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Verma A, Krishna K A, Kumar I, Singh PK, Kar AG, Agrawal NK. Integrated use of contrast-enhanced and grey-scale ultrasound in assigning American College of Radiology Thyroid Imaging-Reporting and Data System scores for characterisation of thyroid nodules: A prospective observational study. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:140-149. [PMID: 39100794 PMCID: PMC11292930 DOI: 10.1177/1742271x231225056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/26/2023] [Indexed: 08/06/2024]
Abstract
Background The advent and increased use of high-resolution ultrasonography has resulted in improved detection of thyroid nodules. Even with the use of various Thyroid Imaging-Reporting and Data System, accurate imaging diagnosis of malignant thyroid nodules has been suboptimal, which necessitated use of newer modalities like contrast-enhanced ultrasonography alone and in combination for this purpose. Although the combined use of various Thyroid Imaging-Reporting and Data System and contrast-enhanced ultrasonography has turned out to be accurate in many studies, the ideal way to integrate contrast-enhanced ultrasonography into the Thyroid Imaging-Reporting and Data System algorithm is under-investigated. Purpose To estimate and compare the diagnostic accuracy of American College of Radiology Thyroid Imaging-Reporting and Data System and contrast-enhanced ultrasonography in differentiating benign and malignant nodules alone and in combination. To estimate the diagnostic accuracy of contrast-enhanced ultrasonography in re-categorisation of Thyroid Imaging-Reporting and Data System 3 and Thyroid Imaging-Reporting and Data System 4 thyroid nodules. Materials and methods This was a prospective cohort study performed in a tertiary care university-based hospital for 3 years. Adult patients with clinical or previous sonographic diagnosis of thyroid nodules were selected. Each of the nodules were assessed using ultrasonography and categorised using American College of Radiology Thyroid Imaging-Reporting and Data System criteria. The lesion was then assessed for contrast-enhanced ultrasonography features. The final diagnosis of the nodules was made using fine needle aspiration cytology. The diagnostic accuracy in diagnosis of malignant thyroid nodules for each of the American College of Radiology Thyroid Imaging-Reporting and Data System and contrast-enhanced ultrasonography alone and in combination was assessed. The diagnostic accuracy of contrast-enhanced ultrasonography in diagnosis of malignant thyroid nodules categorised as Thyroid Imaging-Reporting and Data System 3 and Thyroid Imaging-Reporting and Data System 4 was also assessed. Results American College of Radiology Thyroid Imaging-Reporting and Data System had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 54.5%, 17.4%, 97.3% and 57.7%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 95.4%, 67.9%, 98.4% and 94.4%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93.3%, 100.0%, 100.0%, 99.2% and 99.3%, respectively, in re-categorisation of Thyroid Imaging-Reporting and Data System 3 and Thyroid Imaging-Reporting and Data System 4 nodules. Conclusion Contrast-enhanced ultrasonography can play a key role in diagnosis of malignant thyroid nodules which are categorised as indeterminate on grey-scale ultrasound.
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Affiliation(s)
- Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Adith Krishna K
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ishan Kumar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Pramod Kumar Singh
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Amrita Ghosh Kar
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Neeraj Kumar Agrawal
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Department of Endocrinology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Borlea A, Moisa-Luca L, Popescu A, Bende F, Stoian D. Combining CEUS and ultrasound parameters in thyroid nodule and cancer diagnosis: a TIRADS-based evaluation. Front Endocrinol (Lausanne) 2024; 15:1417449. [PMID: 38952390 PMCID: PMC11215041 DOI: 10.3389/fendo.2024.1417449] [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: 04/14/2024] [Accepted: 05/20/2024] [Indexed: 07/03/2024] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) has been established as a diagnostic tool for assessing microvascularization, essential for understanding angiogenesis in neoplastic development. AIM This study assesses the effectiveness of CEUS as a supplementary tool to TIRADS in enhancing the ultrasound-based diagnosis of thyroid cancer. METHODS AND MATERIALS Over one year, 157 nodules in 133 patients, with predominantly solid thyroid nodules, were examined using ultrasound and CEUS and underwent thyroidectomy, allowing for a comparison of ultrasound findings with pathological reports. RESULTS Thyroid cancer was identified in 31.21% (49/157) of cases. Significant CEUS high-risk features included inhomogeneous enhancement, enhancement defects, and complete hypoenhancement (AUC 0.818, 0.767, 0.864 respectively). Nodules exhibiting any of these features were classified as high-risk in CEUS. The diagnostic performance of TIRADS improved when combined with CEUS, with AUC increasing from 0.707 to 0.840 and improved sensitivity. CONCLUSION The integration of CEUS with TIRADS significantly enhances the diagnostic accuracy and specificity in identifying thyroid cancer. This combination proves to be a more effective method for risk stratification and diagnosis, highlighting the value of CEUS as an adjunctive tool in thyroid cancer evaluation.
