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Bai S, Wu L, Su Y, Xu J, Dong F. Ultrasound-Based Prediction Model for Distinguishing Malignant from Benign Thyroid Nodules with Peripheral Calcification. Acad Radiol 2025:S1076-6332(25)00425-8. [PMID: 40393828 DOI: 10.1016/j.acra.2025.04.073] [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: 04/02/2025] [Revised: 04/25/2025] [Accepted: 04/29/2025] [Indexed: 05/22/2025]
Abstract
RATIONALE AND OBJECTIVES The differential diagnosis of thyroid nodules with peripheral calcifications by ultrasound (US) has always been source of confusion. This study aimed to develop and validate a predictive US-based nomogram model to differentiate malignant from benign nodules with peripheral calcifications. METHODS Of the 8359 thyroid nodules scanned by ultrasonography between January 2017 and January 2025, 380 nodules with peripheral calcifications were included, with confirmed pathological results and US examinations. 268 nodules were included in the training cohort, and 112 nodules were included in the validation cohort. The candidate variables included age, gender, and the image features obtained from grayscale US. Independent risk factors for malignant thyroid nodules were determined by univariate and multivariate analyses, and a predictive nomogram model was developed. The performance of the US nomogram was assessed by the area under the curve (AUC), calibration curve, and decision curve analysis (DCA) results. RESULTS Univariate and multivariate logistic regression analyses revealed that the halo sign, extrusion beyond calcification, type of peripheral calcification, margin, internal echogenicity, and composition were significant independent predictors for malignant thyroid nodules with peripheral calcifications. The nomogram model based on the six variables exhibited excellent calibration and discrimination in the training and validation cohorts, with AUC values of 0.904 and 0.882, respectively. The DCA showed that a probability threshold of 0.11-0.83 could benefit patients clinically. CONCLUSION The US-based nomogram model can potentially predict the malignant risk of thyroid nodules with peripheral calcifications, thereby helping to enhance diagnostic accuracy.
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Affiliation(s)
- Song Bai
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, China (S.B., L.W., Y.S., J.X., F.D.)
| | - Linghu Wu
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, China (S.B., L.W., Y.S., J.X., F.D.)
| | - Youhuan Su
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, China (S.B., L.W., Y.S., J.X., F.D.)
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, China (S.B., L.W., Y.S., J.X., F.D.); Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, Guangdong, China (J.X., F.D.)
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, China (S.B., L.W., Y.S., J.X., F.D.); Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen 518020, Guangdong, China (J.X., F.D.); Department of Ultrasound, Shenzhen People's Hospital, Longhua Branch, Shenzhen 518020, Guangdong, China (F.D.).
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Fu Y, Mei F, Shi L, Ma Y, Liang H, Huang L, Fu R, Cui L. Intra- and Peritumoral Radiomics Based on Ultrasound Images for Preoperative Differentiation of Follicular Thyroid Adenoma, Carcinoma, and Follicular Tumor With Uncertain Malignant Potential. ULTRASOUND IN MEDICINE & BIOLOGY 2025:S0301-5629(25)00120-6. [PMID: 40350346 DOI: 10.1016/j.ultrasmedbio.2025.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 03/26/2025] [Accepted: 04/14/2025] [Indexed: 05/14/2025]
Abstract
OBJECTIVE Differentiating between follicular thyroid adenoma (FTA), carcinoma (FTC), and follicular tumor with uncertain malignant potential (FT-UMP) remains challenging due to their overlapping ultrasound characteristics. This retrospective study aimed to enhance preoperative diagnostic accuracy by utilizing intra- and peritumoral radiomics based on ultrasound images. METHODS We collected post-thyroidectomy ultrasound images from 774 patients diagnosed with FTA (n = 429), FTC (n = 158), or FT-UMP (n = 187) between January 2018 and December 2023. Six peritumoral regions were expanded by 5%-30% in 5% increments, with the segment-anything model utilizing prompt learning to detect the field of view and constrain the expanded boundaries. A stepwise classification strategy addressing three tasks was implemented: distinguishing FTA from the other types (task 1), differentiating FTC from FT-UMP (task 2), and classifying all three tumors. Diagnostic models were developed by combining radiomic features from tumor and peritumoral regions with clinical characteristics. RESULTS Clinical characteristics combined with intratumoral and 5% peritumoral radiomic features performed best across all tasks (Test set: area under the curves, 0.93 for task 1 and 0.90 for task 2; diagnostic accuracy, 79.9%). The DeLong test indicated that all peritumoral radiomics significantly improved intratumoral radiomics performance and clinical characteristics (p < 0.04). The 5% peritumoral regions showed the best performance, though not all results were significant (p = 0.01-0.91). CONCLUSION Ultrasound-based intratumoral and peritumoral radiomics can significantly enhance preoperative diagnostic accuracy for FTA, FTC, and FT-UMP, leading to improved treatment strategies and patient outcomes. Furthermore, the 5% peritumoral area may indicate regions of potential tumor invasion requiring further investigation.
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Affiliation(s)
- Ying Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Fang Mei
- Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Liting Shi
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
| | - Yihan Ma
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Hainan Liang
- Department of Ultrasound, Heilongjiang Shuangyashan Shuangkuang Hospital, Shuangyashan, China
| | - Lei Huang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Rao Fu
- Department of Ultrasound, The People's Hospital of Anyang city, Anyang, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China.
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Wang QG, Li M, Deng GX, Huang HQ, Qiu Q, Lin JJ. Development and validation of a nomogram based on conventional and contrast-enhanced ultrasound for differentiating malignant from benign thyroid nodules. Quant Imaging Med Surg 2025; 15:4641-4654. [PMID: 40384666 PMCID: PMC12082573 DOI: 10.21037/qims-24-1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 03/12/2025] [Indexed: 05/20/2025]
Abstract
Background Conventional ultrasound (US) has been routinely used for differential diagnosis of thyroid nodules, but its discriminatory performance remains unsatisfactory. This study aimed to develop and validate a prediction nomogram model based on conventional US and contrast-enhanced ultrasound (CEUS) features for differentiating malignant from benign thyroid nodules. Methods A total of 815 thyroid nodules with surgical pathology results and complete conventional US and CEUS data were retrospectively collected from the First People's Hospital of Qinzhou between January 2019 and July 2023. The nodules were grouped into a training cohort (n=571) and a validation cohort (n=244) at a 7:3 ratio. Independent risk factors of malignancy were selected by stepwise multivariate logistic regression analysis, and a prediction nomogram model was subsequently constructed. The diagnostic performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC) in both the training and validation cohorts. The unnecessary fine-needle aspiration biopsy (FNAB) rate was calculated. Results Multivariate logistic regression analysis identified irregular margin, aspect ratio >1, and microcalcification from conventional US images, as well as hypo-enhancement intensity and ring enhancement from CEUS images, as independent predictors for malignancy. The AUC, sensitivity, specificity, and accuracy of the prediction nomogram model were 0.947 [95% confidence interval (CI): 0.928-0.966], 90.4%, 88.8%, and 89.8% in the training cohort, and 0.957 (95% CI: 0.928-0.986), 94.5%, 86.4%, and 91.8% in the validation cohort, respectively. Using the prediction model, the unnecessary FNAB rates reduced from 29.6% to 6.1% in the training cohort and from 29.3% to 6.7% in the validation cohort compared to the Chinese Thyroid Imaging Reporting and Data System. Decision curve analysis demonstrated good clinical utility of the nomogram model. Conclusions The prediction nomogram model incorporating conventional US and CEUS features could effectively distinguish between malignant and benign thyroid nodules and reduce unnecessary FNAB rates.
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Affiliation(s)
- Qi-Guo Wang
- Department of Medical Ultrasound, the First People’s Hospital of Qinzhou, Qinzhou, China
| | - Mei Li
- Department of Medical Ultrasound, the People’s Hospital of Chongzuo, Chongzuo, China
| | - Guang-Xiu Deng
- Department of Medical Ultrasound, the First People’s Hospital of Qinzhou, Qinzhou, China
| | - Hai-Qing Huang
- Department of Medical Ultrasound, the First People’s Hospital of Qinzhou, Qinzhou, China
| | - Qin Qiu
- Department of Ultrasound, the People’s Hospital of Pubei, Qinzhou, China
| | - Jian-Jun Lin
- Department of Medical Ultrasound, the First People’s Hospital of Qinzhou, Qinzhou, China
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Tobcu E, Karavaş E, Yılmaz GT, Topçu B. Comparison of K-TIRADS, EU-TIRADS and ACR-TIRADS Guidelines for Malignancy Risk Determination of Thyroid Nodules. Diagnostics (Basel) 2025; 15:1015. [PMID: 40310422 PMCID: PMC12025481 DOI: 10.3390/diagnostics15081015] [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: 02/08/2025] [Revised: 04/02/2025] [Accepted: 04/12/2025] [Indexed: 05/02/2025] Open
Abstract
Background/Objectives: Thyroid nodules are commonly observed in neck ultrasonography. Most nodules are benign; hence, several nodules require biopsy to accurately identify the malignant ones. Numerous risk classification guidelines have been developed for thyroid nodules, varying in their indications for fine-needle aspiration biopsy (FNAB). The aim of this study is to evaluate the performances of three internationally recognized thyroid imaging reporting and data systems (TIRADS) for risk stratification of malignancy in comparison to one another. Methods: A total of 225 thyroid nodules with definitive FNAB cytology or histopathological diagnoses were included in this study. Various ultrasound (US) features were classified into categories based on three TIRADS editions. The guidelines were assessed regarding sensitivity, specificity, predictive values, and diagnostic accuracy to compare diagnostic value. Results: The American College of Radiology (ACR)-TIRADS demonstrated the best diagnostic accuracy (63.1%), the highest specificity (58.7%) and positive predictive value (36.3%), among three different TIRADS systems. Korean (K)-TIRADS exhibited the highest sensitivity (94.2%), negative predictive value (96.1%), and the most favorable negative likelihood ratio (0.13). The European (EU)-TIRADS had a sensitivity of 90.4%, specificity of 48.6%, and diagnostic accuracy of 58.2%, ranking between the other two guidelines across most parameters. Conclusions: The rigorous use of the guidelines established by each of the three TIRADS systems would have markedly reduced the number of FNABs performed. The comparison of the three guidelines in our study indicated that they are effective screening methods for identifying malignant thyroid nodules. Among them, K-TIRADS showed the most effective diagnostic performance in sensitivity, while ACR-TIRADS yielded the best specificity.
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Affiliation(s)
- Eren Tobcu
- Department of Radiology, Bandırma Onyedi Eylul University School of Medicine, 10200 Balıkesir, Türkiye; (E.K.); (B.T.)
| | - Erdal Karavaş
- Department of Radiology, Bandırma Onyedi Eylul University School of Medicine, 10200 Balıkesir, Türkiye; (E.K.); (B.T.)
| | - Gülden Taşova Yılmaz
- Department of Pathology, Bandırma Research and Training Hospital, 10200 Balıkesir, Türkiye;
| | - Bilgin Topçu
- Department of Radiology, Bandırma Onyedi Eylul University School of Medicine, 10200 Balıkesir, Türkiye; (E.K.); (B.T.)
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Zhang R, Wang X, Xiao M, Zhang J. The value of non-punctate echogenic foci in the ultrasonic diagnosis of thyroid nodules. Endocrine 2025; 88:223-233. [PMID: 39798066 DOI: 10.1007/s12020-024-04152-0] [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: 10/19/2024] [Accepted: 12/25/2024] [Indexed: 01/13/2025]
Abstract
PURPOSE To evaluate the diagnostic value of different subtypes of non-punctate echogenic foci in thyroid malignancy. METHODS Retrospective research of 342 thyroid nodules with calcification was performed. The echogenic foci were divided into punctate echogenic foci (type I) and non-punctate echogenic foci (type II), and type II were further divided into four subtypes: macrocalcification (type IIa), continuous peripheral calcification (type IIb), discontinuous peripheral calcification (type IIc) and isolated calcification (type IId). Postoperative histopathological results were used as the gold standard to evaluate the correlation between non-punctate echogenic foci subtypes and thyroid malignancy. RESULTS The malignant risk of nodules with echogenic foci was type I (82.1%) > type IIa (66.2%) > type IIc (52.9%) > type IId (16.7%) > type IIb (13.9%), P < 0.001. Type I and type IIa echogenic foci were independent risk factors for thyroid cancer (OR = 16.593, 7.785). Solid, hypoechogenicity/marked hypoechogenicity and a single lesion in a unilateral thyroid lobe were independently associated with malignant thyroid nodules with macrocalcification(OR = 6.825, 40.042, 5.201). Irregular margins and uneven calcification thickness were independent factors for malignant thyroid nodules with peripheral calcification (OR = 5.676, 2.750). CONCLUSION Type IIa echogenic foci could independently predict thyroid malignancy. The diagnostic value of non-punctate echogenic foci depended on the differentiated combination of ultrasound characteristics. Type IIa nodules with solid composition, irregular margins, and a single lesion in a unilateral thyroid lobe implied a higher risk of malignancy; peripheral calcified nodules with irregular margins and uneven calcification thickness suggested an increased risk of malignancy.
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Affiliation(s)
- Rui Zhang
- Department of Ultrasound, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Xiqian Wang
- Department of Nephrology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Xiao
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
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Cantisani V, Bojunga J, Durante C, Dolcetti V, Pacini P. Multiparametric ultrasound evaluation of thyroid nodules. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2025; 46:14-35. [PMID: 39242086 DOI: 10.1055/a-2329-2866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
Thyroid nodules are common incidental findings. Most of them are benign, but many unnecessary fine-needle aspiration procedures, core biopsies, and even thyroidectomies or non-invasive treatments have been performed. To improve thyroid nodule characterization, the use of multiparametric ultrasound evaluation has been encouraged by most experts and several societies. In particular, US elastography for assessing tissue stiffness and CEUS for providing insight into vascularization contribute to improved characterization. Moreover, the application of AI, particularly machine learning and deep learning, enhances diagnostic accuracy. Furthermore, AI-based computer-aided diagnosis (CAD) systems, integrated into the diagnostic process, aid in risk stratification and minimize unnecessary interventions. Despite these advancements, challenges persist, including the need for standardized TIRADS, the role of US elastography in routine practice, and the integration of AI into clinical protocols. However, the integration of clinical information, laboratory information, and multiparametric ultrasound features remains crucial for minimizing unnecessary interventions and guiding appropriate treatments. In conclusion, ultrasound plays a pivotal role in thyroid nodule management. Open questions regarding TIRADS selection, consistent use of US elastography, and the role of AI-based techniques underscore the need for ongoing research. Nonetheless, a comprehensive approach combining clinical, laboratory, and ultrasound data is recommended to minimize unnecessary interventions and treatments.
