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Liu F, Wang Y, Xiong Y, Li X, Yao J, Ju H, Ren F, Zhang L, Wang H. Diagnostic value of combined ultrasound contrast and elastography for differentiating benign and malignant thyroid nodules: a meta-analysis. Sci Rep 2024; 14:12605. [PMID: 38824246 PMCID: PMC11144246 DOI: 10.1038/s41598-024-63420-1] [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: 03/19/2024] [Accepted: 05/28/2024] [Indexed: 06/03/2024] Open
Abstract
The diagnostic value of contrast-enhanced ultrasound combined with ultrasound elastography for benign and malignant thyroid nodules is still controversial, so we used meta-analysis to seek controversial answers. The PubMed, OVID, and CNKI databases were searched according to the inclusion and exclusion criteria. The literature was selected from the establishment of each database to February 2024. The QUADAS-2 tool assessed diagnostic test accuracy. SROC curves and Spearman's correlation coefficient were made by Review Manager 5.4 software to assess the presence of threshold effects in the literature. Meta-Disc1.4 software was used for Cochrane-Q and χ2 tests, which be used to evaluate heterogeneity, with P-values and I2 indicating heterogeneity levels. The appropriate effect model was selected based on the results of the heterogeneity test. Stata18.0 software was used to evaluate publication bias. The diagnostic accuracy of contrast-enhanced ultrasound combined with ultrasound elastography for benign and malignant thyroid nodules was evaluated by calculating the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, DOR, and area under the SROC curve. A total of 31 studies included 3811 patients with 4718 nodules were analyzed. There is no heterogeneity caused by the threshold effect, but there is significant non-threshold heterogeneity. Combined diagnostic metrics were: sensitivity = 0.93, specificity = 0.91, DOR = 168.41, positive likelihood ratio = 10.60, and negative likelihood ratio = 0.07. The SROC curve area was 0.97. Contrast-enhanced ultrasound and elastography show high diagnostic accuracy for thyroid nodules, offering a solid foundation for early diagnosis and treatment.Trial registration. CRD42024509462.
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Affiliation(s)
- Funing Liu
- School of First Clinical College, Shenyang Medical College, Shenyang, People's Republic of China
| | - Yihan Wang
- School of Public Health, Shenyang Medical College, Shenyang, People's Republic of China
| | - Yu Xiong
- School of First Clinical College, Shenyang Medical College, Shenyang, People's Republic of China
| | - Xin Li
- School of Stomatology, Shenyang Medical College, Shenyang, People's Republic of China
| | - Jun Yao
- School of Forensic Medicine, China Medical University, Shenyang, People's Republic of China
| | - Hao Ju
- Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Fu Ren
- Department of Human Anatomy, School of Basic Medicine, Shenyang Medical College, Shenyang, People's Republic of China
- Key Laboratory of Human Ethnic Specificity and Phenomics of Critical Illness in Liaoning Province, Shenyang, People's Republic of China
- Key Laboratory of Phenomics Research, No.146, Huanghe North Street, Shenyang, 110034, Liaoning, People's Republic of China
| | - Luwei Zhang
- 242 Hospital of Shenyang Medical College, Shenyang, People's Republic of China.
| | - Hongbo Wang
- Department of Human Anatomy, School of Basic Medicine, Shenyang Medical College, Shenyang, People's Republic of China.
- Key Laboratory of Human Ethnic Specificity and Phenomics of Critical Illness in Liaoning Province, Shenyang, People's Republic of China.
- Key Laboratory of Phenomics Research, No.146, Huanghe North Street, Shenyang, 110034, Liaoning, People's Republic of China.
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Xu Y, Pi J, Jinghu Y, Wang X, Xu D, Liu J. Diagnostic Efficiency of ACR-TIRADS Score for Differentiating Benign and Malignant Thyroid Nodules of Various Pathological Types. Med Sci Monit 2024; 30:e943228. [PMID: 38764217 PMCID: PMC11119926 DOI: 10.12659/msm.943228] [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: 11/17/2023] [Accepted: 02/28/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Thyroid nodule prevalence reaches 65% in the general population. Hence, appropriate ultrasonic examination is key in disease monitoring and management. We investigated the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) score for diagnosis of benign and malignant thyroid nodules and pathological types. MATERIAL AND METHODS A retrospective study was conducted. According to ultrasound images, ultrasonic characteristics of benign and malignant thyroid nodules and different pathological types were analyzed using ACR-TIRADS score, and diagnostic value was determined. AUCs were compared for tumor diagnosis and differentiation. RESULTS Overall, 1675 thyroid nodules from 1614 patients were included. AUC value of papillary thyroid carcinoma (PTC) diagnosed with ACR-TIRADS was highest (0.955 [95% CI=0.946-0.965]), while that of follicular thyroid carcinoma (FTC) was lowest (0.877 [95% CI=0.843-0.912]). FTC had the highest sensitivity (95.1%) and lowest specificity (64.8%). When the cut-off value was 5.5 points, accuracy of diagnosing PTC and anaplastic thyroid carcinoma (ATC) was highest, 80.5% and 78.7% respectively. Comparison of the multi-index prediction model constructed by multivariable logistic regression analysis and prediction model constructed by ACR-TIRADS score showed, when evaluating PTC and ATC, the multi-index model was better: AUCs of PTC were 0.966 vs 0.955, and AUCs of ATC were 0.982 vs 0.952, respectively, (P<0.05). CONCLUSIONS ACR-TIRADS score-based ultrasound examination of thyroid nodules aids diagnosis of benign and malignant thyroid nodules. TIRADS criteria favor diagnosis of PTC (and ATC) over FTC. ACR-TIRADS score can help clinicians diagnose thyroid nodules quickly and earlier, exhibits good clinical value, and can prevent missed diagnoses.