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Affiliation(s)
- Andreea Borlea
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Luciana Moisa-Luca
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Alina Popescu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Felix Bende
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Dana Stoian
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
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Liu T, Yang F, Qiao J, Mao M. Deciphering the progression of fine-needle aspiration: A bibliometric analysis of thyroid nodule research. Medicine (Baltimore) 2024; 103:e38059. [PMID: 38758913 PMCID: PMC11098219 DOI: 10.1097/md.0000000000038059] [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: 02/21/2024] [Accepted: 04/08/2024] [Indexed: 05/19/2024] Open
Abstract
This study aims to dissect the evolution and pivotal shifts in Fine-Needle Aspiration (FNA) research for thyroid nodules over the past 2 decades, focusing on delineating key technological advancements and their impact on clinical practice. A comprehensive bibliometric analysis was conducted on 5418 publications from the Web of Science Core Collection database (2000-2023). Publications were rigorously selected based on their contributions to the advancement of FNA techniques and their influence on thyroid nodule management practices. Our analysis uncovered significant breakthroughs, most notably the incorporation of ultrasound and molecular diagnostics in FNA, which have markedly elevated diagnostic accuracy. A pivotal shift was identified towards minimally invasive post-FNA treatments, such as Radiofrequency Ablation, attributable to these diagnostic advancements. Additionally, the emergence of AI-assisted cytology represents a frontier in precision diagnostics, promising enhanced disease identification. The geographical analysis pinpointed the United States, Italy, and China as key contributors, with the United States leading in both publication volume and citation impact. This bibliometric analysis sheds light on the transformative progression in FNA practices for thyroid nodules, characterized by innovative diagnostic technologies and a trend towards patient-centric treatment approaches. The findings underscore the need for further research into AI integration and global practice standardization. Future explorations should focus on the practical application of these advancements in diverse healthcare settings and their implications for global thyroid nodule management.