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Affiliation(s)
- Vito Cantisani
- Department of Radiology, "Sapienza" - University of Rome, ROME, Italy
| | - Jörg Bojunga
- Med. Klinik I, Johann W.-Goethe-Universitätskliniken, Frankfurt, Germany
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" - University of Rome, ROME, Italy
| | - Vincenzo Dolcetti
- Radiological, Anatomopathological and Oncologic Sciences, Università degli Studi di Roma La Sapienza, Facoltà di Medicina e Odontoiatria, Roma, Italy
| | - Patrizia Pacini
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-Patologiche, Umberto I Policlinico di Roma, Italy
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Parsa AA, Gharib H. Thyroid Nodules: Past, Present, and Future. Endocr Pract 2025; 31:114-123. [PMID: 38880348 DOI: 10.1016/j.eprac.2024.05.016] [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: 01/12/2024] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Over the past millennia, the evaluation and management of thyroid nodules has essentially remained the same with thyroidectomy as the only reliable method to identify malignancy. However, in the last 30 years, technological advances have significantly improved diagnostic management of thyroid nodules. Advances in imaging have allowed development of a reliable risk- based stratification system to identify nodules at increased risk of malignancy. At the same time, sensitive imaging has caused collateral damage to the degree that we are now identifying and treating many small, low risk nodules with little to no clinical relevance. OBJECTIVE To review the history of thyroid nodule evaluation with emphasis on recent changes and future pathways. METHODS Literature review and discussion. RESULTS Thyroid ultrasound remains the best initial method to evaluate the thyroid gland for nodules. Different risk-of-malignancy protocols have been developed and introduced by different societies, reporting methods have been developed and improved each, with goals of improving the ability to recognize nodules requiring further intervention and minimizing excessive monitoring of those who do not. Once identified, cytological evaluation of nodules further enhances malignancy identification with molecular markers assisting in ruling out malignancies in indeterminate nodules preventing unneeded intervention. And all societies have urged avoidance of overdiagnosis and overtreatment of low-risk cancers of little to no clinical relevance. CONCLUSION In this review, we describe advancements in nodule evaluation and management, while emphasizing caution in overdiagnosing and overtreating low-risk lesions without clinical importance.
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Affiliation(s)
- Alan A Parsa
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii.
| | - Hossein Gharib
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota
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Wang Y, Tang Y, Luo Z, Li J, Li W. Diagnostic Nomogram Model for ACR TI-RADS 4 Nodules Based on Clinical, Biochemical Data and Sonographic Patterns. Clin Endocrinol (Oxf) 2025; 102:79-90. [PMID: 39279486 PMCID: PMC11612534 DOI: 10.1111/cen.15130] [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: 05/08/2024] [Revised: 08/09/2024] [Accepted: 08/16/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVES The objective of this study was to develop and validate a nomogram model integrating clinical, biochemical and ultrasound features to predict the malignancy rates of Thyroid Imaging Reporting and Data System 4 (TR4) thyroid nodules. METHODS A total of 1557 cases with confirmed pathological diagnoses via fine-needle aspiration (FNA) were retrospectively included. Univariate and multivariate logistic regression analyses were conducted to identify independent predictors of malignancy. These predictors were incorporated into the nomogram model, and its predictive performance was evaluated using receiver-operating characteristic curve (AUC), calibration plots, net reclassification improvement (NRI), integrated discrimination improvement (IDI) and decision curve analysis (DCA). RESULTS Eight out of 22 variables-age, margin, extrathyroidal extension, halo, calcification, suspicious lymph node metastasis, aspect ratio and thyroid peroxidase antibody-were identified as independent predictors of malignancy. The calibration curve demonstrated excellent performance, and DCA indicated favourable clinical utility. Additionally, our nomogram exhibited superior predictive ability compared to the current American College of Radiology (ACR) score model, as indicated by higher AUC, NRI, IDI, negative likelihood ratio (NLR) and positive likelihood ratio (PLR) values. CONCLUSIONS The developed nomogram model effectively predicts the malignancy rate of TR4 thyroid nodules, demonstrating promising clinical applicability.
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Affiliation(s)
- Yongheng Wang
- Department of Surgical OncologyShaanxi Provincial People's HospitalXi'anShaanxiChina
- The Third Affiliated Hospital, School of MedicineXi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yao Tang
- Department of General SurgeryXi'an No. 3 HospitalXi'anShaanxiChina
| | - Ziyu Luo
- Department of Surgical OncologyShaanxi Provincial People's HospitalXi'anShaanxiChina
- The Third Affiliated Hospital, School of MedicineXi'an Jiaotong UniversityXi'anShaanxiChina
| | - Jianhui Li
- Department of Surgical OncologyShaanxi Provincial People's HospitalXi'anShaanxiChina
- The Third Affiliated Hospital, School of MedicineXi'an Jiaotong UniversityXi'anShaanxiChina
| | - Wenhan Li
- Department of Surgical OncologyShaanxi Provincial People's HospitalXi'anShaanxiChina
- The Third Affiliated Hospital, School of MedicineXi'an Jiaotong UniversityXi'anShaanxiChina
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Alhajlan M, Al-Masabi M, Al Mansour M, Saihb A, AlAyed S, Alwadai R, Alhamami A, Alzarra A, Almarzooq M, Ahmed F. The accuracy of fine-needle aspiration cytology and ultrasonography in assessing thyroid nodules in correlation with histopathology: a retrospective study. Ann Med Surg (Lond) 2024; 86:7002-7009. [PMID: 39649848 PMCID: PMC11623872 DOI: 10.1097/ms9.0000000000002676] [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: 07/18/2024] [Accepted: 10/12/2024] [Indexed: 12/11/2024] Open
Abstract
Background Accurately diagnosing thyroid nodules is vital for preventing unnecessary surgeries and providing prompt therapy. Although fine-needle aspiration cytology (FNAC) and ultrasonography (US) are widely used diagnostic methods, their reliability is questioned. This study investigates the effectiveness of US and FNAC in thyroid nodule diagnosis and differentiates benign from malignant nodules in relation to final histopathological diagnosis. Method A retrospective study including 307 adult patients with thyroid diseases who underwent neck US and FNAC before surgery was conducted between April 2019 and May 2023. The diagnostic efficacy of US, FNAC, and their combination usage was compared to histopathological results. Result Histopathological findings revealed that 187 (61%) cases were benign, while 120 (39%) were malignant. The US features of 'taller-than-wider' forms and hypoechoic appearance had the highest diagnostic accuracy in characterizing malignant thyroid nodules, with 83 and 73% accuracy, respectively. The combination of US parameters demonstrated high sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 88.33, 63.10, 60.6, and 89.4%, with a statistically significant area under the ROC curve (AUC: 0.828, P<0.001) than individual parameters. FNAC's sensitivity, specificity, PPV NPV, and accuracy in detecting malignant lesions were 50, 95, 86, 75, and 77%, respectively, with acceptable discrimination and statistical significance (AUC: 0.723, P<0.0001). The combination of US parameters and FNAC significantly improved the AUC value (AUC: 0.878, P<0.0001), sensitivity (83.33%), and specificity (79.14%). Univariate analysis showed that hypoechoic appearance, heterogenicity, large mass size (>4 cm), 'taller-than-wider', infiltrative margins, and microcalcifications were risk factors for malignancy in thyroid nodules and were statistically significant (all P-values <0.05). Conclusion Combining US characteristics with FNAC results can afford the maximum analytical accuracy in distinguishing benign from malignant thyroid nodules. This strategy is practical due to its simplicity, minimal invasiveness, and cost-effectiveness, enabling robust management regimens and avoiding additional surgical procedures.
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Affiliation(s)
- Mana Alhajlan
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | | | - Mohammed Al Mansour
- Department of Otorhinolaryngology, King Khalid Hospital, Najran, Saudi Arabia
| | - Abdullah Saihb
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Salem AlAyed
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Rakan Alwadai
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Abdullah Alhamami
- Department of Otorhinolaryngology, King Khalid Hospital, Najran, Saudi Arabia
| | - Abdullah Alzarra
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Mohammed Almarzooq
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University, Ibb, Yemen
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Kavutarapu SK, Ankathi SK, Thiagarajan S, Deshmukh A, Nair D, Pai PS, Chaukar DA, Pantvaidya G. Diagnostic Accuracy of Ultrasonography in Revision Thyroid Surgery: Can It Predict Disease Outcomes? Indian J Surg Oncol 2024; 15:684-692. [PMID: 39555346 PMCID: PMC11564714 DOI: 10.1007/s13193-024-01955-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/04/2024] [Indexed: 11/19/2024] Open
Abstract
Revision thyroid surgery for residual/recurrent disease is known to have higher complication rates because of parathyroid injury and recurrent laryngeal nerve (RLN) damage. The aim of this study is to evaluate the accuracy of USG in predicting recurrent disease and disease outcomes in patients undergoing reoperation for recurrent/residual thyroid cancer. We performed a retrospective analysis of all thyroid reoperations from 2015 to 2017. Preoperative USG findings were categorized as per prespecified disease stations in the neck and compared with histopathology to calculate sensitivity, specificity, positive predictive value, and negative predictive value of USG. Survival analysis was performed using Kaplan-Meier curves. Two hundred fifty patients were included in the analysis. In a reoperative setting, USG had an overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 89%, 77%, 89%, 94%, and 60%, respectively. We found a significantly lower disease-free survival in patients who had radiologically detected recurrent disease as compared to disease detected only on histopathology. USG has a reasonable accuracy in determining status of lesions in patients undergoing revision thyroid surgeries.
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Affiliation(s)
- Sasi Krishna Kavutarapu
- Dept of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, 12, Thfloorfloor, Homi Bhabha Block, Parel, Mumbai India
| | - Suman Kumar Ankathi
- Dept of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shivakumar Thiagarajan
- Dept of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, 12, Thfloorfloor, Homi Bhabha Block, Parel, Mumbai India
| | - Anuja Deshmukh
- Dept of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, 12, Thfloorfloor, Homi Bhabha Block, Parel, Mumbai India
| | - Deepa Nair
- Dept of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, 12, Thfloorfloor, Homi Bhabha Block, Parel, Mumbai India
| | - Prathamesh Srinivas Pai
- Dept of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, 12, Thfloorfloor, Homi Bhabha Block, Parel, Mumbai India
| | - Devendra Arvind Chaukar
- Dept of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, 12, Thfloorfloor, Homi Bhabha Block, Parel, Mumbai India
| | - Gouri Pantvaidya
- Dept of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, 12, Thfloorfloor, Homi Bhabha Block, Parel, Mumbai India
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Hou X, Hua M, Zhang W, Ji J, Zhang X, Jiang H, Li M, Wu X, Zhao W, Sun S, Cao L, Wang L. An ultrasonography of thyroid nodules dataset with pathological diagnosis annotation for deep learning. Sci Data 2024; 11:1272. [PMID: 39580501 PMCID: PMC11585535 DOI: 10.1038/s41597-024-04156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 11/18/2024] [Indexed: 11/25/2024] Open
Abstract
Ultrasonography (US) of thyroid nodules is often time consuming and may be inconsistent between observers, with a low positivity rate for malignancy in biopsies. Even after determining the ultrasound Thyroid Imaging Reporting and Data System (TIRADS) stage, Fine needle aspiration biopsy (FNAB) is still required to obtain a definitive diagnosis. Although various deep learning methods were developed in medical field, they tend to be trained using TI-RADS reports as image labels. Here, we present a large US dataset with pathological diagnosis annotation for each case, designed for developing deep learning algorithms to directly infer histological status from thyroid ultrasound images. The dataset was collected from two retrospective cohorts, which consists of 8508 US images from 842 cases. Additionally, we explained three deep learning models used as validation examples using this dataset.
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Affiliation(s)
- Xiaowen Hou
- Ningbo Hangzhou Bay Hospital, Ningbo, China
- Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Ningbo, China
| | - Menglei Hua
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Wei Zhang
- Division of Cardiology, State Key Laboratory of Systems Medicine for Cancer, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jianxin Ji
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Xuan Zhang
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Huiru Jiang
- Department of Cardiology Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Mengyun Li
- Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Ningbo, China
| | - Xiaoxiao Wu
- Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Ningbo, China
| | - Wenwen Zhao
- Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Ningbo, China
| | - Shuxin Sun
- Department of Ultrasonography, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
| | - Lei Cao
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150081, China.
| | - Liuying Wang
- Department of Health Management, Harbin Medical University, Harbin, 150081, China.
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12
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Borysewicz-Sańczyk H, Bossowski F, Anikiej K, Sawicka B, Michalak J, Dzięcioł J, Bossowski A. Application of shear wave elastography in the management of thyroid nodules in children and adolescents: our experience and a review of the literature. Front Endocrinol (Lausanne) 2024; 15:1486285. [PMID: 39634183 PMCID: PMC11614656 DOI: 10.3389/fendo.2024.1486285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 10/25/2024] [Indexed: 12/07/2024] Open
Abstract
Introduction Shear wave elastography (SWE) is an ultrasound diagnostic method used to measure tissue stiffness. Since the mechanical properties of tissue involved in the pathological process change, SWE might indicate regions of the examined tissue covered by the disease. It is well documented that SWE helps to differentiate benign and malignant nodules in thyroid glands in adults, however, there are few studies on the application of SWE in thyroid diagnosis in children. The purpose of the study was to assess the application of SWE based on Young's modulus expressed in kPa in the management of thyroid nodules in children and adolescents. Methods In total, 116 pediatric patients (81 girls and 35 boys) with 168 thyroid nodules were enrolled in the study and qualified for SWE followed by fine needle aspiration biopsy. Results According to the result of the cytological examination presented in the Bethesda System, nodules were classified as benign (147 nodules classified as category II according to the Bethesda System) or indeterminate or suspicious (21 nodules classified as categories III, IV, and V according to the Bethesda System). Benign cytological diagnoses were nodular goiter, parenchymal goiter, nodular colloid goiter, or lymphocytic inflammation. Among the indeterminate or suspicious nodules, 15 were diagnosed as category III according to the Bethesda System (atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) in cytology), 1 nodule was diagnosed as category IV according to the Bethesda System (suspicious for follicular neoplasm - oxyphilic cell tumor), and 5 as category V according to the Bethesda System (suspicious for malignancy). There were no significant differences in thyrotropin (TSH) and free thyroxine (fT4) concentrations between the benign and suspicious groups. Patients with benign and indeterminate or suspicious thyroid nodules were of comparable age. Mean SWE in benign nodules was statistically significantly lower than in nodules with indeterminate or suspicious cytology (42.22 ± 16.69 vs. 57.4 ± 24.0 kPa, p=0.0004). Six patients from the indeterminate or suspicious group were revealed to be malignant in the final histopathological examination. Conclusion Our results suggest that SWE is a viable diagnostic method, however, it still seems to need some adjustment for pediatric patients.
