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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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Trimboli P, Bojunga J, Deandrea M, Frasca F, Imperiale A, Leoncini A, Paone G, Pitoia F, Rotondi M, Sadeghi R, Scappaticcio L, Treglia G, Piccardo A. Reappraising the role of thyroid scintigraphy in the era of TIRADS: A clinically-oriented viewpoint. Endocrine 2024; 85:1035-1040. [PMID: 38625504 PMCID: PMC11316686 DOI: 10.1007/s12020-024-03825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
Thyroid nodules (TNs) are a common entity, with the majority being benign. Therefore, employing an accurate rule-out strategy in clinical practice is essential. In the thyroid field, the current era is significantly marked by the worldwide diffusion of ultrasound (US)-based malignancy risk stratification systems of TN, usually reported as Thyroid Imaging Reporting And Data System (TIRADS). With the advent of US (and later TIRADS), the role of thyroid scintigraphy (TS) in clinical practice has gradually diminished. The authors of the present paper believe that the role of TS should be reappraised, also considering its essential role in detecting autonomously functioning thyroid nodules and its limited contribution to detecting thyroid cancers. Thus, this document aims to furnish endocrinologists, radiologists, surgeons, and nuclear medicine physicians with practical information to appropriately use TS.
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Affiliation(s)
- Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland.
| | - Joerg Bojunga
- Department of Medicine I, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Maurilio Deandrea
- Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, Italy
| | - Francesco Frasca
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University Hospitals, Strasbourg, France
- Molecular Imaging, DRHIM, Institut Pluridisciplinaire Hubert Curien (IPHC), UMR7178, CNRS, University of Strasbourg, Strasbourg, France
| | - Andrea Leoncini
- Servizio di Radiologia e Radiologia Interventistica, Istituto di Imaging Della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Gaetano Paone
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Fabian Pitoia
- Head Thyroid Section, Division of Endocrinology, Hospital de Clinicas, University of Buenos Aires, Viamonte, Argentina
| | - Mario Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgio Treglia
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
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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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Sievert M, Koch M, Iro H, Thimsen V. [Sonography of the neck-aspects of differential diagnosis]. HNO 2023; 71:750-762. [PMID: 37801101 DOI: 10.1007/s00106-023-01375-x] [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] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
Sonography is the preferred method for primary diagnosis and acute treatment of pathologies involving the neck's soft tissues. Technological advances, particularly high image resolution and multiparametric ultrasound, have improved diagnostic performance. Clinical interest focuses on examining the cervical lymph nodes, salivary glands, and the thyroid gland, as well as space-occupying and inflammatory processes of the neck. In addition, sonography enables targeted minimally invasive histology acquisition using ultrasound-guided biopsies. In this context, the examiner's comprehensive anatomical knowledge and clinical experience are of utmost importance for the quality of findings. This article provides an overview of the most important findings related to sonography of the neck and highlights the relevance of this imaging modality in the hands of the otorhinolaryngologist.
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Affiliation(s)
- Matti Sievert
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland.
| | - Michael Koch
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Heinrich Iro
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
| | - Vivian Thimsen
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen, Waldstraße 1, 91054, Erlangen, Deutschland
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The FDG Pattern of Autonomously Functioning Thyroid Nodules Correlates With Thyroid-Stimulating Hormone and Histopathology. Clin Nucl Med 2023; 48:119-125. [PMID: 36260757 DOI: 10.1097/rlu.0000000000004396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF THE REPORT Whereas the 18 F-FDG PET/CT pattern of malignant thyroid neoplasia is known, the glucose uptake of autonomously functioning thyroid nodules (AFTNs) has not been fully investigated. We aimed to analyze the FDG uptake of AFTNs and its correlation with clinical, laboratory, ultrasonography, and histological features. METHODS We retrospectively analyzed the records of all AFTN patients from 2 centers, in which an 18 F-FDG PET/CT, thyroid function tests, and neck ultrasound were available within a 3-month window from the thyroid scintigraphy. Forty-five patients (35 female patients; median age, 65 years) were retrospectively included. The presence of FDG uptake was compared with the laboratory data and, whenever available, the histology. RESULTS Over a 36-month follow-up, 20 patients underwent surgery; 4 cancers, 10 follicular adenomas, and 6 follicular hyperplasias were found. Twenty-two AFTNs (48.9%) were FDG-positive, whereas the remaining 23 (51.1%) were not. Thyroid-stimulating hormone (TSH) was significantly lower in FDG-positive AFTNs than in negative ones (0.055 [0.02-0.42] vs 0.65 [0.2-0.96] mIU/L, P = 0.0018). On multivariate analysis, only TSH was independently associated with FDG uptake ( P = 0.008). On receiver operating characteristic curve analysis, TSH <0.08 mIU/L indicated FDG-positive AFTNs, with 64% sensitivity, 87% specificity, 4.88 positive likelihood ratio, and 0.42 negative likelihood ratio. In histologically proven benign lesions, TSH was significantly lower in follicular adenomas than in follicular hyperplasias ( P < 0.001). Patients with cancer had TSH in the low-normal range. CONCLUSIONS Autonomously functioning thyroid nodules show heterogeneous uptake FDG pattern, which depends on histopathology and thyroid function. Particularly, follicular adenomas tend to display increased glucose uptake and suppressed TSH.