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Affiliation(s)
- Tengfei Liu
- Department of Head and Neck Thyroid Surgery, Xingtai People’s Hospital of Hebei Medical University, Xingtai, P.R. China
| | - Fei Yang
- Department of Otorhinolaryngology – Head and Neck Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Junli Qiao
- Department of Head and Neck Thyroid Surgery, Xingtai People’s Hospital of Hebei Medical University, Xingtai, P.R. China
| | - Mengxuan Mao
- Department of Head and Neck Thyroid Surgery, Xingtai People’s Hospital of Hebei Medical University, Xingtai, P.R. China
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Chen JH, Zhang YQ, Zhu TT, Zhang Q, Zhao AX, Huang Y. Applying machine-learning models to differentiate benign and malignant thyroid nodules classified as C-TIRADS 4 based on 2D-ultrasound combined with five contrast-enhanced ultrasound key frames. Front Endocrinol (Lausanne) 2024; 15:1299686. [PMID: 38633756 PMCID: PMC11021584 DOI: 10.3389/fendo.2024.1299686] [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: 09/22/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives To apply machine learning to extract radiomics features from thyroid two-dimensional ultrasound (2D-US) combined with contrast-enhanced ultrasound (CEUS) images to classify and predict benign and malignant thyroid nodules, classified according to the Chinese version of the thyroid imaging reporting and data system (C-TIRADS) as category 4. Materials and methods This retrospective study included 313 pathologically diagnosed thyroid nodules (203 malignant and 110 benign). Two 2D-US images and five CEUS key frames ("2nd second after the arrival time" frame, "time to peak" frame, "2nd second after peak" frame, "first-flash" frame, and "second-flash" frame) were selected to manually label the region of interest using the "Labelme" tool. A total of 7 images of each nodule and their annotates were imported into the Darwin Research Platform for radiomics analysis. The datasets were randomly split into training and test cohorts in a 9:1 ratio. Six classifiers, namely, support vector machine, logistic regression, decision tree, random forest (RF), gradient boosting decision tree and extreme gradient boosting, were used to construct and test the models. Performance was evaluated using a receiver operating characteristic curve analysis. The area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy (ACC), and F1-score were calculated. One junior radiologist and one senior radiologist reviewed the 2D-US image and CEUS videos of each nodule and made a diagnosis. We then compared their AUC and ACC with those of our best model. Results The AUC of the diagnosis of US, CEUS and US combined CEUS by junior radiologist and senior radiologist were 0.755, 0.750, 0.784, 0.800, 0.873, 0.890, respectively. The RF classifier performed better than the other five, with an AUC of 1 for the training cohort and 0.94 (95% confidence interval 0.88-1) for the test cohort. The sensitivity, specificity, accuracy, PPV, NPV, and F1-score of the RF model in the test cohort were 0.82, 0.93, 0.90, 0.85, 0.92, and 0.84, respectively. The RF model with 2D-US combined with CEUS key frames achieved equivalent performance as the senior radiologist (AUC: 0.94 vs. 0.92, P = 0.798; ACC: 0.90 vs. 0.92) and outperformed the junior radiologist (AUC: 0.94 vs. 0.80, P = 0.039, ACC: 0.90 vs. 0.81) in the test cohort. Conclusions Our model, based on 2D-US and CEUS key frames radiomics features, had good diagnostic efficacy for thyroid nodules, which are classified as C-TIRADS 4. It shows promising potential in assisting less experienced junior radiologists.
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Affiliation(s)
| | | | | | | | | | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Gong X, Li J, Ding A, Zuo J, Rao Y, Chen J, Xiong P. Conventional and contrast-enhanced ultrasound in the differential diagnosis of recurrent dermatofibrosarcoma protuberans and postoperative scar. BMC Cancer 2024; 24:285. [PMID: 38438997 PMCID: PMC10910735 DOI: 10.1186/s12885-024-11991-7] [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: 12/05/2023] [Accepted: 02/11/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) has a high recurrence rate after resection. Because of the lack of specific manifestations, recurrent DFSP is easily misdiagnosed as post-resection scar. A few series have reported ultrasound findings of recurrent DFSP; moreover, the usefulness of contrast-enhanced ultrasound in differentiating recurrent DFSP has not been studied. OBJECTIVE We investigated conventional and contrast-enhanced ultrasound in the differential diagnosis of recurrent DFSP and post-resection scar. METHODS We retrospectively evaluated the findings of conventional and contrast-enhanced ultrasound in 34 cases of recurrent DFSP and 38 postoperative scars examined between January 2018 and December 2022. RESULTS The depth and vascular density of recurrent DFSP were greater than those of postoperative scars (P < 0.05). On gray-scale ultrasound, recurrent DFSP lesions were more commonly irregular, heterogeneous, and hypoechoic, with finger-like projections and ill-defined borders. Postoperative scar was more likely to appear as hypoechoic and homogeneous with well-defined borders (P < 0.05). On color Doppler ultrasound, recurrent DFSP was more likely to feature rich arterial and venous blood flow, and postoperative scar was more likely to display poor blood flow (P < 0.05). On contrast-enhanced ultrasound, recurrent DFSP was more likely to feature heterogeneous hyper-enhancement, and postoperative scar was more likely to display homogeneous iso-enhancement (P < 0.05). Recurrent DFSP presented a higher peak and sharpness than postoperative scar (P < 0.05). CONCLUSION Conventional and contrast-enhanced ultrasound produced distinct features of recurrent DFSP and post-resection scar, which could improve the accuracy of differential diagnosis.
