1
|
Leoncini A, Curti M, Ruinelli L, Gamarra E, Trimboli P. Performance of ACR-TIRADS in assessing thyroid nodules does not vary according to patient age. Hormones (Athens) 2024:10.1007/s42000-024-00585-4. [PMID: 39028415 DOI: 10.1007/s42000-024-00585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
AIMS A few studies have evaluated the performance of the American College of Radiology Thyroid Imaging Reporting And Data System (ACR-TIRADS) in pediatric and elderly patients and found differences between the latter two age groups and middle adulthood. Thus, the present study was undertaken to explore the possible variation of ACR-TIRADS performance across different ages of patients. METHODS A retrospective population undergoing thyroidectomy was selected to use histology as the reference standard. Ultrasound images were reviewed, and alignment of ACR-TIRADS with the corresponding histological diagnosis was made afterwards. Results of the age groups were compared. The ACR-TIRADS diagnostic performance was calculated considering the assessment of nodules across risk categories (i.e., from TR1 to TR5), rate of unnecessary FNAC (UN-FNAC), and rate of necessary but non-performed FNAC (NNP-FNAC). RESULTS Overall, 114 patients with a total of 220 nodules (46 carcinomas) were included. The rate of UN-FNAC was 66.3%, being 93.1% in TR3, 82.1% in TR4, and 31.4% in TR5. There were 15 NNP-FNACs. No significant difference was observed between age groups in terms of sample size, nodule, cancer, and FNAC. The nodule assessment according to ACR-TIRADS categories did not vary across ages. Sensitivity and specificity recorded in three age tertiles were not significantly different. CONCLUSIONS The present study shows that the performance of ACR-TIRADS is not significantly influenced by patient age.
Collapse
Affiliation(s)
- Andrea Leoncini
- Servizio Di Radiologia E Radiologia Interventistica, Istituto Di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland
| | - Marco Curti
- Servizio Di Radiologia E Radiologia Interventistica, Istituto Di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland
| | - Lorenzo Ruinelli
- Servizio Di Endocrinologia E Diabetologia, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland
- Team Data Science & Research, Ente Ospedaliero Cantonale, Area ICT, 6500, Bellinzona, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Elena Gamarra
- Servizio Di Endocrinologia E Diabetologia, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland
| | - Pierpaolo Trimboli
- Servizio Di Endocrinologia E Diabetologia, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland.
- Facoltà Di Scienze Biomediche, Università Della Svizzera Italiana (USI), 6900, Lugano, Switzerland.
| |
Collapse
|
2
|
Zhou B, Liu J, Yang Y, Ye X, Liu Y, Mao M, Sun X, Cui X, Zhou Q. Ultrasound-based nomogram to predict the recurrence in papillary thyroid carcinoma using machine learning. BMC Cancer 2024; 24:810. [PMID: 38972977 PMCID: PMC11229345 DOI: 10.1186/s12885-024-12546-6] [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: 10/31/2023] [Accepted: 06/20/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND AND AIMS The recurrence of papillary thyroid carcinoma (PTC) is not unusual and associated with risk of death. This study is aimed to construct a nomogram that combines clinicopathological characteristics and ultrasound radiomics signatures to predict the recurrence in PTC. METHODS A total of 554 patients with PTC who underwent ultrasound imaging before total thyroidectomy were included. Among them, 79 experienced at least one recurrence. Then 388 were divided into the training cohort and 166 into the validation cohort. The radiomics features were extracted from the region of interest (ROI) we manually drew on the tumor image. The feature selection was conducted using Cox regression and least absolute shrinkage and selection operator (LASSO) analysis. And multivariate Cox regression analysis was used to build the combined nomogram using radiomics signatures and significant clinicopathological characteristics. The efficiency of the nomogram was evaluated by receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). Kaplan-Meier analysis was used to analyze the recurrence-free survival (RFS) in different radiomics scores (Rad-scores) and risk scores. RESULTS The combined nomogram demonstrated the best performance and achieved an area under the curve (AUC) of 0.851 (95% CI: 0.788 to 0.913) in comparison to that of the radiomics signature and the clinical model in the training cohort at 3 years. In the validation cohort, the combined nomogram (AUC = 0.885, 95% CI: 0.805 to 0.930) also performed better. The calibration curves and DCA verified the clinical usefulness of combined nomogram. And the Kaplan-Meier analysis showed that in the training cohort, the cumulative RFS in patients with higher Rad-score was significantly lower than that in patients with lower Rad-score (92.0% vs. 71.9%, log rank P < 0.001), and the cumulative RFS in patients with higher risk score was significantly lower than that in patients with lower risk score (97.5% vs. 73.5%, log rank P < 0.001). In the validation cohort, patients with a higher Rad-score and a higher risk score also had a significantly lower RFS. CONCLUSION We proposed a nomogram combining clinicopathological variables and ultrasound radiomics signatures with excellent performance for recurrence prediction in PTC patients.
