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Shen K, Xiao S, Wu X, Zhang G. Preoperative prognostic risk stratification model for papillary thyroid carcinoma based on clinical and ultrasound characteristics. Front Endocrinol (Lausanne) 2022; 13:1025739. [PMID: 36277684 PMCID: PMC9585272 DOI: 10.3389/fendo.2022.1025739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The preoperative risk stratification for patients with papillary thyroid carcinoma (PTC) plays a crucial role in guiding individualized treatment. We aim to construct a predictive model that aids in distinguishing between patients with low-risk and high-risk PTC based on preoperative clinical and ultrasound characteristics. MATERIALS AND METHODS Patients who underwent open surgery and were diagnosed with PTC via a postoperative pathological report between January 2020 and December 2020 were retrospectively reviewed. Data including basic information, preoperative ultrasound characteristics, thyroid function, and postoperative pathology characteristics were obtained. Univariate logistic regression analysis and least absolute shrinkage and selection operator regression analysis were performed to screen candidate variables. Finally, the preoperative predictive model for PTC was established based on the results of the multivariate logistic regression analysis. RESULTS A total of 1,875 patients with PTC were enrolled. Eight variables (sex, age, number of foci, maximum tumor diameter on ultrasound, calcification, capsule, lymph node status on ultrasound, and thyroid peroxidase (TPO) antibody level) significantly associated with risk stratification were included in the predictive model. A nomogram was constructed for clinical utility. The model showed good discrimination, and the area under the curve was 0.777 [95% confidence interval (CI): 0.752-0.803] and 0.769 (95% CI: 0.729-0.809) in the training set and validation set, respectively. The calibration curve exhibited a rather good consistency with the perfect prediction. Furthermore, decision curve analysis and clinical impact curve showed that the model had good efficacy in predicting the prognostic risk of PTC. CONCLUSIONS The nomogram model based on preoperative indicators for predicting the prognostic stratification of PTC showed a good predictive value. This could aid surgeons in deciding on individualized precision treatments.
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Jiang S, Xie Q, Li N, Chen H, Chen X. Modified Models for Predicting Malignancy Using Ultrasound Characters Have High Accuracy in Thyroid Nodules With Small Size. Front Mol Biosci 2021; 8:752417. [PMID: 34901151 PMCID: PMC8662815 DOI: 10.3389/fmolb.2021.752417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
To assess the malignancy risk of thyroid nodules, ten ultrasound characteristics are suggested as key diagnostic markers. The European Thyroid Association Guidelines (EU-TIRADS) and 2015 American Thyroid Association Management Guidelines (2015ATA) are mainly used for ultrasound malignancy risk stratification, but both are less accurate and do not appropriatetly classify high risk patients in clinical examination. Previous studies focus on papillary thyroid carcinoma (PTC), but follicular thyroid carcinoma (FTC) and medullary thyroid carcinoma (MTC) remained to be characterized. Thus, this study aimed to determine the diagnostic accuracy and establish models using all ultrasound features including the nodule size for predicting the malignancy of thyroid nodules (PTC, FTC, and MTC) in China. We applied logistic regression to the data of 1,500 patients who received medical treatment in Shanghai and Fujian. Ultrasound features including taller-than-wide shape and invasion of the thyroid capsule showed high odds ratio (OR 19.329 and 4.672) for PTC in this dataset. Invasion of the thyroid also showed the highest odds ratio (OR = 8.10) for MTC. For FTC, the halo sign has the highest odds ratio (OR = 13.40). Four ultrasound features revealed distinct OR in PTC nodule groups with different sizes. In this study, we constructed a logistic model with accuracy up to 80%. In addition, this model revealed more accuracy than TIRADS in 4b and 4c category nodules. Hence, this model could well predict malignancy in small nodules and classify high-risk patients.
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Affiliation(s)
- Shan Jiang
- Department of Vascular Thyroid Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qingji Xie
- Department of Vascular Thyroid Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Nan Li
- Department of Vascular Thyroid Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Haizhen Chen
- Department of Surgery, Ruijin Hospital Affiliated of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xi Chen
- Department of Surgery, Ruijin Hospital Affiliated of Shanghai Jiaotong University School of Medicine, Shanghai, China
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Min Y, Huang Y, Wei M, Wei X, Chen H, Wang X, Chen J, Xiang K, Feng Y, Yin G. Preoperatively Predicting the Central Lymph Node Metastasis for Papillary Thyroid Cancer Patients With Hashimoto's Thyroiditis. Front Endocrinol (Lausanne) 2021; 12:713475. [PMID: 34367075 PMCID: PMC8339927 DOI: 10.3389/fendo.2021.713475] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The preoperative distinguishment of lymph nodes with reactive hyperplasia or tumor metastasis plays a pivotal role in guiding the surgical extension for papillary thyroid carcinoma (PTC) with Hashimoto's thyroiditis (HT), especially in terms of the central lymph node (CLN) dissection. We aim to identify the preparative risk factors for CLN metastasis in PTC patients concurrent with HT. MATERIALS AND METHODS We retrospectively reviewed and analyzed the data including the basic information, preoperative sonographic characteristics, and thyroid function of consecutive PTC patients with HT in our medical center between Jan 2019 and Apr 2021. The Chi-square and Fisher's exact tests were used for comparison of qualitative variables among patients with or without CLN metastasis. Univariate and multivariate logistic regression analyses were used to determine the risk factors for CLN metastasis. The nomogram was constructed and further evaluated by two cohorts produced by 1,000 resampling bootstrap analysis. RESULTS A total of 98 in 214 (45.8%) PTC patients were identified with CLN metastasis. In multivariate analysis, four variables including high serum thyroglobulin antibody (TgAb) level (>1,150 IU/ml), lower tumor location, irregular margin of CLN, and micro-calcification in the CLN were determined to be significantly associated with the CLN metastasis in PTC patients with HT. An individualized nomogram was consequently established with a favorable C-index of 0.815 and verified via two internal validation cohorts. CONCLUSIONS Our results indicated that preoperatively sonographic characteristics of the tumor and lymph node condition combined with serum TgAb level can significantly predict the CLN in PTC patients with HT and the novel nomogram may further help surgeons to manage the CLN in this subpopulation.