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Affiliation(s)
- Xia Gong
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Jia Li
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Angang Ding
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Jiaxin Zuo
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Jun Chen
- Department of Dermatology and Dermatologic Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China.
| | - Ping Xiong
- Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China.
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Ren JY, Lv WZ, Wang L, Zhang W, Ma YY, Huang YZ, Peng YX, Lin JJ, Cui XW. Dual-modal radiomics nomogram based on contrast-enhanced ultrasound to improve differential diagnostic accuracy and reduce unnecessary biopsy rate in ACR TI-RADS 4-5 thyroid nodules. Cancer Imaging 2024; 24:17. [PMID: 38263209 PMCID: PMC10807093 DOI: 10.1186/s40644-024-00661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS, TR) 4 and 5 thyroid nodules (TNs) demonstrate much more complicated and overlapping risk characteristics than TR1-3 and have a rather wide range of malignancy possibilities (> 5%), which may cause overdiagnosis or misdiagnosis. This study was designed to establish and validate a dual-modal ultrasound (US) radiomics nomogram integrating B-mode ultrasound (BMUS) and contrast-enhanced ultrasound (CEUS) imaging to improve differential diagnostic accuracy and reduce unnecessary fine needle aspiration biopsy (FNAB) rates in TR 4-5 TNs. METHODS A retrospective dataset of 312 pathologically confirmed TR4-5 TNs from 269 patients was collected for our study. Data were randomly divided into a training dataset of 219 TNs and a validation dataset of 93 TNs. Radiomics characteristics were derived from the BMUS and CEUS images. After feature reduction, the BMUS and CEUS radiomics scores (Rad-score) were built. A multivariate logistic regression analysis was conducted incorporating both Rad-scores and clinical/US data, and a radiomics nomogram was subsequently developed. The performance of the radiomics nomogram was evaluated using calibration, discrimination, and clinical usefulness, and the unnecessary FNAB rate was also calculated. RESULTS BMUS Rad-score, CEUS Rad-score, age, shape, margin, and enhancement direction were significant independent predictors associated with malignant TR4-5 TNs. The radiomics nomogram involving the six variables exhibited excellent calibration and discrimination in the training and validation cohorts, with an AUC of 0.873 (95% CI, 0.821-0.925) and 0.851 (95% CI, 0.764-0.938), respectively. The marked improvements in the net reclassification index and integrated discriminatory improvement suggested that the BMUS and CEUS Rad-scores could be valuable indicators for distinguishing benign from malignant TR4-5 TNs. Decision curve analysis demonstrated that our developed radiomics nomogram was an instrumental tool for clinical decision-making. Using the radiomics nomogram, the unnecessary FNAB rate decreased from 35.3 to 14.5% in the training cohort and from 41.5 to 17.7% in the validation cohorts compared with ACR TI-RADS. CONCLUSION The dual-modal US radiomics nomogram revealed superior discrimination accuracy and considerably decreased unnecessary FNAB rates in benign and malignant TR4-5 TNs. It could guide further examination or treatment options.
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Affiliation(s)
- Jia-Yu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan, China
| | - Liang Wang
- Center of Computer, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying-Ying Ma
- Department of Medical Ultrasound, The First People's Hospital of Qinzhou, Qinzhou, China
| | - Yong-Zhen Huang
- Department of Medical Ultrasound, The First People's Hospital of Qinzhou, Qinzhou, China
| | - Yue-Xiang Peng
- Department of Medical Ultrasound, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Jian-Jun Lin
- Department of Medical Ultrasound, The First People's Hospital of Qinzhou, Qinzhou, China.