Collapse
Affiliation(s)
- Binqian Zhou
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Jianxin Liu
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Yaqin Yang
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xuewei Ye
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Yang Liu
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Mingfeng Mao
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xiaofeng Sun
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| | - Qin Zhou
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Ahn HJ, Ishikawa K, Kim MH. Exploring the diagnostic performance of machine learning in prediction of metabolic phenotypes focusing on thyroid function. PLoS One 2024; 19:e0304785. [PMID: 38941283 PMCID: PMC11213305 DOI: 10.1371/journal.pone.0304785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/17/2024] [Indexed: 06/30/2024] Open
Abstract
In this study, we employed various machine learning models to predict metabolic phenotypes, focusing on thyroid function, using a dataset from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. Our analysis utilized laboratory parameters relevant to thyroid function or metabolic dysregulation in addition to demographic features, aiming to uncover potential associations between thyroid function and metabolic phenotypes by various machine learning methods. Multinomial Logistic Regression performed best to identify the relationship between thyroid function and metabolic phenotypes, achieving an area under receiver operating characteristic curve (AUROC) of 0.818, followed closely by Neural Network (AUROC: 0.814). Following the above, the performance of Random Forest, Boosted Trees, and K Nearest Neighbors was inferior to the first two methods (AUROC 0.811, 0.811, and 0.786, respectively). In Random Forest, homeostatic model assessment for insulin resistance, serum uric acid, serum albumin, gamma glutamyl transferase, and triiodothyronine/thyroxine ratio were positioned in the upper ranks of variable importance. These results highlight the potential of machine learning in understanding complex relationships in health data. However, it's important to note that model performance may vary depending on data characteristics and specific requirements. Furthermore, we emphasize the significance of accounting for sampling weights in complex survey data analysis and the potential benefits of incorporating additional variables to enhance model accuracy and insights. Future research can explore advanced methodologies combining machine learning, sample weights, and expanded variable sets to further advance survey data analysis.
Collapse
Affiliation(s)
- Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Kyle Ishikawa
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, United States of America
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul, South Korea
| |
Collapse
|
5
|
Wang Y, Xu Z, Dan R, Yao C, Shao J, Sun Y, Wang Y, Ye J. Automated classification of multiple ophthalmic diseases using ultrasound images by deep learning. Br J Ophthalmol 2024; 108:999-1004. [PMID: 37852741 DOI: 10.1136/bjo-2022-322953] [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: 11/21/2022] [Accepted: 09/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Ultrasound imaging is suitable for detecting and diagnosing ophthalmic abnormalities. However, a shortage of experienced sonographers and ophthalmologists remains a problem. This study aims to develop a multibranch transformer network (MBT-Net) for the automated classification of multiple ophthalmic diseases using B-mode ultrasound images. METHODS Ultrasound images with six clinically confirmed categories, including normal, retinal detachment, vitreous haemorrhage, intraocular tumour, posterior scleral staphyloma and other abnormalities, were used to develop and evaluate the MBT-Net. Images were derived from five different ultrasonic devices operated by different sonographers and divided into training set, validation set, internal testing set and temporal external testing set. Two senior ophthalmologists and two junior ophthalmologists were recruited to compare the model's performance. RESULTS A total of 10 184 ultrasound images were collected. The MBT-Net got an accuracy of 87.80% (95% CI 86.26% to 89.18%) in the internal testing set, which was significantly higher than junior ophthalmologists (95% CI 67.37% to 79.16%; both p<0.05) and lower than senior ophthalmologists (95% CI 89.45% to 92.61%; both p<0.05). The micro-average area under the curve of the six-category classification was 0.98. With reference to comprehensive clinical diagnosis, the measurements of agreement were almost perfect in the MBT-Net (kappa=0.85, p<0.05). There was no significant difference in the accuracy of the MBT-Net across five ultrasonic devices (p=0.27). The MBT-Net got an accuracy of 82.21% (95% CI 78.45% to 85.44%) in the temporal external testing set. CONCLUSIONS The MBT-Net showed high accuracy for screening and diagnosing multiple ophthalmic diseases using only ultrasound images across mutioperators and mutidevices.
Collapse
Affiliation(s)
- Yijie Wang
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zihao Xu
- Microelectronics CAD Center, Hangzhou Dianzi University, Hangzhou, China
| | - Ruilong Dan
- Microelectronics CAD Center, Hangzhou Dianzi University, Hangzhou, China
| | - Chunlei Yao
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ji Shao
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiming Sun
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yaqi Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou, China
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
6
|
Sant VR, Radhachandran A, Ivezic V, Lee DT, Livhits MJ, Wu JX, Masamed R, Arnold CW, Yeh MW, Speier W. From Bench-to-Bedside: How Artificial Intelligence is Changing Thyroid Nodule Diagnostics, a Systematic Review. J Clin Endocrinol Metab 2024; 109:1684-1693. [PMID: 38679750 PMCID: PMC11180510 DOI: 10.1210/clinem/dgae277] [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: 01/30/2024] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
CONTEXT Use of artificial intelligence (AI) to predict clinical outcomes in thyroid nodule diagnostics has grown exponentially over the past decade. The greatest challenge is in understanding the best model to apply to one's own patient population, and how to operationalize such a model in practice. EVIDENCE ACQUISITION A literature search of PubMed and IEEE Xplore was conducted for English-language publications between January 1, 2015 and January 1, 2023, studying diagnostic tests on suspected thyroid nodules that used AI. We excluded articles without prospective or external validation, nonprimary literature, duplicates, focused on nonnodular thyroid conditions, not using AI, and those incidentally using AI in support of an experimental diagnostic outside standard clinical practice. Quality was graded by Oxford level of evidence. EVIDENCE SYNTHESIS A total of 61 studies were identified; all performed external validation, 16 studies were prospective, and 33 compared a model to physician prediction of ground truth. Statistical validation was reported in 50 papers. A diagnostic pipeline was abstracted, yielding 5 high-level outcomes: (1) nodule localization, (2) ultrasound (US) risk score, (3) molecular status, (4) malignancy, and (5) long-term prognosis. Seven prospective studies validated a single commercial AI; strengths included automating nodule feature assessment from US and assisting the physician in predicting malignancy risk, while weaknesses included automated margin prediction and interobserver variability. CONCLUSION Models predominantly used US images to predict malignancy. Of 4 Food and Drug Administration-approved products, only S-Detect was extensively validated. Implementing an AI model locally requires data sanitization and revalidation to ensure appropriate clinical performance.