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Affiliation(s)
- Hanna Borysewicz-Sańczyk
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Filip Bossowski
- Student Research Group by the Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Anikiej
- Student Research Group by the Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Beata Sawicka
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Justyna Michalak
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Janusz Dzięcioł
- Department of Human Anatomy, Medical University of Bialystok, Bialystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
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13
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Alfuraih AM, Alotaibi AM, Alshammari AK, Alrashied BF, Mashhor YM, Mahmoud M, Alsaadi MJ. Evaluating diagnostic accuracy and agreement of TI-RADS scoring in thyroid nodules: A comparative analysis between sonographers and radiologists. PLoS One 2024; 19:e0312121. [PMID: 39392855 PMCID: PMC11469501 DOI: 10.1371/journal.pone.0312121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 10/01/2024] [Indexed: 10/13/2024] Open
Abstract
OBJECTIVE The Thyroid Imaging Reporting and Data System (TI-RADS) is an essential tool for assessing thyroid nodules, primarily used by radiologists. This study aimed to compare the agreement of TI-RADS scores between sonographers and radiologists and to assess the diagnostic performance of these scores against histological findings in suspicious thyroid nodules. METHODS In a retrospective analysis, 168 patients with suspicious thyroid nodules classified as TR3 and above by the radiologists were included. Both sonographers and radiologists independently assigned the American College of Radiologists (ACR) TI-RADS scores, which were then compared for inter-reader agreement using Cohen's Kappa statistic. The scores were also evaluated for diagnostic performance against histological results based on the Bethesda system. RESULTS The study revealed a moderate overall agreement between sonographers and radiologists in TI-RADS scoring (κ = 0.504; 95% CI: 0.409-0.599), with poor agreement noted specifically for nodule margin scores (κ = 0.102; 95% CI: -1.430-0.301). In terms of diagnostic performance against histological outcomes, sonographers' TI-RADS scores showed a sensitivity of 100% and a specificity of 44.6%, while radiologists' scores showed a sensitivity of 100% but a lower specificity of 29.3%. CONCLUSION The findings indicate moderate agreement in TI-RADS scoring between sonographers and radiologists, with reproducibility challenges especially in scoring nodule margins. The marginally superior diagnostic performance of sonographers' scores suggests potential efficiency benefits in involving sonographers in preliminary assessments. Future research should aim to encompass a wider range of TI-RADS categories and focus on minimizing scoring variability to enhance the system's clinical utility.
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Affiliation(s)
- Abdulrahman M. Alfuraih
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia
| | | | - Alanoud K. Alshammari
- Ultrasound Unit, Radiology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Basmah F. Alrashied
- Ultrasound Unit, Radiology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yahya M. Mashhor
- Radiology Department, Altakassusi Alliance Medical, Riyadh, Saudi Arabia
| | - Mustafa Mahmoud
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mohammed J. Alsaadi
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia
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14
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Schenke SA, Petersen M, Görges R, Ruhlmann V, Zimny M, Richter JP, Groener D, Baumgarten J, Kreissl MC, Stahl AR, Grunert M, Klemenz B, Veit F, Zettinig G, Seifert P. Interobserver Agreement in Ultrasound Risk Stratification Systems for Thyroid Nodules on Static Images Versus Cine-Loop Video Sequences. Diagnostics (Basel) 2024; 14:2138. [PMID: 39410542 PMCID: PMC11475346 DOI: 10.3390/diagnostics14192138] [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: 08/18/2024] [Revised: 09/21/2024] [Accepted: 09/25/2024] [Indexed: 10/20/2024] Open
Abstract
PURPOSE To evaluate the impact of video sequences (cine-loops) on the interobserver agreement (IOA) using risk stratification systems (RSSs) for thyroid nodules (TNs). METHODS Twenty TNs were randomly selected from a large database and evaluated by twelve experienced observers using five different RSSs (Kwak-, ACR-, EU-, Korean-TIRADS, ATA Guidelines). In the first step, the evaluation was conducted based on static ultrasound (US) images in two planes ("static"). Six months later, these cases were reevaluated by the same observers using video sequences in two planes ("cine-loops"). Fleiss' kappa (κ) was calculated for the IOA analyses. RESULTS IOA on static was moderate with κ values of 0.46, 0.42, 0.40, 0.45, and 0.38 for the Kwak-, ACR-, EU-, Korean-TIRADS, and ATA Guidelines, respectively, while the IOA on cine-loops was fair with κ values of 0.41, 0.38, 0.37, 0.36, and 0.34 for the Kwak-, ACR-, EU-, Korean-TIRADS, and ATA Guidelines, respectively. The overall IOA was superior in static images versus cine-loops (p = 0.024). Among other findings, the subgroup analyses (related to age, gender, US certificates, number of thyroid US per week, and RSSs experience) particularly showed that the experience of the observers in using RSSs had a significant influence on the IOA. CONCLUSIONS The overall IOA (all twelve observers and all five RSSs) was superior on static US images in comparison to cine-loops. Furthermore, the overall IOA of the five US features revealed superior κ values of the static images over cine-loops. However, this impact was significantly lower when the observers were highly experienced in the use of US RSSs of TNs.
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Affiliation(s)
- Simone Agnes Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.A.S.)
- Department and Institute of Nuclear Medicine, Hospital Bayreuth, 95445 Bayreuth, Germany
| | - Manuela Petersen
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Rainer Görges
- Clinic of Nuclear Medicine, University Hospital Essen, 45147 Essen, Germany
- Practice for Nuclear Medicine, 47051 Duisburg, Germany
| | | | | | | | - Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Justus Baumgarten
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany; (S.A.S.)
- Research Campus STIMULATE, Otto-von-Guericke University, Magdeburg, 39106 Magdeburg, Germany
| | - Alexander R. Stahl
- Institute of Radiology and Nuclear Medicine, RIZ, 86150 Augsburg, Germany
| | - Michael Grunert
- Department of Nuclear Medicine, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
- Department of Nuclear Medicine, University Hospital Ulm, 89081 Ulm, Germany
| | - Burkhard Klemenz
- Department of Nuclear Medicine, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Franziska Veit
- Institute of Radiology and Nuclear Medicine, Dr. von Essen, 56068 Koblenz, Germany
| | - Georg Zettinig
- Vienna Thyroid Center Schilddrüsenpraxis Josefstadt, 1080 Wien, Austria
| | - Philipp Seifert
- Clinic of Nuclear Medicine, University Hospital Jena, 07747 Jena, Germany
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15
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Latia M, Borlea A, Mihuta MS, Neagoe OC, Stoian D. Impact of ultrasound elastography in evaluating Bethesda category IV thyroid nodules with histopathological correlation. Front Endocrinol (Lausanne) 2024; 15:1393982. [PMID: 38863927 PMCID: PMC11165070 DOI: 10.3389/fendo.2024.1393982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Fine needle aspiration (FNA) is the gold standard method recommended in the diagnosis of thyroid nodules. Bethesda IV cytology results are identified in 7-9% of nodules investigated through FNA, with reported malignancy rate in a wide range of 10-40%. The recommended treatment is either surgical or risk additional molecular testing before surgery. However, a large number of nodules belonging to this category (60-80%) are observed to be benign after surgical excision, which can put the patient at risk of unnecessary surgical morbidity. This study aimed to assess the diagnostic performance of conventional ultrasound, the ACR TI-RADS score and elastography in cases of Bethesda IV cytology on FNA. Methods We evaluated ninety-seven consecutive cases with Bethesda category IV results on FNA by using conventional B-mode ultrasound, qualitative strain or shear-wave elastography (Hitachi Preirus Machine, Hitachi Inc., Japan and Aixplorer Mach 30 Supersonic Imagine, Aix-en-Provence, France) and all nodules were classified according to the ACR TI-RADS system. Conventional ultrasound was used to categorize the nodules as potentially malignant based on the following features: hypoechogenicity, inhomogeneity, a taller than wide shape, irregular margins, presence of microcalcifications, an interrupted thyroid capsule and suspicious cervical lymph nodes. Elastography classified nodules with increased stiffness as suspicious for malignancy. Results We considered pathology results as the gold standard diagnosis, finding that 32 out of 97 nodules were carcinomas (33%) and 65 out of 97 were benign nodules (67%). The benign group included twenty cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Finally, we compared ultrasound data with pathology results, which showed that nineteen out of the 32 malignant nodules presented with increased stiffness on elastography (p=0.0002). On conventional ultrasound, we found that microcalcifications (p=0.007), hypoechogenicity and irregular margins (p=0.006) are features which can distinguish between benign and malignant nodules with statistical significance. Discussion Integrating elastography as a parameter of the ACR TI-RADS score in the evaluation of Bethesda category IV nodules showed a sensitivity of 90.62% in detecting thyroid cancer cases (p=0.006). We can conclude that elastographic stiffness as an addition to high risk features observed on conventional ultrasound improves the detection of malignant nodules in cases with Bethesda IV cytology.
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Affiliation(s)
- Monica Latia
- Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
| | - Andreea Borlea
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- 2 Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Monica Simina Mihuta
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Octavian Constantin Neagoe
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
- 1 Department of Surgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical Municipal Hospital, Timisoara, Romania
| | - Dana Stoian
- Dr. D Medical Center, Center for Advanced Ultrasound Evaluation, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- 2 Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Endocrinology Unit, Pius Brinzeu Emergency Clinical Hospital, Timisoara, Romania
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16
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Żyłka A, Dobruch-Sobczak K, Piotrzkowska-Wróblewska H, Jędrzejczyk M, Bakuła-Zalewska E, Góralski P, Gałczyński J, Dedecjus M. The Utility of Contrast-Enhanced Ultrasound (CEUS) in Assessing the Risk of Malignancy in Thyroid Nodules. Cancers (Basel) 2024; 16:1911. [PMID: 38791990 PMCID: PMC11119249 DOI: 10.3390/cancers16101911] [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: 03/21/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Ultrasonography is a primary method used in the evaluation of thyroid nodules, but no single feature of this method predicts malignancy with high accuracy. Therefore, this paper aims to assess the utility of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of thyroid nodules. METHODS The study group comprised 188 adult patients (155 women and 33 men) who preoperatively underwent CEUS of a thyroid nodule classified as Bethesda categories II-VI after fine-needle aspiration biopsy. During the CEUS examination, 1.5 mL of SonoVue contrast was injected intravenously, after which 15 qualitative CEUS enhancement patterns were analysed. RESULTS The histopathologic results comprised 65 benign thyroid nodules and 123 thyroid carcinomas. The dominant malignant CEUS features, such as hypo- and heterogeneous enhancement and slow wash-in phase, were evaluated, whereas high enhancement, ring enhancement, and a slow wash-out phase were assessed as predictors of benign lesions. Two significant combinations of B-mode and CEUS patterns were noted, namely, hypoechogenicity with heterogeneous enhancement and non-smooth margins with hypo- or iso-enhancement. CONCLUSIONS The preliminary results indicate that CEUS is a useful tool in assessing the risk of malignancy of thyroid lesions. The combination of the qualitative enhancement parameters and B-mode sonographic features significantly increases the method's usefulness.
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Affiliation(s)
- Agnieszka Żyłka
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.G.); (J.G.); (M.D.)
| | - Katarzyna Dobruch-Sobczak
- Radiology Department II, Maria Sklodowska-Curie National Research Institute of Oncology, 02-034 Warsaw, Poland;
| | - Hanna Piotrzkowska-Wróblewska
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, 02-106 Warsaw, Poland;
| | - Maciej Jędrzejczyk
- Department of Ultrasound and Mammography Diagnostics, Mazovian Brodnowski Hospital, 03-242 Warsaw, Poland;
| | - Elwira Bakuła-Zalewska
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Piotr Góralski
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.G.); (J.G.); (M.D.)
| | - Jacek Gałczyński
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.G.); (J.G.); (M.D.)
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.G.); (J.G.); (M.D.)
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Russo A, Patanè V, Fusco L, Faggioni L, Boschetti CE, Santagata M, Neri E, Cappabianca S, Reginelli A. Reliability of Ultrasonographic Assessment of Depth of Invasion and Tumor Thickness in Intraoral Mucosa Lesions: A Preliminary Experience. J Clin Med 2024; 13:2595. [PMID: 38731124 PMCID: PMC11084595 DOI: 10.3390/jcm13092595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: Despite the progress made in multidisciplinary care, there has been little improvement in the oncologic outcomes of oral cavity squamous cell carcinomas (OSCCs). In the latest edition of the TNM staging, "depth of invasion" (DOI) has recently been introduced as one of the criteria for determining the T stage, alongside other factors. DOI is widely recognized as an independent risk factor for nodal metastases and is a crucial consideration in the preoperative staging of OSCCs, along with measurements of tumor thickness (TT). While various diagnostic methods exist for assessing DOI, intraoral ultrasonography (IOUS) has gained popularity for its efficacy in evaluating OSCCs. Methods: This study sought to evaluate the diagnostic accuracy and reliability of ultrahigh-frequency ultrasound (UHFUS) in assessing oral cavity lesions compared to histopathological analysis. Results: The results revealed strong reliability in ultrasonographic measurements (ICC TT: 0.94; ICC DOI: 0.97) and distinct ultrasonographic features specific to different oral pathologies. This highlights the potential of UHFUS as a non-invasive imaging tool for precise diagnostic evaluations. Conclusions: Despite limitations such as a small sample size and focus on specific lesions, these promising results suggest that UHFUS could significantly enhance oral lesion diagnostics. Further research involving larger cohorts is necessary to validate and build upon these initial findings.
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Affiliation(s)
- Anna Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Vittorio Patanè
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luigia Fusco
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Lorenzo Faggioni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy; (L.F.)
| | - Ciro Emiliano Boschetti
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Mario Santagata
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy; (L.F.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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18
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Boudina M, Katsamakas M, Chorti A, Panousis P, Tzitzili E, Tzikos G, Chrisoulidou A, Valeri R, Ioannidis A, Papavramidis T. Diagnostic Accuracy of Ultrasound and Fine-Needle Aspiration Cytology in Thyroid Malignancy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:722. [PMID: 38792905 PMCID: PMC11123347 DOI: 10.3390/medicina60050722] [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: 04/03/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
Introduction: Thyroid nodule incidence is increasing due to the widespread application of ultrasonography. Fine-needle aspiration cytology is widely applied for the detection of malignancies. The aim of this study was to evaluate the predictive value of ultrasonography in thyroid cancer. Methods: This retrospective study included patients that underwent total thyroidectomy for benign thyroid disease or well-differentiated thyroid carcinoma from January 2017 to December 2022. The study population was divided into groups: the well-differentiated thyroid cancer group and the control group with benign histopathological reports. Results: In total, 192 patients were enrolled in our study; 159 patients were included in the well-differentiated thyroid cancer group and 33 patients in the control group. Statistical analysis demonstrated that ultrasonographic findings such as microcalcifications (90.4%), hypoechogenicity (89.3%), irregular margins (92.2%) and taller-than-wide shape (90.5%) were correlated to malignancy (p < 0.001). Uni- and multivariate analysis revealed that both US score (OR: 2.177; p < 0.001) and Bethesda System (OR: 1.875; p = 0.002) could predict malignancies. In terms of diagnostic accuracy, the US score displayed higher sensitivity (64.2% vs. 33.3%) and better negative predictive value (34.5% vs. 24.4%) than the Bethesda score, while both scoring systems displayed comparable specificities (90.9% vs. 100%) and positive predictive values (97.1% vs. 100%). Discussion: The malignant potential of thyroid nodules is a crucial subject, leading the decision for surgery. Ultrasonography and fine-needle aspiration cytology are pivotal examinations in the diagnostic process, with ultrasonography demonstrating better negative predictive value.