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Dolidze DD, Bagatelia ZA, Lukin AY, Сovantsev SD, Shevyakova TV, Pichugina NV, Skripnichenko DM, Mulaeva KA. The possibilities of ultrasound imaging in the diagnosis of follicular neoplasia of the thyroid gland. HEAD AND NECK TUMORS (HNT) 2023; 13:81-90. [DOI: 10.17650/2222-1468-2023-13-1-81-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Thyroid cancer is the most common cancer of the endocrine system. The diagnosis of thyroid cancer has taken a step forward due to the introduction of fine-needle biopsy of the thyroid gland with subsequent evaluation of cytological material using the Bethesda system. One category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the neoplasia as benign or malignant and requires surgical intervention. The traditional informative and widely used method for diagnosing thyroid tumors is ultrasound. However, the sensitivity and specificity of the method varies over a wide range. This review analyzes the literature on the possibilities of ultrasound diagnostics in assessing the malignant potential of follicular tumors of the thyroid gland.
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Affiliation(s)
- D. D. Dolidze
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - Z. A. Bagatelia
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - A. Yu. Lukin
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - S. D. Сovantsev
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - T. V. Shevyakova
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - N. V. Pichugina
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | | | - K. A. Mulaeva
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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Chen XJ, Huang LJ, Mao F, Yuan HX, Wang X, Lu Q, Dong CH. Value of CEUS features in diagnosing thyroid nodules with halo sign on B-mode ultrasound. BMC Med Imaging 2023; 23:11. [PMID: 36681788 PMCID: PMC9867848 DOI: 10.1186/s12880-023-00966-y] [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] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The results of halo sign in the differential diagnosis of thyroid nodules were conflicting, and the value of contrast-enhanced ultrasound (CEUS) in characterization of thyroid nodules with halo has not been fully evaluated. This study was therefore designed to investigate the value of contrast-enhanced ultrasound features in the differential diagnosis of thyroid nodules with halo sign on B-mode ultrasound. MATERIAL AND METHODS Seventy-four consecutive thyroid nodules with halo sign on B-mode ultrasound were pathologically confirmed by surgery or fine needle aspiration, including 43 benign and 31 malignant lesions. All these lesions underwent pre-operative CEUS examination. The CEUS features, including enhanced time, enhanced intensity and homogeneity, and presence of enhancing ring, were compared between benign and malignant ones. RESULTS Enhanced intensity was significant different between benign and malignant lesions with halo. Hypo-enhancement was more frequently detected in malignant nodules than that in benign ones, compared with iso-enhancement and hyper-enhancement (p = 0.013, and = 0.014, respectively). Detection rate of high-enhancing ring was significantly higher in benign nodules than that in malignant group (p = 0.001). While in nodules > 10 mm, only high-enhancing ring was the distinguishing feature between benign and malignant nodules. CONCLUSIONS Enhanced intensity and high-enhancing ring may be helpful in the differential diagnosis of thyroid nodules with halo sign on B-mode ultrasound.
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Affiliation(s)
- Xue-Jun Chen
- Department of Ultrasound, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, Fujian Province, China
| | - Lin-Jin Huang
- Department of Ultrasound, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, Fujian Province, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Hai-Xia Yuan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Xi Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Qing Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China.
| | - Cai-Hong Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China.