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Schenke SA, Kreissl MC, Grunert M, Hach A, Haghghi S, Kandror T, Peppert E, Rosenbaum-Krumme S, Ruhlmann V, Stahl A, Wanjura D, Zaplatnikov K, Zimny M, Gilman E, Herrmann K, Görges R. Distribution of Functional Status of Thyroid Nodules and Malignancy Rates of Hyperfunctioning and Hypofunctioning Thyroid Nodules in Germany. Nuklearmedizin 2022; 61:376-384. [PMID: 35917825 DOI: 10.1055/a-1856-4052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM Thyroid scintigraphy enables the depiction of the functional status of thyroid nodules (TNs) with both, 99mTc-pertechnetate and 123Iodine. The functional status is relevant for diagnostic procedures for the differentiation of benign and malignant TNs. The aim of this study was to examine the current frequencies of hyper-, hypo- and isofunctioning TNs in Germany and to estimate the risk of malignancy with regard to functional status. METHODS In 11 study centers, a minimum of 100 nodules per center were consecutively enrolled between July 2019 and April 2020. Inclusion criteria were: newly diagnosed nodule, nodule' size of 10 mm or more, thyroid scintigraphy. Exclusion criteria were: completely cystic TNs, patients with prior radioiodine therapy or thyroid surgery. The risk of malignancy was estimated for hyper- and hypofunctioning TNs. RESULTS Overall, 849 patients (72 % women) with 1262 TNs were included. Patients' age ranged from 18 to 90 years. Most TNs were hypofunctioning (n=535, 42%) followed by isofunctioning TNs (n=488, 39%) and hyperfunctioning TNs (n=239, 19%). When only TNs with a maximum size of 2 cm or more were considered the rate of hyperfunctioning and hypofunctioning TNs increased (to 27% and 49%) while isofunctioning TNs decreased. Only one of all hyperfunctioning TNs was malignant. In hypofunctioning nodules, the malignancy rate was estimated at 10%. CONCLUSION In Germany, the proportion of hyperfunctioning TNs is approximately 20% and increases in larger TNs to up to 27%. Due to the low risk of malignancy in hyperfunctioning TNs, no further procedures to rule out malignancy are necessary. The risk of malignancy of hypofunctioning TNs is significantly higher. Thus, a thyroid scintigraphy is a useful diagnostic tool in Germany.