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Affiliation(s)
- Yan Xu
- Department of Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, PR China
| | - Jiashun Pi
- College of Life Science and Medicine, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, PR China
| | - Yihan Jinghu
- College of Life Science and Medicine, Zhejiang Sci-Tech University, Hangzhou, Zhejiang, PR China
| | - Xiaotao Wang
- Department of Ultrasound, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, PR China
| | - Dong Xu
- Department of Radiology (Ultrasound), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, PR China
| | - Jie Liu
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
- Department of Oncology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, PR China
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Zheng T, Wang L, Wang H, Tang L, Xie X, Fu Q, Wu PY, Song B. Prediction model based on MRI morphological features for distinguishing benign and malignant thyroid nodules. BMC Cancer 2024; 24:256. [PMID: 38395783 PMCID: PMC10885392 DOI: 10.1186/s12885-024-11995-3] [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: 11/13/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The low specificity of Thyroid Imaging Reporting and Data System (TI-RADS) for preoperative benign-malignant diagnosis leads to a large number of unnecessary biopsies. This study developed and validated a predictive model based on MRI morphological features to improve the specificity. METHODS A retrospective analysis was conducted on 825 thyroid nodules pathologically confirmed postoperatively. Univariate and multivariate logistic regression were used to obtain β coefficients, construct predictive models and nomogram incorporating MRI morphological features in the training cohort, and validated in the validation cohort. The discrimination, calibration, and decision curve analysis of the nomogram were performed. The diagnosis efficacy, area under the curve (AUC) and net reclassification index (NRI) were calculated and compared with TI-RADS. RESULTS 572 thyroid nodules were included (training cohort: n = 397, validation cohort: n = 175). Age, low signal intensity on T2WI, restricted diffusion, reversed halo sign in delay phase, cystic degeneration and wash-out pattern were independent predictors of malignancy. The nomogram demonstrated good discrimination and calibration both in the training cohort (AUC = 0.972) and the validation cohort (AUC = 0.968). The accuracy, sensitivity, specificity, PPV, NPV and AUC of MRI-based prediction were 94.4%, 96.0%, 93.4%, 89.9%, 96.5% and 0.947, respectively. The MRI-based prediction model exhibited enhanced accuracy (NRI>0) in comparison to TI-RADSs. CONCLUSIONS The prediction model for diagnosis of benign and malignant thyroid nodules demonstrated a more notable diagnostic efficacy than TI-RADS. Compared with the TI-RADSs, predictive model had better specificity along with a high sensitivity and can reduce overdiagnosis and unnecessary biopsies.
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Affiliation(s)
- Tingting Zheng
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Lanyun Wang
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Lang Tang
- Department of Ultrasound, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Xiaoli Xie
- Department of Pathology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Qingyin Fu
- Department of Ultrasound, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China
| | - Pu-Yeh Wu
- GE Healthcare, MR Research China, Beijing, China
| | - Bin Song
- Department of Radiology, Minhang Hospital, Fudan University, No 170, Xinsong Road, Minhang District, 201199, Shanghai, China.