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Affiliation(s)
- Maria Boudina
- Department of Endocrinology, Theageneio Cancer Hospital, 54636 Thessaloniki, Greece
| | - Michael Katsamakas
- Department of Surgery, Theageneio Cancer Hospital, 54636 Thessaloniki, Greece (P.P.)
| | - Angeliki Chorti
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University, 54636 Thessaloniki, Greece
| | - Panagiotis Panousis
- Department of Surgery, Theageneio Cancer Hospital, 54636 Thessaloniki, Greece (P.P.)
| | - Eleni Tzitzili
- Department of Surgery, Theageneio Cancer Hospital, 54636 Thessaloniki, Greece (P.P.)
| | - Georgios Tzikos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University, 54636 Thessaloniki, Greece
| | | | - Rosalia Valeri
- Department of Pathology, Theageneio Cancer Hospital, 54636 Thessaloniki, Greece
| | - Aris Ioannidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University, 54636 Thessaloniki, Greece
| | - Theodossis Papavramidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University, 54636 Thessaloniki, Greece
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19
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Wang L, Zhang L, Wang D, Chen J, Su W, Sun L, Jiang J, Wang J, Zhou Q. Predicting central cervical lymph node metastasis in papillary thyroid carcinoma with Hashimoto's thyroiditis: a practical nomogram based on retrospective study. PeerJ 2024; 12:e17108. [PMID: 38650652 PMCID: PMC11034492 DOI: 10.7717/peerj.17108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
Background In papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT), preoperative ultrasonography frequently reveals the presence of enlarged lymph nodes in the central neck region. These nodes pose a diagnostic challenge due to their potential resemblance to metastatic lymph nodes, thereby impacting the surgical decision-making process for clinicians in terms of determining the appropriate surgical extent. Methods Logistic regression analysis was conducted to identify independent risk factors associated with central lymph node metastasis (CLNM) in PTC patients with HT. Then a prediction model was developed and visualized using a nomogram. The stability of the model was assessed using ten-fold cross-validation. The performance of the model was further evaluated through the use of ROC curve, calibration curve, and decision curve analysis. Results A total of 376 HT PTC patients were included in this study, comprising 162 patients with CLNM and 214 patients without CLNM. The results of the multivariate logistic regression analysis revealed that age, Tg-Ab level, tumor size, punctate echogenic foci, and blood flow grade were identified as independent risk factors associated with the development of CLNM in HT PTC. The area under the curve (AUC) of this model was 0.76 (95% CI [0.71-0.80]). The sensitivity, specificity, accuracy, and positive predictive value of the model were determined to be 88%, 51%, 67%, and 57%, respectively. Conclusions The proposed clinic-ultrasound-based nomogram in this study demonstrated a favorable performance in predicting CLNM in HT PTCs. This predictive tool has the potential to assist clinicians in making well-informed decisions regarding the appropriate extent of surgical intervention for patients.
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Affiliation(s)
- Lirong Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Lin Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Dan Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Jiawen Chen
- Department of Otolaryngology-Head and Neck Surgery, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Wenxiu Su
- Department of Pathology, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Lei Sun
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Jue Jiang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Juan Wang
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
| | - Qi Zhou
- Department of Ultrasound, the Second Affiliated Hospital of Xi ’an Jiaotong University, Xi ’an, Shannxi, China
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20
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He L, Chen X, Hu J, Meng Y, Zhang Y, Chen W, Fan Y, Li T, Fang J. Score based on contrast-enhanced ultrasound predict central lymph node metastasis in papillary thyroid cancer. Front Endocrinol (Lausanne) 2024; 15:1336787. [PMID: 38699389 PMCID: PMC11063297 DOI: 10.3389/fendo.2024.1336787] [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: 11/11/2023] [Accepted: 04/07/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives To investigate the association between contrast-enhanced ultrasound (CEUS) features of PTC and central lymph node metastasis (CLNM) and to develop a predictive model for the preoperative identification of CLNM. Methods This retrospective study evaluated 750 consecutive patients with PTC from August 2020 to April 2023. Conventional ultrasound and qualitative CEUS features were analyzed for the PTC with or without CLNM using univariate and multivariate logistic regression analysis. A nomogram integrating the predictors was constructed to identify CLNM in PTC. The predictive nomogram was validated using a validation cohort. Results A total of 684 patients were enrolled. The 495 patients in training cohort were divided into two groups according to whether they had CLNM (pCLNM, n= 191) or not (nCLNM, n= 304). There were significant differences in terms of tumor size, shape, echogenic foci, enhancement direction, peak intensity, and score based on CEUS TI-RADS between the two groups. Independent predictive US features included irregular shape, larger tumor size (≥ 1.0cm), and score. Nomogram integrating these predictive features showed good discrimination and calibration in both training and validation cohort with an AUC of 0.72 (95% CI: 0.68, 0.77) and 0.79 (95% CI: 0.72, 0.85), respectively. In the subgroup with larger tumor size, age ≤ 35 years, irregular shape, and score > 6 were independent risk factors for CLNM. Conclusion The score based on preoperative CEUS features of PTC may help to identify CLNM. The nomogram developed in this study provides a convenient and effective tool for clinicians to determine an optimal treatment regimen for patients with PTC.
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Affiliation(s)
| | | | | | | | | | | | | | - Tao Li
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, China
| | - Jingqin Fang
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, China
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21
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Liu D, Yang K, Zhang C, Xiao D, Zhao Y. Fully-Automatic Detection and Diagnosis System for Thyroid Nodules Based on Ultrasound Video Sequences by Artificial Intelligence. J Multidiscip Healthc 2024; 17:1641-1651. [PMID: 38646015 PMCID: PMC11027922 DOI: 10.2147/jmdh.s439629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/08/2024] [Indexed: 04/23/2024] Open
Abstract
Background Interpretation of ultrasound findings of thyroid nodules is subjective and labor-intensive for radiologists. Artificial intelligence (AI) is a relatively objective and efficient technology. We aimed to establish a fully automatic detection and diagnosis system for thyroid nodules based on AI technology by analyzing ultrasound video sequences. Patients and Methods We prospectively acquired dynamic ultrasound videos of 1067 thyroid nodules (804 for training and 263 for validation) from December 2018 to January 2021. All the patients underwent hemithyroidectomy or total thyroidectomy. Dynamic ultrasound videos were used to develop an AI system consisting of two deep learning models that could automatically detect and diagnose thyroid nodules. Average precision (AP) was used to estimate the performance of the detection model. The area under the receiver operating characteristic curve (AUC) was used to measure the performance of the diagnostic model. Results Location and shape were accurately detected with a high AP of 0.914 in the validation cohort. The AUC of the diagnostic model was 0.953 in the validation cohort. The sensitivity and specificity of junior and senior radiologists were 76.9% vs 78.3% and 68.4% vs 81.1%, respectively. The diagnostic performance of the AI diagnostic model was superior to that of junior radiologists (P = 0.016) and was not significantly different from that of senior radiologists (P = 0.281). Conclusion We established a fully automatic detection and diagnosis system for thyroid nodules based on ultrasound video using an AI approach that can be conveniently applied to optimize the management of patients with thyroid nodules.
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Affiliation(s)
- Dan Liu
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Ke Yang
- The First in-Patient Department, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, People’s Republic of China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Dandan Xiao
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Yu Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
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22
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Ding Y, Peng Y, Zhang J, Pan X, Huang X, Zhang CQ. Diagnostic value of contrast-enhanced ultrasound in the diagnosis of papillary thyroid microcarcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37768. [PMID: 38608080 PMCID: PMC11018218 DOI: 10.1097/md.0000000000037768] [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: 08/20/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Using meta-analysis to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in the diagnosis of papillary thyroid microcarcinoma (PTMC). METHODS For this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Web of Science, WanFang Data, VPCS Data, and China National Knowledge Infrastructure electronic databases for diagnostic studies on PTMC by CEUS from January 2013 to November 2022. Data were not available or incomplete such as case reports, nonhuman studies, etc, were excluded. Random-effects meta-analyses were used to evaluate the diagnostic accuracy of CEUS in diagnosing PTMC. The quality of the evidence was assessed with the QUADAS-2 scale. This study is registered on PROSPERO, number CRD42023409417. RESULTS Of 1064 records identified, 33 were eligible. The results showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CEUS in diagnosing PTMC were 0.84 (95% confidence interval [CI] = 0.83-0.86), 0.82 (95% CI = 0.80-0.83), 3.90 (95% CI = 3.23-4.72), 0.21 (95% CI = 0.18-0.25), and 20.01 (95% CI = 14.97-26.74), respectively, and the area under the summary receiver operating characteristic curve was 0.8930 (the Q index was 0.8239). The Deek funnel plot indicated publication bias (P ˂.01). CONCLUSION This meta-analysis provides an overview of diagnostic accuracy of CEUS in diagnosing PTMC which indicates CEUS has a good diagnostic value for PTMC. The limitations of this study are publication bias and strong geographical bias.
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Affiliation(s)
- Yan Ding
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yulan Peng
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jing Zhang
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xueqin Pan
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xu Huang
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Chun-Quan Zhang
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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Chen C, Jiang Y, Yao J, Lai M, Liu Y, Jiang X, Ou D, Feng B, Zhou L, Xu J, Wu L, Zhou Y, Yue W, Dong F, Xu D. Deep learning to assist composition classification and thyroid solid nodule diagnosis: a multicenter diagnostic study. Eur Radiol 2024; 34:2323-2333. [PMID: 37819276 DOI: 10.1007/s00330-023-10269-z] [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: 02/21/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES This study aimed to propose a deep learning (DL)-based framework for identifying the composition of thyroid nodules and assessing their malignancy risk. METHODS We conducted a retrospective multicenter study using ultrasound images from four hospitals. Convolutional neural network (CNN) models were constructed to classify ultrasound images of thyroid nodules into solid and non-solid, as well as benign and malignant. A total of 11,201 images of 6784 nodules were used for training, validation, and testing. The area under the receiver-operating characteristic curve (AUC) was employed as the primary evaluation index. RESULTS The models had AUCs higher than 0.91 in the benign and malignant grading of solid thyroid nodules, with the Inception-ResNet AUC being the highest at 0.94. In the test set, the best algorithm for identifying benign and malignant thyroid nodules had a sensitivity of 0.88, and a specificity of 0.86. In the human vs. DL test set, the best algorithm had a sensitivity of 0.93, and a specificity of 0.86. The Inception-ResNet model performed better than the senior physicians (p < 0.001). The sensitivity and specificity of the optimal model based on the external test set were 0.90 and 0.75, respectively. CONCLUSIONS This research demonstrates that CNNs can assist thyroid nodule diagnosis and reduce the rate of unnecessary fine-needle aspiration (FNA). CLINICAL RELEVANCE STATEMENT High-resolution ultrasound has led to increased detection of thyroid nodules. This results in unnecessary fine-needle aspiration and anxiety for patients whose nodules are benign. Deep learning can solve these problems to some extent. KEY POINTS • Thyroid solid nodules have a high probability of malignancy. • Our models can improve the differentiation between benign and malignant solid thyroid nodules. • The differential performance of one model was superior to that of senior radiologists. Applying this could reduce the rate of unnecessary fine-needle aspiration of solid thyroid nodules.
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Affiliation(s)
- Chen Chen
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Yitao Jiang
- Illuminate, LLC, Shenzhen, Guangdong, 518000, China
| | - Jincao Yao
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Key Laboratory of Head & Neck Cancer, Translational Research of Zhejiang Province, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
| | - Min Lai
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yuanzhen Liu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Xianping Jiang
- Department of Ultrasound, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou, 312400, China
| | - Di Ou
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Key Laboratory of Head & Neck Cancer, Translational Research of Zhejiang Province, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
| | - Bojian Feng
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Lingyan Zhou
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Key Laboratory of Head & Neck Cancer, Translational Research of Zhejiang Province, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Linghu Wu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Yuli Zhou
- Department of Ultrasound, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Wenwen Yue
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China.
| | - Fajin Dong
- Department of Ultrasound, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, 518020, China.
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China.
- Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, 317502, China.
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China.
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de Carlos J, Garcia J, Basterra FJ, Pineda JJ, Dolores Ollero M, Toni M, Munarriz P, Anda E. Interobserver variability in thyroid ultrasound. Endocrine 2024:10.1007/s12020-024-03731-5. [PMID: 38372907 DOI: 10.1007/s12020-024-03731-5] [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: 09/20/2023] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Ultrasound evaluation of thyroid nodules is the preferred technique, but it is dependent on operator interpretation, leading to inter-observer variability. The current study aimed to determine the inter-physician consensus on nodular characteristics, risk categorization in the classification systems, and the need for fine needle aspiration puncture. METHODS Four endocrinologists from the same center blindly evaluated 100 ultrasound images of thyroid nodules from 100 different patients. The following ultrasound features were evaluated: composition, echogenicity, margins, calcifications, and microcalcifications. Nodules were also classified according to ATA, EU-TIRADS, K-TIRADS, and ACR-TIRADS classifications. Krippendorff's alpha test was used to assess interobserver agreement. RESULTS The interobserver agreement for ultrasound features was: Krippendorff's coefficient 0.80 (0.71-0.89) for composition, 0.59 (0.47-0.72) for echogenicity, 0.73 (0.57-0.88) for margins, 0.55 (0.40-0.69) for calcifications, and 0.50 (0.34-0.67) for microcalcifications. The concordance for the classification systems was 0.7 (0.61-0.80) for ATA, 0.63 (0.54-0.73) for EU-TIRADS, 0.64 (0.55-0.73) for K-TIRADS, and 0.68 (0.60-0.77) for K-TIRADS. The concordance in the indication of fine needle aspiration puncture (FNA) was 0.86 (0.71-1), 0.80 (0.71-0.88), 0.77 0.67-0.87), and 0.73 (0.64-0.83) for systems previously described respectively. CONCLUSIONS Interobserver agreement was acceptable for the identification of nodules requiring cytologic study using various classification systems. However, limited concordance was observed in risk stratification and many ultrasonographic characteristics of the nodules.