Collapse
Affiliation(s)
- Vivek R Sant
- Division of Endocrine Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ashwath Radhachandran
- Biomedical Artificial Intelligence Research Lab, UCLA Department of Bioengineering, Los Angeles, CA 90024, USA
| | - Vedrana Ivezic
- Biomedical Artificial Intelligence Research Lab, UCLA Department of Bioengineering, Los Angeles, CA 90024, USA
| | - Denise T Lee
- Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Masha J Livhits
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - James X Wu
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Rinat Masamed
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Corey W Arnold
- Biomedical Artificial Intelligence Research Lab, UCLA Department of Bioengineering, Los Angeles, CA 90024, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - William Speier
- Biomedical Artificial Intelligence Research Lab, UCLA Department of Bioengineering, Los Angeles, CA 90024, USA
| |
Collapse
|
7
|
Zhang R, Hu L, Cheng Y, Chang L, Dong L, Han L, Yu W, Zhang R, Liu P, Wei X, Yu J. Targeted sequencing of DNA/RNA combined with radiomics predicts lymph node metastasis of papillary thyroid carcinoma. Cancer Imaging 2024; 24:75. [PMID: 38886866 PMCID: PMC11181663 DOI: 10.1186/s40644-024-00719-2] [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: 04/01/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE The aim of our study is to find a better way to identify a group of papillary thyroid carcinoma (PTC) with more aggressive behaviors and to provide a prediction model for lymph node metastasis to assist in clinic practice. METHODS Targeted sequencing of DNA/RNA was used to detect genetic alterations. Gene expression level was measured by quantitative real-time PCR, western blotting or immunohistochemistry. CCK8, transwell assay and flow cytometry were used to investigate the effects of concomitant gene alterations in PTC. LASSO-logistics regression algorithm was used to construct a nomogram model integrating radiomic features, mutated genes and clinical characteristics. RESULTS 172 high-risk variants and 7 fusion types were detected. The mutation frequencies in BRAF, TERT, RET, ATM and GGT1 were significantly higher in cancer tissues than benign nodules. Gene fusions were detected in 16 samples (2 at the DNA level and 14 at the RNA level). ATM mutation (ATMMUT) was frequently accompanied by BRAFMUT, TERTMUT or gene fusions. ATMMUT alone or ATM co-mutations were significantly positively correlated with lymph node metastasis. Accordingly, ATM knock-down PTC cells bearing BRAFV600E, KRASG12R or CCDC6-RET had higher proliferative ability and more aggressive potency than cells without ATM knock-down in vitro. Furthermore, combining gene alterations and clinical features significantly improved the predictive efficacy for lymph node metastasis of radiomic features, from 71.5 to 87.0%. CONCLUSIONS Targeted sequencing of comprehensive genetic alterations in PTC has high prognostic value. These alterations, in combination with clinical and radiomic features, may aid in predicting invasive PTC with higher accuracy.
Collapse
Affiliation(s)
- Runjiao Zhang
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Linfei Hu
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Yanan Cheng
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Luchen Chang
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
| | - Li Dong
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Lei Han
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wenwen Yu
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Immunology, Key Laboratory of Cancer Immunology and Biotherapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Rui Zhang
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Pengpeng Liu
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xi Wei
- Tianjin's Clinical Research Center for Cancer, Tianjin, China.
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China.
| | - Jinpu Yu
- Cancer Molecular Diagnostics Core, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China.
- Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| |
Collapse
|
8
|
Elendu C, Amaechi DC, Amaechi EC, Chima-Ogbuiyi NL, Afuh RN, Arrey Agbor DB, Abdi MA, Nwachukwu NO, Oderinde OO, Elendu TC, Elendu ID, Akintunde AA, Onyekweli SO, Omoruyi GO. Diagnostic criteria and scoring systems for thyroid storm: An evaluation of their utility - comparative review. Medicine (Baltimore) 2024; 103:e37396. [PMID: 38552097 PMCID: PMC10977538 DOI: 10.1097/md.0000000000037396] [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: 10/01/2023] [Accepted: 02/06/2024] [Indexed: 04/02/2024] Open
Abstract
A thyroid storm is a life-threatening endocrine emergency characterized by severe hyperthyroidism and many systemic manifestations. Prompt recognition and treatment are essential for patient survival. This study evaluates the utility of existing diagnostic criteria and scoring systems for thyroid storm. A comprehensive literature review encompassed articles published up to December 2023. Various diagnostic criteria and scoring systems, such as the Burch-Wartofsky Point Scale and the Japanese Thyroid Association criteria, were critically assessed based on their sensitivity, specificity, and clinical applicability. Our findings reveal that existing diagnostic criteria and scoring systems, although valuable tools, exhibit limitations. They may lack sensitivity in identifying milder cases of thyroid storm or fail to differentiate it from other critical conditions. Furthermore, some criteria rely heavily on subjective clinical Judgment, which can vary among healthcare providers. Future research should focus on refining existing criteria and developing more objective and universally applicable diagnostic tools to address these limitations. Incorporating advanced laboratory markers and modern imaging techniques may enhance diagnostic accuracy. Additionally, a standardized scoring system approach could improve clinical practice consistency. In conclusion, while current diagnostic criteria and scoring systems provide a foundation for identifying thyroid storm, their utility has shortcomings. Advancements in diagnostic methods and a collaborative effort to establish standardized criteria are imperative to enhance the accuracy and reliability of thyroid storm diagnosis, ultimately improving patient outcomes.