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Lu WJ, Mao L, Li J, OuYang LY, Chen JY, Chen SY, Lin YY, Wu YW, Chen SN, Qiu SD, Chen F. Three-dimensional ultrasound-based radiomics nomogram for the prediction of extrathyroidal extension features in papillary thyroid cancer. Front Oncol 2023; 13:1046951. [PMID: 37681026 PMCID: PMC10482087 DOI: 10.3389/fonc.2023.1046951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 07/21/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose To develop and validate a three-dimensional ultrasound (3D US) radiomics nomogram for the preoperative prediction of extrathyroidal extension (ETE) in papillary thyroid cancer (PTC). Methods This retrospective study included 168 patients with surgically proven PTC (non-ETE, n = 90; ETE, n = 78) who were divided into training (n = 117) and validation (n = 51) cohorts by a random stratified sampling strategy. The regions of interest (ROIs) were obtained manually from 3D US images. A larger number of radiomic features were automatically extracted. Finally, a nomogram was built, incorporating the radiomics scores and selected clinical predictors. Receiver operating characteristic (ROC) curves were performed to validate the capability of the nomogram on both the training and validation sets. The nomogram models were compared with conventional US models. The DeLong test was adopted to compare different ROC curves. Results The area under the receiver operating characteristic curve (AUC) of the radiologist was 0.67 [95% confidence interval (CI), 0.580-0.757] in the training cohort and 0.62 (95% CI, 0.467-0.746) in the validation cohort. Sixteen features from 3D US images were used to build the radiomics signature. The radiomics nomogram, which incorporated the radiomics signature, tumor location, and tumor size showed good calibration and discrimination in the training cohort (AUC, 0.810; 95% CI, 0.727-0.876) and the validation cohort (AUC, 0.798; 95% CI, 0.662-0.897). The result suggested that the diagnostic efficiency of the 3D US-based radiomics nomogram was better than that of the radiologist and it had a favorable discriminate performance with a higher AUC (DeLong test: p < 0.05). Conclusions The 3D US-based radiomics signature nomogram, a noninvasive preoperative prediction method that incorporates tumor location and tumor size, presented more advantages over radiologist-reported ETE statuses for PTC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Fei Chen
- *Correspondence: Shao-Dong Qiu, ; Fei Chen,
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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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Lian KM, Lin T. Role of color-coded virtual touch tissue imaging in suspected thyroid nodules. Technol Health Care 2022; 30:673-682. [PMID: 34511520 DOI: 10.3233/thc-213156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Conventional ultrasound (US) is the most widely used imaging test for thyroid nodule surveillance. OBJECTIVE We used the color-coded virtual touch tissue imaging (VTI) in the Acoustic Radiation Force Impulse (ARFI) technique to assess the hardness of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) TR3-5 nodules. The ability of color-coded VTI (CV) to discriminate between benign and malignant nodules was investigated. METHODS In this retrospective study, US and CV were performed on 211 TR3-5 thyroid lesions in 181 consecutive patients. All nodules were operated on to obtain pathological results. A multivariate logistic regression model was chosen to integrate the data obtained from the US and CV. RESULTS The area under the receiver operating characteristic (ROC) curve for the model was 0.945 (95% CI, 0.914 to 0.976). The cutoff value of predictive probability for diagnosing malignant thyroid nodules was 10.64%, the sensitivity was 94.43%, and the specificity was 83.12%. Through comparing with US and CV, respectively, it had been observed that the regression model had the best performance (all P< 0.001). However, when the US was compared with CV, the difference was not significant (P= 0.3304). CONCLUSIONS A combination of US and CV should be recommended for suspected malignant thyroid nodules in clinical practice.
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Affiliation(s)
- Kai-Mei Lian
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Teng Lin
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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Cao Y, Zhong X, Diao W, Mu J, Cheng Y, Jia Z. Radiomics in Differentiated Thyroid Cancer and Nodules: Explorations, Application, and Limitations. Cancers (Basel) 2021; 13:2436. [PMID: 34069887 PMCID: PMC8157383 DOI: 10.3390/cancers13102436] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 02/05/2023] Open
Abstract
Radiomics is an emerging technique that allows the quantitative extraction of high-throughput features from single or multiple medical images, which cannot be observed directly with the naked eye, and then applies to machine learning approaches to construct classification or prediction models. This method makes it possible to evaluate tumor status and to differentiate malignant from benign tumors or nodules in a more objective manner. To date, the classification and prediction value of radiomics in DTC patients have been inconsistent. Herein, we summarize the available literature on the classification and prediction performance of radiomics-based DTC in various imaging techniques. More specifically, we reviewed the recent literature to discuss the capacity of radiomics to predict lymph node (LN) metastasis, distant metastasis, tumor extrathyroidal extension, disease-free survival, and B-Raf proto-oncogene serine/threonine kinase (BRAF) mutation and differentiate malignant from benign nodules. This review discusses the application and limitations of the radiomics process, and explores its ability to improve clinical decision-making with the hope of emphasizing its utility for DTC patients.
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Affiliation(s)
- Yuan Cao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610040, China; (Y.C.); (X.Z.); (W.D.); (J.M.)
| | - Xiao Zhong
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610040, China; (Y.C.); (X.Z.); (W.D.); (J.M.)
| | - Wei Diao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610040, China; (Y.C.); (X.Z.); (W.D.); (J.M.)
| | - Jingshi Mu
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610040, China; (Y.C.); (X.Z.); (W.D.); (J.M.)
| | - Yue Cheng
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610040, China;
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610040, China; (Y.C.); (X.Z.); (W.D.); (J.M.)
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