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Affiliation(s)
- Joaquín de Carlos
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | - Javier Garcia
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Francisco Javier Basterra
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
- Universidad Pública de Navarra, Pamplona, Navarra, Spain
| | - Jose Javier Pineda
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - M Dolores Ollero
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Marta Toni
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
- Universidad Pública de Navarra, Pamplona, Navarra, Spain
| | - Patricia Munarriz
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Emma Anda
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
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Bojunga J, Trimboli P. Thyroid ultrasound and its ancillary techniques. Rev Endocr Metab Disord 2024; 25:161-173. [PMID: 37946091 DOI: 10.1007/s11154-023-09841-1] [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] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
Ultrasound (US) of the thyroid has been used as a diagnostic tool since the late 1960s. US is the most important imaging tool for diagnosing thyroid disease. In the majority of cases a correct diagnosis can already be made in synopsis of the sonographic together with clinical findings and basal thyroid hormone parameters. However, the characterization of thyroid nodules by US remains challenging. The introduction of Thyroid Imaging Reporting and Data Systems (TIRADSs) has improved diagnostic accuracy of thyroid cancer significantly. Newer techniques such as elastography, superb microvascular imaging (SMI), contrast enhanced ultrasound (CEUS) and multiparametric ultrasound (MPUS) expand diagnostic options and tools further. In addition, the use of artificial intelligence (AI) is a promising tool to improve and simplify diagnostics of thyroid nodules and there is evidence that AI can exceed the performance of humans. Combining different US techniques with the introduction of new software, the use of AI, FNB as well as molecular markers might pave the way for a completely new area of diagnostic accuracy in thyroid disease. Finally, interventional ultrasound using US-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for benign as well as malignant thyroid diseases.
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Affiliation(s)
- Joerg Bojunga
- Department of Medicine I, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany.
| | - Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
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26
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Petersen M, Schenke SA, Veit F, Görges R, Seifert P, Zimny M, Croner RS, Kreissl MC, Stahl AR. Thyroid Imaging Reporting and Data Systems: Applicability of the "Taller than Wide" Criterium in Primary/Secondary Care Units and the Role of Thyroid Scintigraphy. J Clin Med 2024; 13:514. [PMID: 38256648 PMCID: PMC10816136 DOI: 10.3390/jcm13020514] [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: 11/19/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND To examine the applicability of the "taller than wide" (ttw) criterium for risk assessment of thyroid nodules (TNs) in primary/secondary care units and the role of thyroid scintigraphy therein. METHODS German bicenter study performed in a setting of primary/secondary care. Patient recruitment and analysis in center A was conducted in a prospective manner. In center B, patient data were retrieved from a database that was originally generated by prospective data collection. TNs were assessed by ultrasound and thyroid scans, mostly fine needle biopsy and occasionally surgery and others. In center A, only patients who presented for the first time were included. The inclusion criterion was any TN ≥ 10 mm that had at least the following two sonographic risk features: solidity and a ttw shape. In center B, consecutive patients who had at least ttw and hypofunctioning nodules ≥ 10 mm were retrieved from the above-mentioned database. The risk of malignancy was determined according to a mixed reference standard and compared with literature data. RESULTS In center A, 223 patients with 259 TNs were included into the study. For further analysis, 200 nodules with a reference standard were available. The overall malignancy rate was 2.5% (upper limit of the 95% CI: 5.1%). After the exclusion of scintigraphically hyperfunctioning nodules, the malignancy rate increased slightly to 2.8% (upper limit of the 95% CI: 5.7%). Malignant nodules exhibited sonographic risk features additional to solidity and ttw shape more often than benign ones. In addition to the exclusion of hyperfunctioning nodules, when considering only nodules without additional US risk features, i.e., exclusively solid and ttw-nodules, the malignancy rate decreased to 0.9% (upper limit 95% CI: 3.7%). In center B, from 58 patients, 58 ttw and hypofunctioning TNs on thyroid scans with a reference standard were available. Malignant nodules from center B were always solid and hypoechoic. The overall malignancy rate of hypofunctioning and ttw nodules was 21%, with the lower limit of the 95% CI (one-sided) being 12%. CONCLUSIONS In primary/secondary care units, the lowest TIRADS categories for indicating FNB, e.g., applying one out of five sonographic risk features, may not be appropriate owing to the much lower a priori malignancy risk in TNs compared to tertiary/quaternary care units. Even the combination of two sonographic risk features, "solidity" and "ttw", may only be appropriate in a limited fashion. In contrast, the preselection of TNs according to hypofunctioning findings on thyroid scans clearly warranted FNB, even when applying only one sonographic risk criterion ("ttw"). For this reason, thyroid scans in TNs may not only be indicated to rule out hyperfunctioning nodules from FNB but also to rule in hypofunctioning ones.
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Affiliation(s)
- Manuela Petersen
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Simone A. Schenke
- Department and Institute of Nuclear Medicine, Hospital Bayreuth, 95445 Bayreuth, Germany
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Franziska Veit
- Institute of Radiology Dr. von Essen, 56068 Koblenz, Germany
| | - Rainer Görges
- Clinic for Nuclear Medicine, University Hospital Essen, 45147 Essen, Germany
| | - Philipp Seifert
- Clinic of Nuclear Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau, 63450 Hanau, Germany
| | - Roland S. Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39106 Magdeburg, Germany
| | - Alexander R. Stahl
- Institute for Radiology and Nuclear Medicine, Radiologie im Zentrum (RIZ), 86150 Augsburg, Germany
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Sosnowska-Sienkiewicz P, Danielewicz D, Januszkiewicz-Lewandowska D, Rusak P, Anderko I, Rzepecki M, Niedziela M, Harasymczuk J, Mańkowski P. Thyroid diseases in children and adolescents requiring surgical treatment-indications, techniques, results, and complications based on 10 years of the single center's own experience. Front Endocrinol (Lausanne) 2024; 14:1301191. [PMID: 38283745 PMCID: PMC10811211 DOI: 10.3389/fendo.2023.1301191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Although thyroid abnormalities are observed less frequently in children than in adults, the increased incidence of thyroid cancer makes it mandatory for all pediatric surgeons to be knowledgeable about the disorders of this gland. Thyroid abnormalities can be associated with hyperthyroidism or hypothyroidism and euthyroidism and/or symmetric or asymmetric enlargement of the gland. Aim The present study was undertaken to retrospectively analyze the indications, surgical techniques used, results obtained, and complications found in the surgical treatment of thyroid diseases in children and adolescents in a surgical center for the macro-region of western Poland. Methods The data of 148 patients undergoing total or partial thyroidectomy between 2013 and 2022 were analyzed from the medical records of the Department of Pediatric Surgery, Traumatology, and Urology of the Medical University of Poznan, Poland. Results A total of 95 children underwent subtotal thyroidectomy and 64 underwent total thyroidectomy, of which the procedure was widened to include prophylactic removal of neck lymph nodes in 45 patients. There were 113 girls (76%) in the analyzed group, and the average age of the patients at the time of surgical treatment was 15 years. The average time from the diagnosis of thyroid disease to surgery was 4 months, ranging from 2 weeks to 3 years. Of the 64 patients undergoing total thyroid resection, 35 (54.69%) were diagnosed with thyroid cancer. Conclusions Collaboration within a multidisciplinary team ensures optimal surgical outcomes in children and adolescents with thyroid disease. With extreme caution, thyroid removal is a safe procedure with few complications, but the experience of the surgeon performing thyroid surgery in children remains crucial. Despite the absence of such a diagnosis in the first fine-needle aspiration biopsy, the high percentage of thyroid carcinomas in the analyzed group may be because the initial biopsy was performed in a less experienced center, also in terms of histopathological laboratory. Hence, we point out the necessity of performing a repeat fine-needle aspiration biopsy (according to the Bethesda classification) in a more experienced center before the final decision of thyroidectomy.
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Affiliation(s)
| | - Dajana Danielewicz
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Paulina Rusak
- Student Research Group of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Iwona Anderko
- Student Research Group of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Maciej Rzepecki
- Student Research Group of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Jerzy Harasymczuk
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznań, Poland
| | - Przemysław Mańkowski
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznań, Poland
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Fan J, Tao L, Zhan W, Li W, Kuang L, Zhao Y, Zhou W. Diagnostic value of qualitative and quantitative parameters of contrast-enhanced ultrasound for differentiating differentiated thyroid carcinomas from benign nodules. Front Endocrinol (Lausanne) 2024; 14:1240615. [PMID: 38250738 PMCID: PMC10797774 DOI: 10.3389/fendo.2023.1240615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
Objective To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) of qualitative and quantitative parameters for differentiating differentiated thyroid cancers from benign nodules. Method A total of 290 thyroid nodules that were pathologically confirmed were enrolled in this study. The univariate analysis was performed for the clinical characteristics and CEUS qualitative and quantitative parameters of the inside and peripheral zone of nodules, including age, gender, nodule size, intensity of enhancement, homogeneity, wash-in and wash-out patterns, margin after CEUS, ring enhancement, peak intensity, sharpness, time to peak(TP), and area under the curve(AUC), and the meaningful indicators in the single-factor analysis were further included in multivariate logistic regression analysis. Results Multivariate analysis showed that there were significant differences in age (p=0.031), nodule size (p<0.001), heterogeneous enhancement (p<0.001), hypo-enhancement (p=0.001), unclear margin after CEUS(p=0.007), inside peak (p<0.001), and outside sharpness(p<0.001) between benign and malignant nodules. However, there were no significant differences in gender, ring enhancement, wash-in, wash-out, outside TP, outside AUC between benign and malignant thyroid nodules (P>0.05, for all). Conclusion CEUS might be useful in the differential diagnosis of differentiated thyroid cancers and benign nodules, which could provide a certain basis for clinical treatment.
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Affiliation(s)
- Jinfang Fan
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lingling Tao
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Li
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lijun Kuang
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yingyan Zhao
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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AlSaedi AH, Almalki DS, ElKady RM. Approach to Thyroid Nodules: Diagnosis and Treatment. Cureus 2024; 16:e52232. [PMID: 38352091 PMCID: PMC10861804 DOI: 10.7759/cureus.52232] [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] [Accepted: 01/13/2024] [Indexed: 02/16/2024] Open
Abstract
Thyroid nodules (TNs) are prevalent and found in up to 50% of individuals. While most TNs are benign, some can be malignant. The evaluation of TNs is crucial to rule out malignancy and identify those requiring surgical intervention. This study aimed to clarify the reported prevalence of TNs, focusing specifically on their various types, assessment and diagnostic processes, current evaluation methods, and evidence-based management. It also provides recommendations for follow-up. TNs are typically found during physical exams or incidentally during imaging procedures. Routine laboratory and clinical evaluations of TNs are common. Ultrasound is the preferred imaging method to determine if a TN needs a biopsy. Fine-needle aspiration (FNA) is crucial in deciding whether surgery or surveillance is necessary. TNs that show suspicious features on the ultrasound may require cytologic analysis to assess the risk of malignancy. The effectiveness of several supplementary molecular tests is still uncertain, although some studies report promising results. The management and treatment approach for TNs primarily depends on the results of FNA cytology and ultrasound characteristics. The optimal treatment strategy for TNs ranges from straightforward follow-ups for low-risk cases to surgical intervention for high-risk patients. Rather than adopting a uniform approach, clinicians should assess each patient on a case-by-case basis using current knowledge and a collaborative, multidisciplinary method.
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Affiliation(s)
| | | | - Reem M ElKady
- Radiology and Medical Imaging, Taibah University, Al-Madenah, SAU
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30
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Yazgi D, Richa C, Salenave S, Kamenicky P, Bourouina A, Clavier L, Dupeux M, Papon JF, Young J, Chanson P, Maione L. Differentiating pathologic parathyroid glands from thyroid nodules on neck ultrasound: the PARATH-US cross-sectional study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100751. [PMID: 37915399 PMCID: PMC10616552 DOI: 10.1016/j.lanepe.2023.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023]
Abstract
Background Neck ultrasound (US) is a widely used and accessible operator-dependent technique that helps characterize thyroid nodules and pathologic parathyroid glands (PPGs). However, thyroid nodules may sometimes be confused with PPGs. PARATH-US study aims at identifying US characteristics to differentiate PPGs from thyroid nodules, as there is no study, at present, which directly compares the US features of these two common neoplasms. Methods PARATH-US is a single-center study that was conducted at a tertiary referral center, including consecutive lesions from patients undergoing neck US examination from 2016 to 2022. Findings 176 PPGs (158 patients: serum calcium levels 2.91 [IQR 2.74-3.05] mmol/L, PTH levels 173 [112-296] ng/L) were compared to 232 size- and volume-matched thyroid nodules (204 age- and sex-matched patients). The morphologic patterns, echoic content and vascular status were all different between PPGs and thyroid neoplasms (p < 0.01 for all comparisons). The combined parameters maximally discriminated PPGs from thyroid nodules (OR, 7.6; 95% CI: 3.4, 17.1, p < 0.0001). When applying risk stratification systems developed for thyroid malignancies, 58-63% of PPGs were classified as high-risk lesions. Parathyroid adenomas had larger sizes and volumes than hyperplasias (p = 0.013 and p = 0.029). Serum calcium and PTH levels were significantly correlated with PPG size and volume (p < 0.0001 for all comparisons). Interpretation We demonstrate the presence of distinct US characteristics in PPGs, which help differentiate them from thyroid nodules. When mistaken for thyroid nodules, PPGs bear high-risk US features. When dealing with high-risk cervical lesions detected on US, a PPG should be suspected, and an assessment of calcium levels recommended to avoid unnecessary invasive procedures. Funding CYTO-TRAIN, C2022DOSRH053, funded by the French Regional Health Agency.