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Affiliation(s)
- Simone Agnes Schenke
- Klinik und Institut für Nuklearmedizin, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | | | - Michael Grunert
- Klinik für Nuklearmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Anja Hach
- Institut für Radiologie und Nuklearmedizin Bremerhaven, Bremerhaven, Germany
| | - Sarvar Haghghi
- Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | | | - Eckhard Peppert
- ANZW, Ambulant-Nuklearmedizinsches Zentrum Würzburg, Würzburg, Germany
| | | | - Verena Ruhlmann
- Gemeinschaftspraxis Nuklearmedizin Duisburg, Duisburg, Standort Moers, Germany
| | | | | | | | - Michael Zimny
- Standort Hanau, Überörtliche Berufsausübungsgemeinschaft für Nuklearmedizin Hanau, Hanau, Germany
| | | | - Ken Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany
| | - Rainer Görges
- Gemeinschaftspraxis Nuklearmedizin Duisburg, Duisburg, Germany.,Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany
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Giovanella L, Petranović Ovčariček P. Functional and molecular thyroid imaging. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:86-92. [PMID: 35166094 DOI: 10.23736/s1824-4785.22.03428-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nuclear medicine methods were introduced in the 1940s for thyroid disease diagnosis and therapy. They is still a crucial part of thyroid nodules work-up. Thyroid imaging with iodine or iodine-analog isotopes is widely employed in patients with thyrotoxicosis and remains the only examination able to prove the presence of autonomously functioning thyroid tissue, which excludes malignancy with a high probability. In addition, technetium-99m-methoxyisobutylisonitrile ([99mTc]Tc-MIBI) scintigraphy and positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-2-deoxy-d-glucose ([18F]FDG) are able to avoid unnecessary surgical procedures for cytologically inconclusive thyroid nodules, as confirmed by meta-analysis and cost-effectiveness studies. All considered thyroid molecular imaging allows functional characterization of different thyroid diseases, even before clinical symptoms become manifest, and remains integral to the management of such conditions. This paper summarizes main concepts of thyroid scintigraphy and its clinical use. In addition, it elaborates development of thyroid scintigraphy, as well as thyroid molecular imaging in patients with thyroid nodules and thyrotoxicosis.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale - EOC, Bellinzona, Switzerland -
- Clinic for Nuclear Medicine and Interdisciplinary Thyroid Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland -
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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Giovanella L, Avram AM, Ovčariček PP, Clerc J. Thyroid functional and molecular imaging. Presse Med 2022; 51:104116. [PMID: 35124101 DOI: 10.1016/j.lpm.2022.104116] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/02/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Radioiodine uptake (RAIU) test with iodine-123 (Na[123I]I) or iodine-131 (Na[131I]I) enables accurate evaluation and quantification of iodine uptake and kinetics within thyroid cells. Thyroid Scintigraphy (TS) employing Na[123I]I or 99mTc-pertechnetate (Na[99mTc]TcO4) provides information regarding the function and topographical distribution of thyroid cells activity, including detection and localization of ectopic thyroid tissue. Destructive thyrotoxicosis is characterized by low RAIU with scintigraphically reduced radiotracer activity in the thyroid tissue, while productive thyrotoxicosis (i.e. hyperthyroidism "stricto sensu") is characterized by high RAIU with scintigraphically diffuse (i.e. Graves' Disease, GD and diffuse thyroid autonomy) or focal (i.e. autonomously functioning thyroid nodules, AFTN) overactivity. Accordingly, RAIU and/or TS are widely used to differentiate different causes of thyrotoxicosis. In addition, several radiopharmaceuticals are also available to help differentiate benign from malignant thyroid nodules and inform clinical decision-making: scintigraphic identification of AFTNs obviate fine-needle aspiration (FNA) biopsy, and [99mTc]Tc-hexakis-(2‑methoxy-2-isobutyl isonitrile ([99mTc]Tc-MIBI) and/or 18F-fluoro-d-glucose ([18F]FDG) may complement the work-up of cytologically indeterminate "cold" nodules for reducing the need for diagnostic lobectomies/thyroidectomies. Finally, RAIU studies are also useful for calculating the administered therapeutic activity of Na[131I]I to treat hyperthyroidism and euthyroid multinodular goiter. All considered, thyroid molecular imaging allows functional characterization of different thyroid diseases, even before clinical symptoms become manifest, and remains integral to the management of such conditions. Our present paper summarizes basic concepts, clinical applications, and potential developments of thyroid molecular imaging in patients affected by thyrotoxicosis and thyroid nodules.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Division of Endocrinology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Jerome Clerc
- Department of Nuclear Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, DMU Imagina, University of Paris France
