physicians and beginners in the radiology department underwent varying degrees of improvement. CONCLUSIONS This study demonstrates that the DL-based auxiliary diagnosis model using US static images can improve the performance of radiologists and radiology students in identifying thyroid echogenic foci.
Collapse
Affiliation(s)
- Yuanzhen Liu
- Department of Diagnostic Ultrasound Imaging and Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, Zhejiang 317502, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310018, China.
| | - Chen Chen
- Department of Diagnostic Ultrasound Imaging and Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, Zhejiang 317502, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310018, China; Graduate School, Wannan Medical College, Wuhu, Anhui 241002, China
| | - Kai Wang
- Department of Ultrasound, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, China
| | - Maoliang Zhang
- Department of Ultrasound, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, China
| | - Yuqi Yan
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310022, China
| | - Lin Sui
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310022, China
| | - Jincao Yao
- Department of Diagnostic Ultrasound Imaging and Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310018, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China; Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, Zhejiang 310022, China.
| | - Xi Zhu
- Department of Diagnostic Ultrasound Imaging and Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, Zhejiang 317502, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310018, China
| | - Hui Wang
- Taizhou Cancer Hospital, Taizhou, Zhejiang 317502, China
| | - Qianmeng Pan
- Taizhou Cancer Hospital, Taizhou, Zhejiang 317502, China
| | - Yifan Wang
- Department of Diagnostic Ultrasound Imaging and Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, Zhejiang 317502, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310018, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China; Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, Zhejiang 310022, China; Taizhou Cancer Hospital, Taizhou, Zhejiang 317502, China.
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging and Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China; Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, Zhejiang 317502, China; Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310018, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, China; Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, Zhejiang 310022, China; Taizhou Cancer Hospital, Taizhou, Zhejiang 317502, China.
| |
Collapse
|