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Affiliation(s)
- Dolly Yazgi
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Carine Richa
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Sylvie Salenave
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Peter Kamenicky
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Amel Bourouina
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | | | - Margot Dupeux
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre Service d’Anatomie et Cytologie Pathologiques, Le Kremlin-Bicêtre, France
| | - Jean-François Papon
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie et Chirurgie Cervico-Maxillo Faciale, Le Kremlin-Bicêtre, France
| | - Jacques Young
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
| | - Luigi Maione
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Le Kremlin-Bicêtre, France
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Liu J, Luo T, Zhang H, Liu H, Gu Y, Chen X, Shi L, Guan L, Ni X, Zhang X, Zhang R, Jia X, Dong Y, Zhang J, Xu W, Zhou J. Markedly hypoechoic: a new definition improves the diagnostic performance of thyroid ultrasound. Eur Radiol 2023; 33:7857-7865. [PMID: 37338557 DOI: 10.1007/s00330-023-09828-1] [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: 11/04/2022] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To determine the contribution of a modified definition of markedly hypoechoic in the differential diagnosis of thyroid nodules. METHODS A total of 1031 thyroid nodules were included in this retrospective multicenter study. All of the nodules were examined with US before surgery. The US features of the nodules were evaluated, in particular, the classical markedly hypoechoic and modified markedly hypoechoic (decreased or similar echogenicity relative to the adjacent strap muscles). The sensitivity, specificity, and AUC of classical/modified markedly hypoechoic and the corresponding ACR-TIRADS, EU-TIRADS, and C-TIRADS categories were calculated and compared. The inter- and intraobserver variability in the evaluation of the main US features of the nodules was assessed. RESULTS There were 264 malignant nodules and 767 benign nodules. Compared with classical markedly hypoechoic as a diagnostic criterion for malignancy, using modified markedly hypoechoic as the criterion resulted in a significant increase in sensitivity (28.03% vs. 63.26%) and AUC (0.598 vs. 0.741), despite a significant decrease in specificity (91.53% vs. 84.88%) (p < 0.001 for all). Compared to the AUC of the C-TIRADS with the classical markedly hypoechoic, the AUC of the C-TIRADS with the modified markedly hypoechoic increased from 0.878 to 0.888 (p = 0.01); however, the AUCs of the ACR-TIRADS and EU-TIRADS did not change significantly (p > 0.05 for both). There was substantial interobserver agreement (κ = 0.624) and perfect intraobserver agreement (κ = 0.828) for the modified markedly hypoechoic. CONCLUSION The modified definition of markedly hypoechoic resulted in a significantly improved diagnostic efficacy in determining malignant thyroid nodules and may improve the diagnostic performance of the C-TIRADS. CLINICAL RELEVANCE STATEMENT Our study found that, compared with the original definition, modified markedly hypoechoic significantly improved the diagnostic performance in differentiating malignant from benign thyroid nodules and the predictive efficacy of the risk stratification systems. KEY POINTS • Compared with the classical markedly hypoechoic as a diagnostic criterion for malignancy, the modified markedly hypoechoic resulted in a significant increase in sensitivity and AUC. • The C-TIRADS with the modified markedly hypoechoic achieved higher AUC and specificity than that with the classical markedly hypoechoic (p = 0.01 and < 0.001, respectively).
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Affiliation(s)
- Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China
| | - Hua Zhang
- Department of Ultrasound, The Anyang Tumor Hospital, 1 Huanbinbei Road, Anyang, 455001, China
| | - Hui Liu
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, 25 TaiPing Street, Luzhou, 646000, China
| | - Ying Gu
- Department of Ultrasound, The Affiliated Hospital of Guizhou Medical University, 28 Guiyijie Street, Guiyang, 550001, China
| | - Xia Chen
- Department of Ultrasound, The Affiliated Hospital of Guizhou Medical University, 28 Guiyijie Street, Guiyang, 550001, China
| | - LiYing Shi
- Department of Ultrasound, The Affiliated Hospital of Guizhou Medical University, 28 Guiyijie Street, Guiyang, 550001, China
| | - Ling Guan
- Department of Ultrasound, Gansu Provincial Cancer Hospital, 2 Xiaoxihu East Road, Qilihe District, Lanzhou, 730050, China
| | - XueJun Ni
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, China
| | - XinDan Zhang
- Department of Ultrasound, Dalian Central Hospital Affiliated to Dalian Medical University, 42 Xuegong Street, Shahekou District, Dalian, 116033, China
| | - RuiFang Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, 1 Eastern Jianshe Road, Zhengzhou, 450052, China
| | - XiaoHong Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China
| | - YiJie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China
| | - JingWen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China
| | - WenWen Xu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China
| | - JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Rd, Shanghai, 200025, China.
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Rajabzadeh F, Hassannejad E, Akhlaghipour I, Imen MJ, Babazadeh Baghan A, Goshayeshi L, Taghavi SM, Vojouhi S, Payandeh A, Moodi Ghalibaf A. Differentiating benign and malignant thyroid nodules: A cross-sectional study on the comparison of diagnostic value of ultrasound elastography and fine needle aspiration biopsy. Health Sci Rep 2023; 6:e1619. [PMID: 37822842 PMCID: PMC10563170 DOI: 10.1002/hsr2.1619] [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: 06/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
Background and Aim This study examines the comparison of ultrasound elastography and fine needle aspiration (FNA) in diagnosing thyroid cancers and investigates the use of elastography as the initial diagnostic test of thyroid cancers to avoid the need for invasive diagnostic tests. Methods In this study, 28 patients with 48 thyroid nodules (TNs) who were candidates for FNA or surgery were examined within a period of 18 months. Cut-off and subsequently sensitivity and specificity for elastography results, compared to pathology results as the gold standard, were calculated using the receiver operating characteristic curve (ROC). Results Based on ROC, the cut-off point differentiating the tissue stiffness between benign and malignant TNs was 25.400 kilopascal (kPa) (sensitivity of 90.9% and specificity of 78.4%). It was observed that age affects the tissue stiffness; therefore, the cut-off was defined as 65.625 kpa for age groups under 50 years old (sensitivity of 100% and specificity of 100%) and 25.400 kpa for the age group above 50 years old (sensitivity of 88.9% and specificity of 70.4%). Conclusion Based on the high sensitivity and specificity of shear wave elastography in the differentiation of benign and malignant TNs, it can be employed as a stand-alone or in combination with other diagnostic techniques to reduce the need for inessential surgical operations. However, future studies or developments are needed on this promising diagnostic technique.
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Affiliation(s)
- Farnood Rajabzadeh
- Department of Radiology, Faculty of Medicine, Mashhad Medical SciencesIslamic Azad UniversityMashhadIran
| | - Ehsan Hassannejad
- Department of Radiology, School of MedicineBirjand University of Medical SciencesBirjandIran
| | - Iman Akhlaghipour
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Atefeh Babazadeh Baghan
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ladan Goshayeshi
- Department of Gastroentrology and Hepatology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
- Surgical Oncology Research Center, Imam Reza Hospital, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Shohreh Vojouhi
- Endocrine Research Center, School of MedicineMashhad University of Medical SciencesMashhadIran
| | - Asma Payandeh
- Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - AmirAli Moodi Ghalibaf
- Student Research Committee, Faculty of MedicineBirjand University of Medical SciencesBirjandIran
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Durante C, Hegedüs L, Na DG, Papini E, Sipos JA, Baek JH, Frasoldati A, Grani G, Grant E, Horvath E, Hoang JK, Mandel SJ, Middleton WD, Ngu R, Orloff LA, Shin JH, Trimboli P, Yoon JH, Tessler FN. International Expert Consensus on US Lexicon for Thyroid Nodules. Radiology 2023; 309:e231481. [PMID: 37906014 DOI: 10.1148/radiol.231481] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Multiple US-based systems for risk stratification of thyroid nodules are in use worldwide. Unfortunately, the malignancy probability assigned to a nodule varies, and terms and definitions are not consistent, leading to confusion and making it challenging to compare study results and craft revisions. Consistent application of these systems is further hampered by interobserver variability in identifying the sonographic features on which they are founded. In 2018, an international multidisciplinary group of 19 physicians with expertise in thyroid sonography (termed the International Thyroid Nodule Ultrasound Working Group) was convened with the goal of developing an international system, tentatively called the International Thyroid Imaging Reporting and Data System, or I-TIRADS, in two phases: (phase I) creation of a lexicon and atlas of US descriptors of thyroid nodules and (phase II) development of a system that estimates the malignancy risk of a thyroid nodule. This article presents the methods and results of phase I. The purpose herein is to show what has been accomplished thus far, as well as generate interest in and support for this effort in the global thyroid community.
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Affiliation(s)
- Cosimo Durante
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Laszlo Hegedüs
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Dong Gyu Na
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Enrico Papini
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jennifer A Sipos
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jung Hwan Baek
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Andrea Frasoldati
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Giorgio Grani
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Edward Grant
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Eleonora Horvath
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jenny K Hoang
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Susan J Mandel
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - William D Middleton
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Rose Ngu
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Lisa Ann Orloff
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jung Hee Shin
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Pierpaolo Trimboli
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jung Hyun Yoon
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Franklin N Tessler
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
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Mancini L, Khehra A, Nguyen T, Barootchi S, Tavelli L. Echo intensity and gray-level co-occurrence matrix analysis of soft tissue grafting biomaterials and dental implants: an in vitro ultrasonographic pilot study. Dentomaxillofac Radiol 2023; 52:20230033. [PMID: 37427600 PMCID: PMC10552129 DOI: 10.1259/dmfr.20230033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To characterize different allogeneic and xenogeneic soft tissue graft substitutes and to assess their echo intensity and grayscale texture-related outcomes by using high-frequency ultrasonography (HFUS). METHODS Ten samples from each of the following biomaterials were scanned using HFUS: bilayered collagen matrix (CM), cross-linked collagen matrix (CCM), multilayered cross-linked collagen matrix (MCCM), human-derived acellular dermal matrix (HADM), porcine-derived acellular dermal matrix (PADM), collagen tape dressing (C) and dental implants (IMPs). The obtained images were then imported in a commercially available software for grayscale analysis. First-order grayscale outcomes included mean echo intensity (EI), standard deviation, skewness, and kurtosis, while second-order grayscale outcomes comprised entropy, contrast, correlation, energy and homogeneity derive from the gray-level co-occurrence matrix analysis. Descriptive statistics were performed for visualization of results, and one-way analysis of variance with Bonferroni post-hoc tests were performed to relative assessments of the biomaterials. RESULTS The statistical analysis revealed a statistically significant difference among the groups for EI (p < .001), with the group C showing the lowest EI, and the IMP group presenting with the greatest EI values. All groups showed significantly higher EI when compared with C (p < .001). No significant differences were observed for energy, and correlation, while a statistically significant difference among the groups was found in terms of entropy (p < 0.01), contrast (p < .001) and homogeneity (p < .001). IMP exhibited the highest contrast, that was significantly higher than C, HADM, PADM, CCM and CM. CONCLUSIONS HFUS grayscale analysis can be applied to characterize the structure of different biomaterials and holds potential for translation to in-vivo assessment following soft tissue grafting-related procedures.
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Affiliation(s)
| | - Anahat Khehra
- Department of Oral Medicine, Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA, United States
| | - Tu Nguyen
- Department of Oral Medicine, Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA, United States
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Owens C, Fitzhugh A, Harrington K, Paleri V, Sharma B, Shur J, Ap Dafydd D. Incidentally detected 18 F-FDG PET-CT-avid thyroid nodules in patients with advanced malignancy: long-term oncological outcomes from a single-centre retrospective cohort. Nucl Med Commun 2023; 44:810-815. [PMID: 37272278 DOI: 10.1097/mnm.0000000000001720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES In this retrospective study, we assessed the clinical outcomes of patients with a primary malignancy who had incidentally detected thyroid avidity on their staging 18 F-fluorodeoxyglucose PET-computed tomography ( 18 F-FDG PET-CT) examinations. METHODS A focused retrospective search was made using a Radiology Information System to identify only patients with positive thyroid nodules on their 18 F-FDG PET-CT imaging between January 2012 and December 2017. Patient demographics, principal oncological diagnosis, and stage were recorded. The sonographic appearances of thyroid nodules, number of fine needle aspiration (FNA) attempts, final cytology, management plan, and clinical outcome were recorded. Follow-up records were available for between 2 and 7 years. RESULTS Following exclusions, 136 patients were found to have incidental thyroid avidity on their 18 F-FDG PET-CT. A total of 50 of these patients proceeded to thyroid ultrasound assessment. Of these, 37 patients underwent FNA (average 1.3 FNA attempts) with 17 having atypical cytology and 6 diagnosed with an incidental thyroid cancer either by FNA or thyroidectomy. Four patients who underwent surgery had benign pathology. All thyroid cancers identified were indolent papillary cancers without any impact on the treatment plan or survival. CONCLUSION The clinical outcomes of patients with an established primary malignancy are determined by their primary cancer and not by incidentally detected thyroid cancer. It may therefore be reasonable not to formally investigate a proportion of incidental 18 F-FDG PET-CT positive thyroid nodules where added benefit is unlikely. In such cases, a 'watch-and-wait' approach to the thyroid might be considered more appropriate.
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Affiliation(s)
- Cara Owens
- Royal Brompton Hospital
- Royal Marsden Hospital, London, UK
| | | | | | - Vinidh Paleri
- Institute of Cancer Research
- Royal Marsden Hospital, London, UK
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Li LQ, Hilmi O, England J, Tolley N. An update on the management of thyroid nodules: rationalising the guidelines. J Laryngol Otol 2023; 137:965-970. [PMID: 36318928 DOI: 10.1017/s002221512200233x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Guidance for the management of thyroid nodules has evolved over time, from initial evaluation based predominantly on clinical grounds to now including the established role of ultrasound and fine needle aspiration cytology in their assessment. There is, however, significant variation in the management of thyroid nodules depending on which national guidelines are followed. In addition, there are certain clinical situations such as pregnancy and paediatric thyroid nodules that have differing evaluation priorities. OBJECTIVES This review aimed to provide an overview of currently accepted practices for the initial investigation and subsequent management of patients with thyroid nodules for the non-specialist. The review also addresses areas of variance between the systems in common clinical use, as well as newer, evolving technologies, including molecular testing in the evaluation of malignancy in thyroid nodules.
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Affiliation(s)
- L Q Li
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - O Hilmi
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - J England
- Department of Otorhinolaryngology Head and Neck Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - N Tolley
- Department of Otorhinolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
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Cordes M, Götz TI, Coerper S, Kuwert T, Schmidkonz C. Ultrasound characteristics of follicular and parafollicular thyroid neoplasms: diagnostic performance of artificial neural network. Thyroid Res 2023; 16:25. [PMID: 37635221 PMCID: PMC10463771 DOI: 10.1186/s13044-023-00168-2] [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: 01/08/2023] [Accepted: 06/10/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Ultrasound is the first-line imaging modality for detection and classification of thyroid nodules. Certain features observable by ultrasound have recently been equated with potential malignancy. This retrospective cohort study was conducted to test the hypothesis that radiomics of the four categorical divisions (medullary [MTC], papillary [PTC], or follicular [FTC] carcinoma and follicular thyroid adenoma [FTA]) demonstrate distinctive sonographic characteristics. Using an artificial neural network model for proof of concept, these sonographic features served as input. METHODS A total of 148 patients were enrolled for study, all with confirmed thyroid pathology in one of the four named categories. Preoperative ultrasound profiles were obtained via standardized protocols. The neural network consisted of seven input neurons; three hidden layers with 50, 250, and 100 neurons, respectively; and one output layer. RESULTS Radiomics of contour, structure, and calcifications differed significantly according to nodule type (p = 0.025, p = 0.032, and p = 0.0002, respectively). Levels of accuracy shown by artificial neural network analysis in discriminating among categories ranged from 0.59 to 0.98 (95% confidence interval [CI]: 0.57-0.99), with positive and negative predictive ranges of 0.41-0.99 and 0.78-0.97, respectively. CONCLUSIONS Our data indicate that some MTCs, PTCs, FTCs, and FTAs have distinctive sonographic characteristics. However, a significant overlap of these characteristics may impede an explicit classification. Further prospective investigations involving larger patient and nodule numbers and multicenter access should be pursued to determine if neural networks of this sort are beneficial, helping to classify neoplasms of the thyroid gland.