Collapse
|
9
|
Xiong Z, Shi Y, Zhang Y, Duan S, Ding Y, Zheng Q, Jiao Y, Yan J. Ultrasound radiomics based XGBoost model to differential diagnosis thyroid nodules and unnecessary biopsy rate: Individual application of SHapley additive exPlanations. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:305-314. [PMID: 38149658 DOI: 10.1002/jcu.23631] [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: 10/25/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES Radiomics-based eXtreme gradient boosting (XGBoost) model was developed to differentiate benign thyroid nodules from malignant thyroid nodules and to prevent unnecessary thyroid biopsies, including positive and negative effects. METHODS The study evaluated a data set of ultrasound images of thyroid nodules in patients retrospectively, who initially received ultrasound-guided fine-needle aspiration biopsy (FNAB) for diagnostic purposes. According to ACR TI-RADS, a total of five ultrasound feature categories and the maximum size of the nodule were determined by four radiologists. A radiomics score was developed by the LASSO algorithm from the ultrasound-based radiomics features. An interpretative method based on Shapley additive explanation (SHAP) was developed. XGBoost was compared with ACR TI-RADS for its diagnostic performance and FNAB rate and was compared with six other machine learning models to evaluate the model performance. RESULTS Finally, 191 thyroid nodules were examined from 177 patients. The radiomics score were calculated using 8 features, which were selected among 789 candidate features generated from the ultrasound images. The model yielded an AUC of 93% in the training cohort and 92% in the test cohort. It outperformed traditional machine learning models in assessing the nature of thyroid nodules. Compared with ACR TI-RADS, the FNAB rate decreased from 34% to 30% in training and from 35% to 41% in test. CONCLUSIONS The radiomics-based XGBoost model proposed could distinguish benign and malignant thyroid nodules, thereby reduced significantly the number of unnecessary FNAB. It was effective in making preoperative decisions and managing selected patients using the SHAP visual interpretation tools.
Collapse
Affiliation(s)
- Zhengbiao Xiong
- Department of Ultrasonography, Binzhou Medical University Hospital, Shandong, China
| | - Yan Shi
- Department of Ultrasonography, Binzhou Medical University Hospital, Shandong, China
| | - Yunyun Zhang
- Department of Orthopaedic Trauma, Binzhou Medical University Hospital, Shandong, China
| | - Shuhui Duan
- Department of Ultrasonography, Binzhou Medical University Hospital, Shandong, China
| | - Yushuang Ding
- Department of Ultrasonography, Binzhou Medical University Hospital, Shandong, China
| | - Qi Zheng
- Department of Ultrasonography, Binzhou Medical University Hospital, Shandong, China
| | - Yuting Jiao
- Department of Ultrasonography, Binzhou Medical University Hospital, Shandong, China
| | - Junhong Yan
- Department of Ultrasonography, Binzhou Medical University Hospital, Shandong, China
| |
Collapse
|
10
|
Wang SR, Zhu PS, Li J, Chen M, Cao CL, Shi LN, Li WX. Study on diagnosing thyroid nodules of ACR TI-RADS 4-5 with multimodal ultrasound radiomics technology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:274-283. [PMID: 38105371 DOI: 10.1002/jcu.23625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Explore the feasibility of using the multimodal ultrasound (US) radiomics technology to diagnose American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) 4-5 thyroid nodules. METHOD This study prospectively collected the clinical characteristics, conventional, and US elastography images of 100 patients diagnosed with ACR TI-RADS 4-5 nodules from May 2022 to 2023. Independent risk factors for malignant thyroid nodules were extracted and screened using methods such as the least absolute shrinkage and selection operator (LASSO) logistic regression (LR) model, and a multimodal US radiomics combined diagnostic model was established. Using a multifactorial LR analysis and a Rad-score rating, the predictive performance was validated and evaluated, and the final threshold range was determined to assess the clinical net benefit of the model. RESULTS In the training set, the US radiomics combined predictive model area under curve (AUC = 0.928) had higher diagnostic performance compared with clinical characteristics (AUC = 0.779), conventional US (AUC = 0.794), and US elastography model (AUC = 0.852). In the validation set, the multimodal US radiomics combined diagnostic model (AUC = 0.829) also had higher diagnostic performance compared with clinical characteristics (AUC = 0.799), conventional US (AUC = 0.802), and US elastography model (AUC = 0.718). CONCLUSION Multi-modal US radiomics technology can effectively diagnose thyroid nodules of ACR TI-RADS 4-5, and the combination of radiomics signature and conventional US features can further improve the diagnostic performance.