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Affiliation(s)
- Yu Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yizhou Huang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Minjie Wei
- Department of Ultrasound, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaoyuan Wei
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hang Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xing Wang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jialin Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Feng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Guobing Yin, ; Yang Feng,
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Guobing Yin, ; Yang Feng,
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Li F, Pan D, Wu Y, Peng J, Li Q, Gui X, Ma W, Yang H, He Y, Chen J. Ultrasound characteristics of thyroid nodules facilitate interpretation of the malignant risk of Bethesda system III/IV thyroid nodules and inform therapeutic schedule. Diagn Cytopathol 2019; 47:881-889. [PMID: 31211509 PMCID: PMC6772092 DOI: 10.1002/dc.24248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022]
Abstract
Background This study was designed to explore whether ultrasound of thyroid nodules facilitates the interpretation of the malignant risk of Bethesda III/IV thyroid nodules to inform further therapies. Methods We reviewed patient records in which the results of ultrasound‐guided fine‐needle aspiration (US‐FNA) were classified by the Bethesda III/IV in our institution between January 2016 and June 2018. Studies were retrieved from PubMed, Cochrane Central Register of Controlled Trials, ISI Web of Science, Science Direct, Wiley Online Library, EMBASE, China National Knowledge Infrastructure, WanFang, and Chinese VIP. The odds ratio (OR) was used to measure associations between risk factors and thyroid nodule malignancy. Results Fifty‐nine cases of Bethesda III/IV with corresponding surgeries were included, and the malignancy risk was 54.2%. Meta‐analysis revealed irregular borders, solitary nodules, hypoechogenicity, microcalcifications, and being taller than wide, all of which increased the malignancy risk of thyroid nodules. Combined ORs for these factors were 4.08 (95% CI: 2.34‐7.14, P < .001), 2.18 (95% CI: 1.39‐3.42, P = .001), 2.02 (95% CI: 1.35‐3.01, P = .001), 3.21 (95% CI: 2.26‐4.56, P < .001), and 4.35 (95% CI: 3.07‐6.15, P < .001), respectively. Conclusion As the risk of malignancy for papillary thyroid carcinoma (PTC) is high, when any one of the five ultrasound features of malignancy were confirmed, repeated FNA is recommended to confirm PTC‐type malignancy, even though nodules were Bethesda III/IV classification. However, repeated FNA should be avoided when none of these ultrasound features are identified because repeated FNA does not contribute to identifying non‐PTC type malignancies, such as follicular thyroid carcinoma and poorly differentiated thyroid carcinoma.
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Affiliation(s)
- Fu Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Denghua Pan
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yuquan Wu
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Jinbo Peng
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Qing Li
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xiaolong Gui
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Wei Ma
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Hong Yang
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yun He
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Junqiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
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Akhavan A, Jafari SM, Khosravi MH, Khajehpour H, Karimi-Sari H. Reliability of fine-needle aspiration and ultrasound-based characteristics of thyroid nodules for diagnosing malignancy in Iranian patients. Diagn Cytopathol 2016; 44:269-73. [PMID: 26780293 DOI: 10.1002/dc.23430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/13/2015] [Accepted: 12/18/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sonography and fine-needle aspiration biopsy (FNA-B) have been approved as method of choice in diagnosis of malignant thyroid nodules. Unnecessary FNA-B not only is invasive and costly but also results in second biopsy or unnecessary surgery. So we aimed to determine the specificity and sensitivity of sonography and FNA-B, without sonography guidance, in diagnosis of malignant and benign thyroid nodules. METHODS Patients with thyroid nodule referred to Baqiyatallah Hospital in 2014-2015 and candidates for surgical nodule resection were selected using simple random sampling method. Patients were evaluated by sonography and FNA. Sonographic characteristics of nodule were described. All patients underwent surgical resection and gross samples were sent for pathological evaluation, the gold standard for measuring the specificity and sensitivity of sonographic findings and FNA in diagnosis of malignant nodules. RESULTS Ninety patients with the mean age of 45.95 ± 12.3 years were evaluated (17 male and 73 female). Comparing the patients with correct and incorrect sonography-based diagnosis showed significant differences in nodule's width, area, calcification, border, and cervical lymphadenopathy (P < 0.05). Comparing the patients with correct and incorrect FNA-based diagnosis showed significant differences in patients' age and tall-shape nodule (P < 0.05). The diagnosis of sonographist had 56.25% sensitivity and 95.9% specificity, and the FNA-based diagnosis had 81.25% sensitivity and 93.7% specificity. CONCLUSION Among sonography findings, width and area of nodule, calcification, and nodule border have significant effect on malignancy diagnosis. Also FNA is necessary in nodules with calcification, border irregularity, and less width and area, especially in younger patients.
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Affiliation(s)
- Asghar Akhavan
- Department of Otorhinolaryngology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyyed Mehrdad Jafari
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Hojjatollah Khajehpour
- Department of Radiology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamidreza Karimi-Sari
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
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