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Affiliation(s)
- Michael Cordes
- Radiologisch-Nuklearmedizinisches Zentrum, Nürnberg, Germany.
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany.
| | - Theresa Ida Götz
- Department of Industrial Engineering and Health, Institute of Medical Engineering, Technical University Amberg-Weiden, Weiden, Germany
| | - Stephan Coerper
- Klinik für Allgemein und Viszeralchirurgie, Krankenhaus Martha-Maria, Nürnberg, Germany
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Industrial Engineering and Health, Institute of Medical Engineering, Technical University Amberg-Weiden, Weiden, Germany
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
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Grani G, Del Gatto V, Cantisani V, Mandel SJ, Durante C. A Reappraisal of Suspicious Sonographic Features of Thyroid Nodules: Shape Is Not an Independent Predictor of Malignancy. J Clin Endocrinol Metab 2023; 108:e816-e822. [PMID: 36810804 DOI: 10.1210/clinem/dgad092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT For the correct clinical application of the sonographic risk-stratification systems, the definition of independent risk features that are foundational to each system is crucial. OBJECTIVE The aim of this study was to identify the gray-scale sonographic features independently associated with malignancy, and to compare different definitions. METHODS This prospective, diagnostic accuracy study took place in a single thyroid nodule referral center. All patients consecutively referred to our center for fine-needle aspiration cytology of a thyroid nodule between November 1, 2015 and March 30, 2020, were enrolled before cytology. Each nodule was examined by 2 experienced clinicians to record the sonographic features on a rating form. Histologic (when available) or cytologic diagnosis was used as the reference standard. For each single sonographic feature and definition, the sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratios (DOR) were calculated. The significant predictors were then included in a multivariable regression model. RESULTS The final study cohort consisted of 903 nodules in 852 patients. A total of 76 nodules (8.4%) were malignant. Six features were independent predictors of malignancy: suspicious lymph node (DOR 16.23), extrathyroidal extension (DOR 6.60), irregular or infiltrative margins (DOR 7.13), marked hypoechogenicity (DOR 3.16), solid composition (DOR 3.61), and punctate hyperechoic foci (including microcalcifications and indeterminate foci; DOI 2.69). Taller-than-wide shape was not confirmed as an independent predictor. CONCLUSION We identified the key suspicious features of thyroid nodules and provided a simplified definition of some debated ones. Malignancy rate increases with number of features.
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Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| | - Vito Cantisani
- Department of Radiological, Anatomo-Pathological, and Oncological Sciences, "Sapienza" University of Rome, Rome 00161, Italy
| | - Susan J Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
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Keskin L, Karahan D, Yaprak B. Comparison of thyroid fine needle aspiration biopsy and ultrasonography results. Medicine (Baltimore) 2023; 102:e33822. [PMID: 37390290 PMCID: PMC10313267 DOI: 10.1097/md.0000000000033822] [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: 10/29/2022] [Accepted: 05/01/2023] [Indexed: 07/02/2023] Open
Abstract
Thyroid nodules are one of the most common health problems in the community. Although most of the nodules are benign, Fine needle aspiration biopsy (FNAB) is requested due to malignancy concerns. In this research, the aim was to make a comparison of the results of thyroid ultrasonography (USG) and FNAB for thyroid nodules. This study was conducted retrospectively on the data of 532 patients. Detail Edu ultrasonographic assessment was conducted before the FNAB procedure and FNAB was performed by an endocrinology specialist. FNAB results and Thyroid USG features were compared, and thyroid FNAB results were graded using the classification of World Health Organization Bethesda-2017. The average age of the individuals included in the research was 49.99 ± 13.65 (min = 18-max = 97). According to the 2017 Bethesda classification, 74.6% of FNAB results were benign, 16% follicular lesion of undated mined significance or A type of undated mined significance, 0.9% were malignant, and 1.1% were suspicious for malignancy. When USG findings were compared according to FNAB results, it was found that malignant lesions were significantly higher in single nodules (non- cystic and non- mixed lesions). Lesions with a single nodule on USG were found to be 3.6 times more likely to be malignant (OR 95% CI: 1.172-11.352). The gold standard method for the diagnosis the presence of thyroid nodules is thyroid fine needle aspiration biopsy with ultrasound guidance. Taking samples from the correct nodule and component increases its value. The presence of a single nodule from the thyroid USG features was found to be an important predictor of malignancy according to the biopsy results.
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Affiliation(s)
- Lezzan Keskin
- Turgut Ozal University, Malatya Training and Research Hospital, Internal Medicine Department, Malatya, Turkey
| | - Doğu Karahan
- Turgut Ozal University, Malatya Training and Research Hospital, Internal Medicine Department, Malatya, Turkey
| | - Bülent Yaprak
- Turgut Ozal University, Malatya Training and Research Hospital, Internal Medicine Department, Malatya, Turkey
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Okasha HH, Mansor M, Sheriba N, Abdelfattah Y, Abdelfatah D, Orabi HE, Elebrashy IN, Saif A, Meligi AAE, Elshazli M, Elhadidy KE, Abushady MM, Islam EE, Yosef TM, Salama ASED, Ouf TI, Said SM, Eid YM, Mohsen AA, Rizk MN, Yousief E, Elrawi H, Ahmed TM, Roshdy E, Sedrak HK, Din HGE, Aboulsoud S, El-Sawy SS, El-Feki MA, Alzamzamy A, Elenin SA, Tag-Adeen M, Abdelhameed H, Awad A. Value of TI-RADS and elastography strain ratio in predicting malignant thyroid nodules: experience from a single center in Egypt. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:45. [DOI: https:/doi.org/10.1186/s43162-023-00227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/04/2023] [Indexed: 11/04/2023] Open
Abstract
Abstract
Introduction
Thyroid nodules are highly prevalent in the general population; therefore, it is crucial to discriminate benign from malignant nodules. A practical thyroid imaging reporting and data system (TI-RADS) for thyroid nodules and ultrasound elastography are valuable tools not only for characterization of nodules but also for the selection of tumors for fine-needle aspiration cytology (FNAC).
Objective
This study aimed to evaluate the diagnostic accuracy of US evaluation in the prediction of malignant thyroid nodules and evaluate the role of the elastography score, strain ratio (SR), and the TI-RADS scoring system as non-invasive tools in differentiation between malignant and benign thyroid nodules.
Material and methods
A total of 1269 patients were evaluated between February 2017 and April 2020 by a single expert thyroid ultrasound operator. The final diagnosis was achieved from cytological and/or histological evaluation and follow-up for at least 1 year.
Results
There were 1088 females and 181 males with a mean age of 44 ± 10 SD. The final diagnosis was 1197 benign nodules and 72 malignant nodules. Most malignant nodules were scored elastography score 4 (83.3%) and TI-RADS category 5 (86.11%). We found that nodules with antero-posterior to transverse (A-P/T) diameter > 1, have 21 times more risk to be malignant than those with A-P/T diameter < 1, patients with solitary thyroid nodules have 4.5 times to develop malignancy compared to those with multinodular goiter (MNG), nodules with absent halo have 4 times more risk of malignancy. Furthermore, microcalcifications in thyroid nodules increase the risk of malignancy 9 times compared to those without calcifications. SR was found to be an excellent discriminator to differentiate between benign and malignant nodules with P < 0.001. Also, we found that for every unit increase in SR, the risk of malignancy increased by 20%. We reported that the accuracy of ultrasonography in the detection of malignant thyroid nodules had a sensitivity of 89%, specificity of 98%, 70% PPV, and 99.3% NPV, with an overall accuracy of 97.2%.
Conclusion
The application of ultrasonographic non-invasive criteria for thyroid nodules in clinical practice might significantly reduce the number of unnecessary FNAC. Elastography, SR, and TI-RADS classification could be good predictors for malignant thyroid nodules.
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Rho M, Chun SH, Lee E, Lee HS, Yoon JH, Park VY, Han K, Kwak JY. Diagnosis of thyroid micronodules on ultrasound using a deep convolutional neural network. Sci Rep 2023; 13:7231. [PMID: 37142760 PMCID: PMC10160046 DOI: 10.1038/s41598-023-34459-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/30/2023] [Indexed: 05/06/2023] Open
Abstract
To assess the performance of deep convolutional neural network (CNN) to discriminate malignant and benign thyroid nodules < 10 mm in size and compare the diagnostic performance of CNN with those of radiologists. Computer-aided diagnosis was implemented with CNN and trained using ultrasound (US) images of 13,560 nodules ≥ 10 mm in size. Between March 2016 and February 2018, US images of nodules < 10 mm were retrospectively collected at the same institution. All nodules were confirmed as malignant or benign from aspirate cytology or surgical histology. Diagnostic performances of CNN and radiologists were assessed and compared for area under curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Subgroup analyses were performed based on nodule size with a cut-off value of 5 mm. Categorization performances of CNN and radiologists were also compared. A total of 370 nodules from 362 consecutive patients were assessed. CNN showed higher negative predictive value (35.3% vs. 22.6%, P = 0.048) and AUC (0.66 vs. 0.57, P = 0.04) than radiologists. CNN also showed better categorization performance than radiologists. In the subgroup of nodules ≤ 5 mm, CNN showed higher AUC (0.63 vs. 0.51, P = 0.08) and specificity (68.2% vs. 9.1%, P < 0.001) than radiologists. Convolutional neural network trained with thyroid nodules ≥ 10 mm in size showed overall better diagnostic performance than radiologists in the diagnosis and categorization of thyroid nodules < 10 mm, especially in nodules ≤ 5 mm.
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Affiliation(s)
- Miribi Rho
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sei Hyun Chun
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eunjung Lee
- School of Mathematics and Computing, Yonsei University, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
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Li C, Xin X, Wang X, Wei X, Zhang S. The diagnostic value of a new ultrasonographic method for the measurement of a taller-than-wide shape of benign and malignant thyroid nodules. Endocrine 2023:10.1007/s12020-023-03358-y. [PMID: 37040007 DOI: 10.1007/s12020-023-03358-y] [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: 11/26/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the diagnostic value of a new ultrasonographic method in the measurement of thyroid nodules with a taller-than-wide (TTW) shape. METHODS A total of 982 thyroid nodules were analysed, 571 of which were malignant thyroid nodules and 411 of which were benign nodules. Nodules were divided into two groups by size: Group A (<1 cm, n = 627) and Group B (≥1 cm, n = 355). The angle between the maximum diameter of each nodule and the horizontal axis was measured by image analysis software. The best cut-off value for distinguishing between benign and malignant thyroid nodules and the diagnostic accuracy of the new ultrasonographic method in the measurement of TTW shapes were determined by receiver operating characteristic (ROC) curve analysis. RESULTS The cut-off value for distinguishing benign and malignant thyroid nodules was 44.5 degrees. The area under the ROC curve (AUC) was 0.849 (95% CI: 0.822~0.875), and the sensitivity and specificity of the diagnosis of malignant thyroid nodules were 86.9% and 84.4%, respectively. Regarding the angle between the maximum diameter and the transverse axis of the thyroid nodules, an angle greater than 45 degrees was a significant indicator of a diagnosis of malignant thyroid nodules. The AUC for distinguishing malignant from benign thyroid nodules with the new ultrasonographic method in the measurement of TTW shapes was higher than that with the first method (FM) in the whole group, Group A and Group B (respectively, 0.849 vs. 0.812, 0.853 vs. 0.808, 0.852 vs. 0.828). The diagnostic sensitivity of a TTW shape measured by the new ultrasonographic method for predicting thyroid malignancy was significantly higher than that measured by the FM in the whole group, Group A and Group B (respectively, 0.858 vs. 0.760, 0.764 vs. 0.669, 0.890 vs. 0.815). CONCLUSION A TTW shape measured by our new ultrasonographic method showed superior performance for predicting thyroid malignancy.
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Affiliation(s)
- Chunxiang Li
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaojie Xin
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaoqing Wang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China.
| | - Sheng Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China.
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Nabahati M, Moazezi Z. Performance of European Thyroid Imaging Reporting and Data System in Stratifying Malignancy Risk of Thyroid Nodules: A Prospective Study. J Med Ultrasound 2023; 31:127-132. [PMID: 37576418 PMCID: PMC10413406 DOI: 10.4103/jmu.jmu_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/07/2022] [Accepted: 05/24/2022] [Indexed: 08/15/2023] Open
Abstract
Background There is a limited number of studies reporting the performance of European Thyroid Imaging Reporting and Data System (EU-TIRADS) guideline in identifying thyroid nodule malignancy. We aimed to evaluate diagnostic accuracy of EU-TIRADS regardless of thyroid nodule size. Methods During August 2019-November 2021, subjects with thyroid nodules were prospectively included. Sonographic characteristics were recorded and scored as per EU-TIRADS guideline. Finally, fine-needle aspiration (FNA) was performed, and cytological findings were reported. Results Totally, 1266 thyroid nodules from 984 subjects were assessed, of which 295 nodules were smaller than 10 mm and 971 nodules were 10 mm or larger. Among nodules <10 mm, prevalence rates of malignancy for EU-TIRADS classes 2-5 were 0.0%, 3.7%, 20.6%, and 40.9%, respectively; these rates among nodules ≥10 mm were 2.3%, 4.0%, 19.3%, and 43.2%, respectively. The accuracy values of EU-TIRADS class 5 and EU-TIRADS class 4 or 5 in diagnosis of malignancy for nodules <10 mm were 86.4% and 79.7%, respectively; these rates for nodules ≥10 mm were 83.8% and 76.3%, respectively. Hypoechogenicity, microcalcification, ill-defined and irregular margins were predictors for malignancy regardless of thyroid nodule size. Conclusion EU-TIRADS could provide an acceptable malignancy risk stratification that is helpful for better distinguishing benignity from malignancy, as well as preventing unnecessary FNA biopsies, in thyroid nodules irrespective of their size.