Collapse
Affiliation(s)
- Si-Rui Wang
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Pei-Shan Zhu
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Jun Li
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Ming Chen
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Chun-Li Cao
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Li-Nan Shi
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Wen-Xiao Li
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| |
Collapse
|
11
|
Ha EJ, Lee JH, Lee DH, Moon J, Lee H, Kim YN, Kim M, Na DG, Kim JH. Artificial Intelligence Model Assisting Thyroid Nodule Diagnosis and Management: A Multicenter Diagnostic Study. J Clin Endocrinol Metab 2024; 109:527-535. [PMID: 37622451 DOI: 10.1210/clinem/dgad503] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 08/26/2023]
Abstract
CONTEXT It is not clear how to integrate artificial intelligence (AI)-based models into diagnostic workflows. OBJECTIVE To develop and validate a deep-learning-based AI model (AI-Thyroid) for thyroid cancer diagnosis, and to explore how this improves diagnostic performance. METHODS The system was trained using 19 711 images of 6163 patients in a tertiary hospital (Ajou University Medical Center; AUMC). It was validated using 11 185 images of 4820 patients in 24 hospitals (test set 1) and 4490 images of 2367 patients in AUMC (test set 2). The clinical implications were determined by comparing the findings of six physicians with different levels of experience (group 1: 4 trainees, and group 2: 2 faculty radiologists) before and after AI-Thyroid assistance. RESULTS The area under the receiver operating characteristic (AUROC) curve of AI-Thyroid was 0.939. The AUROC, sensitivity, and specificity were 0.922, 87.0%, and 81.5% for test set 1 and 0.938, 89.9%, and 81.6% for test set 2. The AUROCs of AI-Thyroid did not differ significantly according to the prevalence of malignancies (>15.0% vs ≤15.0%, P = .226). In the simulated scenario, AI-Thyroid assistance changed the AUROC, sensitivity, and specificity from 0.854 to 0.945, from 84.2% to 92.7%, and from 72.9% to 86.6% (all P < .001) in group 1, and from 0.914 to 0.939 (P = .022), from 78.6% to 85.5% (P = .053) and from 91.9% to 92.5% (P = .683) in group 2. The interobserver agreement improved from moderate to substantial in both groups. CONCLUSION AI-Thyroid can improve diagnostic performance and interobserver agreement in thyroid cancer diagnosis, especially in less-experienced physicians.
Collapse
Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 16499, South Korea
| | - Jeong Hoon Lee
- Department of Radiology, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 16499, South Korea
| | - Da Hyun Lee
- Department of Radiology, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 16499, South Korea
| | - Jayoung Moon
- Department of Radiology, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 16499, South Korea
| | - Haein Lee
- Department of Radiology, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 16499, South Korea
| | - You Na Kim
- Department of Radiology, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 16499, South Korea
| | - Minji Kim
- Department of Radiology, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 16499, South Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, Gangwon-do 25440, South Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, South Korea
| |
Collapse
|
12
|
Lai M, Feng B, Yao J, Wang Y, Pan Q, Chen Y, Chen C, Feng N, Shi F, Tian Y, Gao L, Xu D. Value of Artificial Intelligence in Improving the Accuracy of Diagnosing TI-RADS Category 4 Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2413-2421. [PMID: 37652837 DOI: 10.1016/j.ultrasmedbio.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Considerable heterogeneity is observed in the malignancy rates of thyroid nodules classified as category 4 according to the Thyroid Imaging Reporting and Data System (TI-RADS). This study was aimed at comparing the diagnostic performance of artificial intelligence algorithms and radiologists with different experience levels in distinguishing benign and malignant TI-RADS 4 (TR4) nodules. METHODS Between January 2019 and September 2022, 1117 TR4 nodules with well-defined pathological findings were collected for this retrospective study. An independent external data set of 125 TR4 nodules was incorporated for testing purposes. Traditional feature-based machine learning (ML) models, deep convolutional neural networks (DCNN) models and a fusion model that integrated the prediction outcomes from all models were used to classify benign and malignant TR4 nodules. A fivefold cross-validation approach was employed, and the diagnostic performance of each model and radiologists was compared. RESULTS In the external test data set, the area under the receiver operating characteristic curve (AUROC) of the three DCNN-based secondary transfer learning models-InceptionV3, DenseNet121 and ResNet50-were 0.852, 0.837 and 0.856, respectively. These values were higher than those of the three traditional ML models-logistic regression, multilayer perceptron and random forest-at 0.782, 0.790, and 0.767, respectively, and higher than that of an experienced radiologist (0.815). The fusion diagnostic model we developed, with an AUROC of 0.880, was found to outperform the experienced radiologist in diagnosing TR4 nodules. CONCLUSION The integration of artificial intelligence algorithms into medical imaging studies could improve the accuracy of identifying high-risk TR4 nodules pre-operatively and have significant clinical application potential.
Collapse
Affiliation(s)
- Min Lai
- Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Taizhou Cancer Hospital, Taizhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China
| | - Bojian Feng
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Jincao Yao
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Yifan Wang
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China
| | - Qianmeng Pan
- Taizhou Cancer Hospital, Taizhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China
| | - Yuhang Chen
- Zhejiang Gongshang University, Hangzhou, China
| | - Chen Chen
- Taizhou Cancer Hospital, Taizhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China; Graduate School, Wannan Medical College, Wuhu, China
| | - Na Feng
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China
| | - Fang Shi
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, China
| | - Yuan Tian
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, China
| | - Lu Gao
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, China
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Taizhou Cancer Hospital, Taizhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China.
| |
Collapse
|
13
|
Bini F, Pica A, Marinozzi F, Giusti A, Leoncini A, Trimboli P. Model-Optimizing Radiofrequency Parameters of 3D Finite Element Analysis for Ablation of Benign Thyroid Nodules. Bioengineering (Basel) 2023; 10:1210. [PMID: 37892940 PMCID: PMC10604455 DOI: 10.3390/bioengineering10101210] [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: 08/07/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Radiofrequency (RF) ablation represents an efficient strategy to reduce the volume of thyroid nodules. In this study, a finite element model was developed with the aim of optimizing RF parameters, e.g., input power and treatment duration, in order to achieve the target volume reduction rate (VRR) for a thyroid nodule. RF ablation is modelled as a coupled electro-thermal problem wherein the electric field is applied to induce tissue heating. The electric problem is solved with the Laplace equation, the temperature distribution is estimated with the Pennes bioheat equation, and the thermal damage is evaluated using the Arrhenius equation. The optimization model is applied to RF electrode with different active tip lengths in the interval from 5 mm to 40 mm at the 5 mm step. For each case, we also explored the influence of tumour blood perfusion rate on RF ablation outcomes. The model highlights that longer active tips are more efficient as they require lesser power and shorter treatment time to reach the target VRR. Moreover, this condition is characterized by a reduced transversal ablation zone. In addition, a higher blood perfusion increases the heat dispersion, requiring a different combination of RF power and time treatment to achieve the target VRR. The model may contribute to an improvement in patient-specific RF ablation treatment.