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Lian KM, Lin T. Diagnostic performance of the thyroid imaging reporting and data system improved by color-coded acoustic radiation force pulse imaging. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023; 31:511-523. [PMID: 36806542 DOI: 10.3233/xst-221359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To explore the value of color-coded virtual touch tissue imaging (CCV) using acoustic radiation force pulse technology (ARFI) in diagnosing malignant thyroid nodules. METHODS Images including 189 thyroid nodules were collected as training samples and a binary logistic regression analysis was used to calculate regression coefficients for Thyroid Imaging Reporting and Data System (TI-RADS) and CCV. An integrated prediction model (TI-RADS+CCV) was then developed based on the regression coefficients. Another testing dataset involving 40 thyroid nodules was used to validate and compare the diagnostic performance of TI-RADS, CCV, and the integrated predictive models using the receiver operating characteristic (ROC) curves. RESULTS Both TI-RADS and CCV are independent predictors. The diagnostic performance advantage of CCV is insignificant compared to TI-RADS (P = 0.61). However, the diagnostic performance of the integrated prediction model is significantly higher than that of TI-RADS or CCV (all P < 0.05). Applying to the validation image dateset, the integrated predictive model yields an area under the curve (AUC) of 0.880. CONCLUSIONS Developing a new predictive model that integrates the regression coefficients calculated from TI-RADS and CCV enables to achieve the superior performance of thyroid nodule diagnosis to that of using TI-RADS or CCV alone.
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Affiliation(s)
- Kai-Mei Lian
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Teng Lin
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
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Han Z, Huang Y, Wang H, Chu Z. Multimodal ultrasound imaging: A method to improve the accuracy of diagnosing thyroid TI-RADS 4 nodules. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1345-1352. [PMID: 36169185 DOI: 10.1002/jcu.23352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Thyroid nodule is a common and frequently occurring disease in the neck in recent years, and ultrasound has become the preferred imaging diagnosis method for thyroid nodule due to its advantages of noninvasive, nonradiation, real-time, and repeatable. The thyroid imaging, reporting and data system (TI-RADS) classification standard scores suspicious nodules that are difficult to determine benign and malignant as grade 4, and further pathological puncture is recommended clinically, which may lead to a large number of unnecessary biopsies and operations. Including conventional ultrasound, ACR TI-RADS, shear wave elastography, super microvascular imaging, contrast enhanced ultrasound, "firefly," artificial intelligence, and multimodal ultrasound imaging used in combination. In order to identify the most clinically significant malignant tumors when reducing invasive operations. This article reviews the application and research progress of multimodal ultrasound imaging in the diagnosis of TI-RADS 4 thyroid nodules.
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Affiliation(s)
- Zhengyang Han
- Department of Ultrasound, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yuanjing Huang
- Department of Ultrasound, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Honghu Wang
- Department of Ultrasound, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Zhaoyang Chu
- Department of Ultrasound, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
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Yi D, Fan L, Zhu J, Yao J, Peng C, Xu D. The diagnostic value of a nomogram based on multimodal ultrasonography for thyroid-nodule differentiation: A multicenter study. Front Oncol 2022; 12:970758. [PMID: 36059607 PMCID: PMC9435436 DOI: 10.3389/fonc.2022.970758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To establish and verify a nomogram based on multimodal ultrasonography (US) for the assessment of the malignancy risk of thyroid nodules and to explore its value in distinguishing benign from malignant thyroid nodules. Methods From September 2020 to December 2021, the data of 447 individuals with thyroid nodules were retrieved from the multicenter database of medical images of the National Health Commission’s Capacity Building and Continuing Education Center, which includes data from more than 20 hospitals. All patients underwent contrast-enhanced US (CEUS) and elastography before surgery or fine needle aspiration. The training set consisted of three hundred datasets from the multicenter database (excluding Zhejiang Cancer Hospital), and the external validation set consisted of 147 datasets from Zhejiang Cancer Hospital. As per the pathological results, the training set was separated into benign and malignant groups. The characteristics of the lesions in the two groups were analyzed and compared using conventional US, CEUS, and elastography score. Using multivariate logistic regression to screen independent predictive risk indicators, then a nomogram for risk assessment of malignant thyroid nodules was created. The diagnostic performance of the nomogram was assessed utilizing calibration curves and receiver operating characteristic (ROC) from the training and validation cohorts. The nomogram and The American College of Radiology Thyroid Imaging, Reporting and Data System were assessed clinically using decision curve analysis (DCA). Results Multivariate regression showed that irregular shape, elastography score (≥ 3), lack of ring enhancement, and unclear margin after enhancement were independent predictors of malignancy. During the training (area under the ROC [AUC]: 0.936; 95% confidence interval [CI]: 0.902–0.961) and validation (AUC: 0.902; 95% CI: 0.842–0.945) sets, the multimodal US nomogram with these four variables demonstrated good calibration and discrimination. The DCA results confirmed the good clinical applicability of the multimodal US nomogram for predicting thyroid cancer. Conclusions As a preoperative prediction tool, our multimodal US-based nomogram showed good ability to distinguish benign from malignant thyroid nodules.