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Affiliation(s)
- Mehrdad Nabahati
- Department of Radiology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Zoleika Moazezi
- Department of Endocrinology, Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
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R E, R S, Gopinathan A, R B. Triple Assessment in Diagnosis of Thyroid Nodules and Its Comparison With Histopathology. Cureus 2023; 15:e36021. [PMID: 37051009 PMCID: PMC10085519 DOI: 10.7759/cureus.36021] [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] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Thyroid nodules are more common than previously realised, and the rate of prevalence is hugely impacted by the method of detection and their easy access. No single test is sufficient to access the thyroid nodule at any given time. Hence this necessitates the need for clinicians to use an evidence-based protocol for their assessment and diagnosis. AIMS AND OBJECTIVE To determine the likelihood of malignancy in individuals who have thyroid nodules of any size, by a) performing a triple assessment, including a history and physical examination, an ultrasound of the neck and fine needle aspiration and cytology (FNAC) b) predicting the percentage of correlation between findings of malignancy on FNAC and final histopathological diagnosis c) identifying and validate individual risk factors in the clinical examination and ultrasound imaging that point towards a nodule being malignant Methods: Patients presenting with thyroid nodules in a clinically euthyroid state were studied over a time period of 18 months. Seventy-five patients were included in this study. Patients having external cytology and ultrasonography reports were reassessed if they consented to the study. If the pathologists thought the smears were sufficient, slide reviews were accepted. A senior consultant conducted the clinical evaluation. Prior to doing the FNACs, the designated radiologist performed the majority of the ultrasonograms. If the physicians believed it was necessary, ultrasound-guided FNACs were performed. According to Bethesda criteria, the cytology was reported. The outcome of the histopathological analysis was used as the gold standard for diagnosis in this investigation. RESULT Out of 75 patients included in the study, the older age group (50-70) patients had mostly malignant lesions (92%). In the younger age group (20-39), about 77% had benign lesions. Benign lesions were more common in females than males according to the histopathology study. Seventy-three percent of fixed swellings turned out to be malignant. About 86% of patients who had extrathyroidal extension ended up being found to have malignant lesions but even 41% of patients who didn't have any extrathyroidal extension also turned out to be having malignant lesions. However, the presence of pressure symptoms didn't necessarily translate to being an indicator of malignancy. Ninety-seven percent of patients who had punctate microcalcifications turned out to have malignant lesions. Hypoechogenicity on imaging also is an important marker of malignancy, with about 87% of patients who had hypoechogenicity having malignant lesions proven on histopathology. All the patients who had solid lesions on imaging were proven to have malignant lesions. About 77% of patients who had cystic features ended up having benign lesions. Hence, it is a very significant marker. Intranodular vascularity, taller than wider lesions and positive lymph nodes on imaging were proven to have malignant lesions. FNAC is an important diagnostic tool. It is made out that the reporting of FNAC more or less matched the histopathological diagnosis in almost all categories. CONCLUSION There are definite correlations in the role of triple assessment as a standard protocol in the diagnosis of thyroid nodules and guiding its management.
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Affiliation(s)
- Elakkiya R
- General Surgery, SRM Medical College Hospital and Research Centre, Chennai, IND
| | - Sivamarieswaran R
- General Surgery, SRM Medical College Hospital and Research Centre, Chennai, IND
| | - Athira Gopinathan
- General Surgery, SRM Medical College Hospital and Research Centre, Chennai, IND
| | - Balamurugan R
- General Surgery, SRM Medical College Hospital and Research Centre, Chennai, IND
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Boers T, Braak SJ, Rikken NET, Versluis M, Manohar S. Ultrasound imaging in thyroid nodule diagnosis, therapy, and follow-up: Current status and future trends. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023. [PMID: 36655705 DOI: 10.1002/jcu.23430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Ultrasound, the primary imaging modality in thyroid nodule management, suffers from drawbacks including: high inter- and intra-observer variability, limited field-of-view and limited functional imaging. Developments in ultrasound technologies are taking place to overcome these limitations, including three-dimensional-Doppler, -elastography, -nodule characteristics-extraction, and novel machine-learning algorithms. For thyroid ablative treatments and biopsies, perioperative use of three-dimensional ultrasound opens a new field of research. This review provides an overview of the current and future applications of ultrasound, and discusses the potential of new developments and trends that may improve the diagnosis, therapy, and follow-up of thyroid nodules.
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Affiliation(s)
- Tim Boers
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Sicco J Braak
- Department of Radiology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Nicole E T Rikken
- Department of Endocrinology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Michel Versluis
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Srirang Manohar
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
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Zhang Y, Mao J, Zhao X, Liu H, Cheng Y. Analysis of the risk factors of negative emotions in patients undergoing microwave ablation of thyroid nodules during the perioperative period and its impact on prognosis: a prospective cohort study. Gland Surg 2023; 12:81-92. [PMID: 36761476 PMCID: PMC9906096 DOI: 10.21037/gs-22-696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
Background Thyroid nodule (TN) is one or more abnormal lump structures in the thyroid gland parenchyma caused by genetic, environmental, and other factors. It is the most common thyroid disease in clinics. Microwave ablation (MWA) can significantly reduce the nodule volume and effectively reduce the symptoms caused by nodules. However, the patient's negative emotions during the perioperative period may affect the postoperative recovery. This study explored the risk factors of negative emotions in patients during the perioperative period and its impact on patient prognosis. This data provides a basis for clinical psychological interventions before MWA, so as to improve the quality of life of patients with TN. Methods A total of 238 patients who were hospitalized for TNs in The First Affiliated Hospital of Soochow University from January 2017 to January 2022, and who received MWA therapy were enrolled in this study. The patients were evaluated with a general situation questionnaire, a Self-rating Anxiety Scale (SAS), and a Self-rating Depression Scale (SDS). The TN volume was followed up to evaluate the prognosis of patients. Binary logistic regression was used to analyze the risk factors of perioperative negative emotions and the impact of negative emotions on the prognosis. Results The results of binary logistic regression analysis showed that education, income, hypertension, hyperglycemia, and solid nodule volume were independent influencing factors of anxiety (P<0.05). Age, income, hypertension, hyperglycemia, and solid nodule volume were independent influencing factors of depression (P<0.05). The prognosis of patients with no negative emotions at the first, third, and sixth months after surgery was significantly better than that of patients with negative emotions (P<0.05). Conclusions Negative emotions have a significant impact on the prognosis of TNs. According to individual differences, targeted nursing intervention should be supplemented to stabilize a patient's emotions, improve compliance, and enhance quality of life.
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Affiliation(s)
- Ying Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Juming Mao
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiangqin Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Liu
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Rezkallah EMN, Hanna RS, Elsaify WM. Risk of malignancy in Thy3 thyroid nodules. Endocr Regul 2023; 58:19-25. [PMID: 38345495 DOI: 10.2478/enr-2024-0003] [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] [Indexed: 02/15/2024] Open
Abstract
Objective. Thyroid cancer is the most common endocrine malignancy in humans. Ultrasound guided fine needle aspiration cytology (FNAC) is now considered the best diagnostic tool for the evaluation of any thyroid nodule. Thyroid cytology is graded from Thy1 to Thy5 with Thy3 being the most challenging in diagnosis. Our aim was to identify the risk of malignancy in Thy3 cytology in our centre. This risk should be explained to the patient before taking any decision. Methods. One hundred and one patients were included in our study. All patients had Thy3 cytology on preoperative ultrasound scan guided FNAC. All patients had diagnostic hemithyroidectomy. The results from the histology were compared with the cytology findings and the rates of malignancy were identified. Results. Of the 101 patients, 17 were males and 84 females. Average age for diagnosis was 52.4±15 years of age. Patients were classified into three groups; patient who had completely benign histology (n=70), patients who had incidental finding of micro-carcinoma after diagnostic hemithyroidectomy (n=10), and patients who had thyroid macro-carcinomas (n=21). Total rate of malignancy was 30.7% when combining both the malignant and the incidental groups and 20.8% when excluding the incidental group. Conclusion. Our rates of malignancy in Thy3 cytology are similar to the literature. These rates should be explained clearly to the patient during the preoperative counselling. Future advances in biomarkers technology may help to improve the preoperative diagnostic accuracy and reduce the rate of unnecessary thyroid surgery.
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Affiliation(s)
| | - Ragai Sobhi Hanna
- General Surgery Department, Assiut University Hospitals, Assiut, Egypt
| | - Wael Magdy Elsaify
- General Surgery Department, James Cook University Hospital, Middlesbrough, Egypt
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Zhou P, Chen F, Zhou P, Xu L, Wang L, Wang Z, Yu Y, Liu X, Wang B, Yan W, Zhou H, Tao Y, Liu W. The use of modified TI-RADS using contrast-enhanced ultrasound features for classification purposes in the differential diagnosis of benign and malignant thyroid nodules: A prospective and multi-center study. Front Endocrinol (Lausanne) 2023; 14:1080908. [PMID: 36817602 PMCID: PMC9929352 DOI: 10.3389/fendo.2023.1080908] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To evaluate the diagnostic efficacy of a modified thyroid imaging reporting and data system (TI-RADS) in combination with contrast-enhanced ultrasound (CEUS) for differentiating between benign and malignant thyroid nodules and to assess inter-observer concordance between different observers. METHODS This study included 3353 patients who underwent thyroid ultrasound (US) and CEUS in ten multi-centers between September 2018 and March 2020. Based on a modified TI-RADS classification using the CEUS enhancement pattern of thyroid lesions, ten radiologists analyzed all US and CEUS examinations independently and assigned a TI-RADS category to each thyroid nodule. Pathology was the reference standard for determining the diagnostic performance (accuracy (ACC), sensitivity (SEN), specificity (SPN), positive predictive value (PPV), and negative predictive value (NPV)) of the modified TI-RADS for predicting malignant thyroid nodules. The risk of malignancy was stratified for each TI-RADS category-based on the total number of benign and malignant lesions in that category. ROC curve was used to determine the cut-off value and the area under the curve (AUC). Cohen's Kappa statistic was applied to assess the inter-observer agreement of each sonological feature and TI-RADS category for thyroid nodules. RESULTS The calculated malignancy risk in the modified TI-RADS categories 5, 4b, 4a, 3 and 2 nodules was 95.4%, 86.0%, 12.0%, 4.1% and 0%, respectively. The malignancy risk for the five categories was in agreement with the suggested malignancy risk. The ROC curve showed that the AUC under the ROC curve was 0.936, and the cutoff value of the modified TI-RADS classification was >TI-RADS 4a, whose SEN, ACC, PPV, NPV and SPN were 93.6%, 91.9%, 90.4%, 93.7% and 88.5% respectively. The Kappa value for taller than wide, microcalcification, marked hypoechoic, solid composition, irregular margins and enhancement pattern of CEUS was 0.94, 0.93, 0.75, 0.89, 0.86 and 0.81, respectively. There was also good agreement between the observers with regards to the modified TI-RADS classification, the Kappa value was 0.80. CONCLUSIONS The actual risk of malignancy according to the modified TI-RADS concurred with the suggested risk of malignancy. Inter-observer agreement for the modified TI-RADS category was good, thus suggesting that this classification was very suitable for clinical application.
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Affiliation(s)
- Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Chen
- Department of Ultrasound, Yiyang Central Hospital of Hunan University of Chinese Medicine, Yiyang, Hunan, China
| | - Peng Zhou
- Department of Ultrasound, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Lifeng Xu
- Department of Ultrasound, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Lei Wang
- Department of Ultrasound, Huang Shi Central Hospital, Huang Shi, Hubei, China
| | - Zhiyuan Wang
- Department of Ultrasound, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Yi Yu
- Department of Ultrasound, The People’s Hospital of Liuyang, Changsha, Hunan, China
| | - Xueling Liu
- Department of Ultrasound, The First Affiliated of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Bin Wang
- Department of Ultrasound, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Wei Yan
- Department of Ultrasound, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Heng Zhou
- Department of Ultrasound, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Yichao Tao
- Department of Ultrasound, Xiaogan Central Hospital, Xiaogan, Hubei, China
| | - Wengang Liu
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Wengang Liu,
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Lopes SC, Shah B, Eloy C. Thyroid cytology: The reality before and after the introduction of ultrasound classification systems for thyroid nodules. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:39-47. [PMID: 36764746 DOI: 10.1016/j.endien.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/30/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Several ultrasound-based systems for classification of thyroid nodules are available. They allow for a better triage of the nodules that require cytological assessment, and lead to standardized recommendations. Our aim was to compare patients and nodules referred to fine-needle aspiration (FNA) before and after the introduction of these systems. METHODS A retrospective study comparing two cohorts of patients referred for FNA was performed (386 patients and 463 nodules in 2015; 220 patients and 263 nodules in 2021). RESULTS The sex distribution (89.1% vs 85.9% females, p=0.243), number of nodules referred to FNA per patient (median of 1), and the distribution of the Bethesda categories (p=0.082) was similar in both years. In 2021, patients were older (53.4±14.5 years vs 57.8±13.2 years, p<0.001) and nodules over one centimetre were larger (median 17.0mm vs 19.0mm, p=0.002), especially the ones categorized as Bethesda III (median size 11mm vs 23mm, p=0.043). In 2021, at least 23.1% of the nodules referred to FNA did not have any criteria, and 38.8% of the nodules were not categorized by any system. CONCLUSION This analysis draws attention to the importance of systematically applying ultrasound-based classification systems. It seems that, by not being focused mainly on size thresholds, they allow for longer surveillance periods, without aggravating the cytology results when FNA becomes indicated. Nevertheless, greater efforts are needed to ensure more standardized reports, and to increase adherence to the resulting recommendations to reduce clinical uncertainty, unnecessary FNA, and overtreatment.
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Affiliation(s)
| | - Bijal Shah
- Histopathology Department, St. James's Hospital, Dublin, Ireland
| | - Catarina Eloy
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal; Pathology Department of Medical Faculty, University of Porto, Porto, Portugal
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Nabahati M, Moazezi Z. Malignancy risk stratification of thyroid nodules smaller than 10 mm with ACR-TIRADS, K-TIRADS, and ATA-2015 guidelines: a prospective study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00802-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Small thyroid nodules (≤ 10 mm) are common findings in thyroid ultrasonography. The first purpose of this study was to compare the performance of three guidelines in the diagnosis of malignancy for small thyroid nodules. The second aim was to find the ultrasonographic characteristics potentially associated with the risk of malignancy. This prospective cross-sectional study was performed on the patients with a diagnosis of small thyroid nodules (≤ 10 mm), who were rereferred to the radiologists for sonography and FNA. Sonographic features were recorded and scored according to the American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS), American Thyroid Association (ATA-2015), and Korean-TIRADS (K-TIRADS). Finally, FNA was conducted and cytological findings were reported.
Results
In total, 287 thyroid nodules from 256 subjects (64 men and 192 women) were finally included in the study. The accuracy of ACR-TIRADS categories TR5 and TR4/5 was 88.9% and 72.1%, respectively. This rate for ATA-2015 classes high suspicion and intermediate suspicion/high suspicion was 88.9% and 82.6%, respectively. For K-TIRADS classes 5 and 4/5, the diagnostic accuracy was 89.6% and 82.9%, respectively. Significant direct associations were found between malignancy and punctate echogenic foci (odds ratio [OR] = 6.46), hypoechogenicity (OR = 6.39), ill-defined margin (OR = 4.38), and irregular margin (OR = 7.33).
Conclusion
The differences in the strength of the three guidelines in the prediction of the malignancy should be considered by clinicians and radiologists in the management of thyroid nodules smaller than 10 mm.
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