Collapse
Affiliation(s)
- Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy; (A.P.); (F.M.)
| | - Andrada Pica
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy; (A.P.); (F.M.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy; (A.P.); (F.M.)
| | - Alessandro Giusti
- Dalle Mole Institute for Artificial Intelligence (IDSIA), Università della Svizzera Italiana (USI), The University of Applied Sciences and Arts of Southern Switzerland (SUPSI), 6900 Lugano, Switzerland;
| | - Andrea Leoncini
- Servizio di Radiologia e Radiologia Interventistica, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
| | - Pierpaolo Trimboli
- Clinic of Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| |
Collapse
|
14
|
Zhong NN, Wang HQ, Huang XY, Li ZZ, Cao LM, Huo FY, Liu B, Bu LL. Enhancing head and neck tumor management with artificial intelligence: Integration and perspectives. Semin Cancer Biol 2023; 95:52-74. [PMID: 37473825 DOI: 10.1016/j.semcancer.2023.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023]
Abstract
Head and neck tumors (HNTs) constitute a multifaceted ensemble of pathologies that primarily involve regions such as the oral cavity, pharynx, and nasal cavity. The intricate anatomical structure of these regions poses considerable challenges to efficacious treatment strategies. Despite the availability of myriad treatment modalities, the overall therapeutic efficacy for HNTs continues to remain subdued. In recent years, the deployment of artificial intelligence (AI) in healthcare practices has garnered noteworthy attention. AI modalities, inclusive of machine learning (ML), neural networks (NNs), and deep learning (DL), when amalgamated into the holistic management of HNTs, promise to augment the precision, safety, and efficacy of treatment regimens. The integration of AI within HNT management is intricately intertwined with domains such as medical imaging, bioinformatics, and medical robotics. This article intends to scrutinize the cutting-edge advancements and prospective applications of AI in the realm of HNTs, elucidating AI's indispensable role in prevention, diagnosis, treatment, prognostication, research, and inter-sectoral integration. The overarching objective is to stimulate scholarly discourse and invigorate insights among medical practitioners and researchers to propel further exploration, thereby facilitating superior therapeutic alternatives for patients.
Collapse
Affiliation(s)
- Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Han-Qi Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Xin-Yue Huang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Zi-Zhan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Fang-Yi Huo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China.
| |
Collapse
|
15
|
Aversano L, Bernardi ML, Cimitile M, Maiellaro A, Pecori R. A systematic review on artificial intelligence techniques for detecting thyroid diseases. PeerJ Comput Sci 2023; 9:e1394. [PMID: 37346658 PMCID: PMC10280452 DOI: 10.7717/peerj-cs.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/21/2023] [Indexed: 06/23/2023]
Abstract
The use of artificial intelligence approaches in health-care systems has grown rapidly over the last few years. In this context, early detection of diseases is the most common area of application. In this scenario, thyroid diseases are an example of illnesses that can be effectively faced if discovered quite early. Detecting thyroid diseases is crucial in order to treat patients effectively and promptly, by saving lives and reducing healthcare costs. This work aims at systematically reviewing and analyzing the literature on various artificial intelligence-related techniques applied to the detection and identification of various diseases related to the thyroid gland. The contributions we reviewed are classified according to different viewpoints and taxonomies in order to highlight pros and cons of the most recent research in the field. After a careful selection process, we selected and reviewed 72 papers, analyzing them according to three main research questions, i.e., which diseases of the thyroid gland are detected by different artificial intelligence techniques, which datasets are used to perform the aforementioned detection, and what types of data are used to perform the detection. The review demonstrates that the majority of the considered papers deal with supervised methods to detect hypo- and hyperthyroidism. The average accuracy of detection is high (96.84%), but the usage of private and outdated datasets with a majority of clinical data is very common. Finally, we discuss the outcomes of the systematic review, pointing out advantages, disadvantages, and future developments in the application of artificial intelligence for thyroid diseases detection.
Collapse
Affiliation(s)
- Lerina Aversano
- Department of Engineering, University of Sannio, Benevento, Italy
| | | | - Marta Cimitile
- Dept. of Law and Digital Society, UnitelmaSapienza University, Rome, Italy
| | - Andrea Maiellaro
- Department of Engineering, University of Sannio, Benevento, Italy
| | - Riccardo Pecori
- Institute of Materials for Electronics and Magnetism, National Research Council, Parma, Italy
- SMARTEST Research Centre, eCampus University, Novedrate (CO), Italy
| |
Collapse
|
16
|
Gao X, Ran X, Ding W. The progress of radiomics in thyroid nodules. Front Oncol 2023; 13:1109319. [PMID: 36959790 PMCID: PMC10029726 DOI: 10.3389/fonc.2023.1109319] [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: 11/27/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Due to the development of Artificial Intelligence (AI), Machine Learning (ML), and the improvement of medical imaging equipment, radiomics has become a popular research in recent years. Radiomics can obtain various quantitative features from medical images, highlighting the invisible image traits and significantly enhancing the ability of medical imaging identification and prediction. The literature indicates that radiomics has a high potential in identifying and predicting thyroid nodules. So in this article, we explain the development, definition, and workflow of radiomics. And then, we summarize the applications of various imaging techniques in identifying benign and malignant thyroid nodules, predicting invasiveness and metastasis of thyroid lymph nodes, forecasting the prognosis of thyroid malignancies, and some new advances in molecular level and deep learning. The shortcomings of this technique are also summarized, and future development prospects are provided.