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Affiliation(s)
- Dan Yi
- 1Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, China
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Libin Fan
- Department of Surgery, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Jianbo Zhu
- 1Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, China
| | - Jincao Yao
- Department of Ultrasound in Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Chanjuan Peng
- Department of Ultrasound in Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- *Correspondence: Dong Xu, ; Chanjuan Peng,
| | - Dong Xu
- Department of Ultrasound in Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
- *Correspondence: Dong Xu, ; Chanjuan Peng,
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Zhu T, Chen J, Zhou Z, Ma X, Huang Y. Differentiation of Thyroid Nodules (C-TIRADS 4) by Combining Contrast-Enhanced Ultrasound Diagnosis Model With Chinese Thyroid Imaging Reporting and Data System. Front Oncol 2022; 12:840819. [PMID: 35847847 PMCID: PMC9280912 DOI: 10.3389/fonc.2022.840819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To establish a contrast-enhanced ultrasound (CEUS) diagnostic schedule by CEUS analysis of thyroid nodules of C-TIRADS 4. To establish a CEUS-TIRADS diagnostic model to differentiate thyroid nodules (C-TIRADS 4) by combining CEUS with Chinese thyroid imaging reporting and data system (C-TIRADS). Methods A total of 228 thyroid nodules (C-TIRADS 4) were estimated by CEUS. The arrival time, enhancement degree, enhancement homogeneity, enhancement pattern, enhancement ring, and wash-out time were analyzed in CEUS for all of the nodules. Multivariate factors logistic analysis was performed and a CEUS diagnostic schedule was established. If the nodule had a regular hyper-enhancement ring or got a score of less than 2 in CEUS analysis, CEUS-TIRADS subtracted 1 category. If the nodule got a score of 2 in the CEUS schedule, the CEUS-TIRADS category remained the same as before. If the nodule got a score of more than 2 in the CEUS schedule, CEUS-TIRADS added 1 category. When it reflected an absent enhancement in CEUS, the nodule was judged as CEUS-TIRADS 3. All of the C-TIRADS 4 nodules were re-graded by CEUS-TIRADS. We then compare the diagnosis performance of C-TIRADS, CEUS, and CEUS-TIRADS by sensitivity, specificity, and accuracy. Results Among the 228 C-TIRADS 4 nodules, 69 were determined as C-TIRADS 4a, 114 were C-TIRADS 4b, and 45 were C-TIRADS 4c. The sensitivity, specificity, and accuracy of C-TIRADS were 93.1%, 55.3%, and 74.6% respectively. The area under the curve was 0.753. Later arrival time, hypo-enhancement, heterogeneous enhancement, centripetal enhancement, and rapid washout were risk factors of malignancy in multivariate analysis. The sensitivity, specificity, and accuracy of CEUS were 78.7%, 87.5%, and 83.3% respectively. The area under the curve was 0.803. By CEUS-TIRADS diagnostic model combining CEUS with C-TIRADS, a total of 127 cases were determined as malignancy (111 were malignant and 16 were benign) and 101 were diagnosed as benign ones (5 were malignant and 96 were benign). The sensitivity, specificity, and accuracy of CEUS-TIRADS were 95.7%, 85.7%, and 92.1% respectively. The area under the curve was 0.916. The diagnostic performance of CEUS-TIRADS was significantly better than CEUS and C-TIRADS. The difference was statistically significant (P<0.05). Conclusions The diagnostic schedule of CEUS could get better diagnostic performance than US in the differentiation of thyroid nodules. The CEUS-TIRADS combining CEUS analysis with C-TIRADS could make up for the deficient sensibility of C-TIRADS, showing a better diagnostic performance than US and CEUS.