Collapse
Affiliation(s)
| | - Xuan Ran
- *Correspondence: Wei Ding, ; Xuan Ran,
| | - Wei Ding
- *Correspondence: Wei Ding, ; Xuan Ran,
| |
Collapse
|
17
|
Sorrenti S, Dolcetti V, Radzina M, Bellini MI, Frezza F, Munir K, Grani G, Durante C, D’Andrea V, David E, Calò PG, Lori E, Cantisani V. Artificial Intelligence for Thyroid Nodule Characterization: Where Are We Standing? Cancers (Basel) 2022; 14:cancers14143357. [PMID: 35884418 PMCID: PMC9315681 DOI: 10.3390/cancers14143357] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/24/2022] [Accepted: 07/08/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary In the present review, an up-to-date summary of the state of the art of artificial intelligence (AI) implementation for thyroid nodule characterization and cancer is provided. The opinion on the real effectiveness of AI systems remains controversial. Taking into consideration the largest and most scientifically valid studies, it is possible to state that AI provides results that are comparable or inferior to expert ultrasound specialists and radiologists. Promising data approve AI as a support tool and simultaneously highlight the need for a radiologist supervisory framework for AI provided results. Therefore, current solutions might be more suitable for educational purposes. Abstract Machine learning (ML) is an interdisciplinary sector in the subset of artificial intelligence (AI) that creates systems to set up logical connections using algorithms, and thus offers predictions for complex data analysis. In the present review, an up-to-date summary of the current state of the art regarding ML and AI implementation for thyroid nodule ultrasound characterization and cancer is provided, highlighting controversies over AI application as well as possible benefits of ML, such as, for example, training purposes. There is evidence that AI increases diagnostic accuracy and significantly limits inter-observer variability by using standardized mathematical algorithms. It could also be of aid in practice settings with limited sub-specialty expertise, offering a second opinion by means of radiomics and computer-assisted diagnosis. The introduction of AI represents a revolutionary event in thyroid nodule evaluation, but key issues for further implementation include integration with radiologist expertise, impact on workflow and efficiency, and performance monitoring.
Collapse
Affiliation(s)
- Salvatore Sorrenti
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (S.S.); (V.D.); (E.L.)
| | - Vincenzo Dolcetti
- Department of Radiological, Anatomo-Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.); (V.C.)
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia;
- Medical Faculty, University of Latvia, Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1007 Riga, Latvia
| | - Maria Irene Bellini
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (S.S.); (V.D.); (E.L.)
- Correspondence:
| | - Fabrizio Frezza
- Department of Information Engineering, Electronics and Telecommunications, “Sapienza” University of Rome, 00184 Rome, Italy; (F.F.); (K.M.)
- Consorzio Nazionale Interuniversitario per le Telecomunicazioni (CNIT), Viale G.P. Usberti 181/A Sede Scientifica di Ingegneria-Palazzina 3, 43124 Parma, Italy
| | - Khushboo Munir
- Department of Information Engineering, Electronics and Telecommunications, “Sapienza” University of Rome, 00184 Rome, Italy; (F.F.); (K.M.)
| | - Giorgio Grani
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (G.G.); (C.D.); (E.D.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (G.G.); (C.D.); (E.D.)
| | - Vito D’Andrea
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (S.S.); (V.D.); (E.L.)
| | - Emanuele David
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (G.G.); (C.D.); (E.D.)
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, “Policlinico Universitario Duilio Casula”, University of Cagliari, 09042 Monserrato, Italy;
| | - Eleonora Lori
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (S.S.); (V.D.); (E.L.)
| | - Vito Cantisani
- Department of Radiological, Anatomo-Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.); (V.C.)
| |
Collapse
|
18
|
Personalized Diagnosis in Differentiated Thyroid Cancers by Molecular and Functional Imaging Biomarkers: Present and Future. Diagnostics (Basel) 2022; 12:diagnostics12040944. [PMID: 35453992 PMCID: PMC9030409 DOI: 10.3390/diagnostics12040944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Personalized diagnosis can save unnecessary thyroid surgeries, in cases of indeterminate thyroid nodules, when clinicians tend to aggressively treat all these patients. Personalized diagnosis benefits from a combination of imagery and molecular biomarkers, as well as artificial intelligence algorithms, which are used more and more in our timeline. Functional imaging diagnosis such as SPECT, PET, or fused images (SPECT/CT, PET/CT, PET/MRI), is exploited at maximum in thyroid nodules, with a long history in the past and a bright future with many suitable radiotracers that could properly contribute to diagnosing malignancy in thyroid nodules. In this way, patients will be spared surgery complications, and apparently more expensive diagnostic workouts will financially compensate each patient and also the healthcare system. In this review we will summarize essential available diagnostic tools for malignant and benignant thyroid nodules, beginning with functional imaging, molecular analysis, and combinations of these two and other future strategies, including AI or NIS targeted gene therapy for thyroid carcinoma diagnosis and treatment as well.