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Affiliation(s)
- Tiantong Zhu
- Department of ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiahui Chen
- Department of ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zimo Zhou
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaofen Ma
- Department of ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Huang
- Department of ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Ying Huang,
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Chen Q, Lin M, Wu S. Validating and Comparing C-TIRADS, K-TIRADS and ACR-TIRADS in Stratifying the Malignancy Risk of Thyroid Nodules. Front Endocrinol (Lausanne) 2022; 13:899575. [PMID: 35784558 PMCID: PMC9247196 DOI: 10.3389/fendo.2022.899575] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
The thyroid imaging reporting and data system (TIRADS) was proposed by experts for optimal ultrasound evaluation of malignancy risk of thyroid focal lesions. There are several versions of TIRADS, some of them have been validated sufficiently, and the others have not been well assessed. In this study, a recently launched Chinese version of TIRADS (C-TIRADS) for malignancy risk stratification of thyroid nodules was validated, and the performance was compared to that of the Korean TIRADS (K-TIRADS) and American College of Radiology(ACR) TIRADS (ACR-TIRADS). Archives of 2177 patients who had undergone thyroid ultrasound examination, coarse needle tissue biopsy and/or surgery were reviewed, and 1978 patients with 1982 thyroid nodules were assessed according to the three TIRADSs. The histopathology was taken as the golden standard. The results showed the 1982 thyroid nodules were consisted of 1306 benign nodules and 676 malignant nodules. The malignancy risk accounted for 1.09%, 2.14%, 10.34%, 49.28%, 88.19% and 85.29% of the total nodules that were categorised as C-TIRADS 2, 3, 4A, 4B, 4C and 5, respectively; 0.00%, 1.64%, 2.87%,18.71% and 82.22% of the total nodules that were categorised as ACR-TIRADS 1, 2, 3, 4 and 5, respectively; 0.85%, 3.27%, 24.27% and 80.96% of the total nodules that were categorised as K-TIRADS 2, 3, 4 and 5, respectively. The correlation between the category of TIRADS and percentile of malignancy was 0.94 in the C-TIRADS, 1.00 in the ACR-TIRADS, and 1.00 in the K-TIRADS, respectively. The highest values of accuracy(AUC) of ROC curves of C-TIRADS 4B, K-TIRADS 5 and ACR-TIRADS 5 were taken as the cut-off values for risk stratification, respectively. The sensitivity, specificity, positive and negative predictive values and AUC by C-TIRADS 4B, K-TIRADS 5 and ACR-TIRADS 5 for malignancy risk stratification of thyroid nodules were 90.83%, 84.23%, 74.88% and 94.66% and 0.88, respectively; 83.58%, 89.82%, 80.95%, 91.36% and 0.87, respectively; and 85.50%, 90.35%, 82.10%, 92.33% and 0.88, respectively (P>0.05 for all). We concluded that the C-TIRADS has excellent performance in the malignancy risk stratification of thyroid nodules by the optimized cut-off value, which is comparable to that in K-TIRADS and ACR-TIRADS.
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Affiliation(s)
| | | | - Size Wu
- *Correspondence: Size Wu, ; orcid.org/0000-0002-1086-764X
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Radzina M, Ratniece M, Putrins DS, Saule L, Cantisani V. Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives. Cancers (Basel) 2021; 13:5469. [PMID: 34771632 PMCID: PMC8582579 DOI: 10.3390/cancers13215469] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nodules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and "fast-in and slow-out" are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an operative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy.
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Affiliation(s)
- Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Madara Ratniece
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
| | - Davis Simanis Putrins
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Laura Saule
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, Italy;
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