Collapse
|
19
|
Artificial Intelligence (AI) Tools for Thyroid Nodules on Ultrasound, From the AJR Special Series on AI Applications. AJR Am J Roentgenol 2022; 219:1-8. [PMID: 35383487 DOI: 10.2214/ajr.22.27430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Artificial intelligence (AI) methods for evaluating thyroid nodules on ultrasound have been widely described in the literature, with reported performance of AI tools matching or in some instances surpassing radiologists. As these data have accumulated, products for classification and risk stratification of thyroid nodules on ultrasound have become commercially available. This article reviews FDA-approved products currently on the market, with a focus on product features, reported performance, and considerations for implementation. The products perform risk stratification primarily using the Thyroid Imaging Reporting and Data System (TI-RADS), though may provide additional prediction tools independent of TI-RADS. Key issues in implementation include integration with radiologist interpretation, impact on workflow and efficiency, and performance monitoring. AI applications beyond nodule classification, including report construction and incidental findings follow-up, are also described. Anticipated future directions of research and development in AI tools for thyroid nodules are highlighted.
Collapse
|
20
|
Advancements in Ultrasound and Ultrasound-Based Risk Stratification Systems for the Assessment of Thyroid Nodule. Cancers (Basel) 2022; 14:cancers14071668. [PMID: 35406440 PMCID: PMC8997102 DOI: 10.3390/cancers14071668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
|
21
|
Swan KZ, Thomas J, Nielsen VE, Jespersen ML, Bonnema SJ. External validation of AIBx, an artificial intelligence model for risk stratification, in thyroid nodules. Eur Thyroid J 2022; 11:e210129. [PMID: 35113036 PMCID: PMC8963165 DOI: 10.1530/etj-21-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Artificial intelligence algorithms could be used to risk-stratify thyroid nodules and may reduce the subjectivity of ultrasonography. One such algorithm is AIBx which has shown good performance. However, external validation is crucial prior to clinical implementation. MATERIALS AND METHODS Patients harboring thyroid nodules 1-4 cm in size, undergoing thyroid surgery from 2014 to 2016 in a single institution, were included. A histological diagnosis was obtained in all cases. Medullary thyroid cancer, metastasis from other cancers, thyroid lymphomas, and purely cystic nodules were excluded. Retrospectively, transverse ultrasound images of the nodules were analyzed by AIBx, and the results were compared with histopathology and Thyroid Imaging Reporting and Data System (TIRADS), calculated by experienced physicians. RESULTS Out of 329 patients, 257 nodules from 209 individuals met the eligibility criteria. Fifty-one nodules (20%) were malignant. AIBx had a negative predictive value (NPV) of 89.2%. Sensitivity, specificity, and positive predictive values (PPV) were 78.4, 44.2, and 25.8%, respectively. Considering both TIRADS 4 and TIRADS 5 nodules as malignant lesions resulted in an NPV of 93.0%, while PPV and specificity were only 22.4 and 19.4%, respectively. By combining AIBx with TIRADS, no malignant nodules were overlooked. CONCLUSION When applied to ultrasound images obtained in a different setting than used for training, AIBx had comparable NPVs to TIRADS. AIBx performed even better when combined with TIRADS, thus reducing false negative assessments. These data support the concept of AIBx for thyroid nodules, and this tool may help less experienced operators by reducing the subjectivity inherent to thyroid ultrasound interpretation.
Collapse
Affiliation(s)
- Kristine Z Swan
- Department of ORL, Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- Correspondence should be addressed to K Z Swan:
| | - Johnson Thomas
- Department of Endocrinology, Mercy Hospital, Springfield, Missouri, USA
| | - Viveque E Nielsen
- Department of ORL, Head- and Neck Surgery, Odense University Hospital, Odense, Denmark
| | | | - Steen J Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
22
|
Yu J, Zhang Y, Zheng J, Jia M, Lu X. Ultrasound images-based deep learning radiomics nomogram for preoperative prediction of RET rearrangement in papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:1062571. [PMID: 36605945 PMCID: PMC9807879 DOI: 10.3389/fendo.2022.1062571] [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: 10/06/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To create an ultrasound -based deep learning radiomics nomogram (DLRN) for preoperatively predicting the presence of RET rearrangement among patients with papillary thyroid carcinoma (PTC). METHODS We retrospectively enrolled 650 patients with PTC. Patients were divided into the RET/PTC rearrangement group (n = 103) and the non-RET/PTC rearrangement group (n = 547). Radiomics features were extracted based on hand-crafted features from the ultrasound images, and deep learning networks were used to extract deep transfer learning features. The least absolute shrinkage and selection operator regression was applied to select the features of nonzero coefficients from radiomics and deep transfer learning features; then, we established the deep learning radiomics signature. DLRN was constructed using a logistic regression algorithm by combining clinical and deep learning radiomics signatures. The prediction performance was evaluated using the receiver operating characteristic curve, calibration curve, and decision curve analysis. RESULTS Comparing the effectiveness of the models by linking the area under the receiver operating characteristic curve of each model, we found that the area under the curve of DLRN could reach 0.9545 (95% confidence interval: 0.9133-0.9558) in the test cohort and 0.9396 (95% confidence interval: 0.9185-0.9607) in the training cohort, indicating that the model has an excellent performance in predicting RET rearrangement in PTC. The decision curve analysis demonstrated that the combined model was clinically useful. CONCLUSION The novel ultrasonic-based DLRN has an important clinical value for predicting RET rearrangement in PTC. It can provide physicians with a preoperative non-invasive primary screening method for RET rearrangement diagnosis, thus facilitating targeted patients with purposeful molecular sequencing to avoid unnecessary medical investment and improve treatment outcomes.
Collapse
Affiliation(s)
- Jialong Yu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yihan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jian Zheng
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Meng Jia
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, China
- *Correspondence: Xiubo Lu, ; Meng Jia,
| | - Xiubo Lu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, China
- *Correspondence: Xiubo Lu, ; Meng Jia,
| |
Collapse
|