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Li Z, Zhang H, Chen W, Li H. Contrast-Enhanced CT-Based Radiomics for the Differentiation of Nodular Goiter from Papillary Thyroid Carcinoma in Thyroid Nodules. Cancer Manag Res 2022; 14:1131-1140. [PMID: 35342307 PMCID: PMC8943619 DOI: 10.2147/cmar.s353877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/01/2022] [Indexed: 01/08/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) and nodular goiter (NG) represent the most commonly malignant and benign diseases of thyroid nodules and are often confused in diagnosis. CT examination has a certain diagnostic value for the diagnosis of suspected malignant thyroid nodules. The application of machine learning to radiomics features provides a new diagnostic approach, which has been widely used in ultrasound examination of the thyroid, but there are few literatures on CT examination. Purpose To explore the efficacy of a diagnostic model aided by machine learning for preoperative differentiation of nodular goiter and papillary thyroid carcinoma thyroid nodules on the basis of 3D arterial-phase contrast-enhanced computed tomography (CECT) features. Materials and Methods We collected the data of 193 NG and 214 PTC thyroid nodules from 407 patients in CT examinations. Together with the pathologist findings and radiology diagnosis, we built a radiomics model using the 1218 features extracted from the arterial phase of CECT images. By comparing the diagnostic performance of the radiomics model with that of the clinical diagnosis, we assessed the performance of the radiomics model. Results The radiomics model was developed based on multivariable logistic regression with the optimal 12 radiomics features after feature dimension reduction. The radiomics model performed well on the classification accuracy of the PTC and NG thyroid nodules in the training group and validation group. Conclusion The radiomics model based on the 3D arterial phase of CECT features performed better than the group of experienced radiologists in differentiating NG and PTC thyroid nodules.
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Affiliation(s)
- Zhenyu Li
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Haiming Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Wenying Chen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
| | - Hengguo Li
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, People’s Republic of China
- Correspondence: Hengguo Li, Email
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Vu DL, Pham MT, Nguyen VB, Le TM. Efficacy and Safety of Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules: A Long-Term Prospective Study. Ther Clin Risk Manag 2022; 18:11-19. [PMID: 35023921 PMCID: PMC8747785 DOI: 10.2147/tcrm.s344464] [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: 10/14/2021] [Accepted: 12/11/2021] [Indexed: 12/05/2022] Open
Abstract
Objective This study aims to evaluate the efficacy and safety of RFA in the AFTN treatment after 2 years of follow-up and to find the factors related to treatment responses through TSH level and VRR. Materials and Methods This long-term prospective study was conducted from September 2017 to April 2021 on 17 AFTNs treated with RFA. Clinical evaluations, thyroid function tests, thyroid scintigraphy, and ultrasonography examinations were performed at 1 month, 3 months, 6 months, and 24 months after ablation. The primary endpoint was the success rate of RFA in restoring the euthyroidism stage after 24 months of follow-ups; secondary outcomes were VRR and improvements of US parameters, clinical examinations, and complications. The Spearman rank correlation test was used to determine related factors with treatment response variables. Results At the 24 months after the procedure, symptom score, cosmetic score, vascularity grade, and nodule volume significantly decreased. The VRR reduced approximately 42.77%, 63.13%, 78.3%, and 95.65% after 1 month, 3 months, 6 months, and 24 months follow-up. All 17 patients were restored euthyroid state without taking ATDs. No major complications were collected. The last TSH level was significantly correlated with the age of patients (Spearman rho = −0.637, p = 0.008). The VRR was significantly correlated with age of patients (Spearman rho = 0.566, p = 0.018) and initial TSH (Spearman rho = 0.485, p = 0.048). Conclusion RFA was demonstrated as a safe and effective option for AFTN treatment in long-term follow-up. It can be used as an alternative treatment with encouraging results.
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Affiliation(s)
- Dang Luu Vu
- Bach Mai Radiology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Minh Thong Pham
- Bach Mai Radiology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Van Bang Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Thi My Le
- Radiology Department, Vinmec Times City International Hospital, Hanoi, Vietnam
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Liang X, Huang Y, Cai Y, Liao J, Chen Z. A Computer-Aided Diagnosis System and Thyroid Imaging Reporting and Data System for Dual Validation of Ultrasound-Guided Fine-Needle Aspiration of Indeterminate Thyroid Nodules. Front Oncol 2021; 11:611436. [PMID: 34692466 PMCID: PMC8529148 DOI: 10.3389/fonc.2021.611436] [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: 09/29/2020] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The fully automatic AI-Sonic computer-aided design (CAD) system was employed for the detection and diagnosis of benign and malignant thyroid nodules. The aim of this study was to investigate the efficiency of the AI-Sonic CAD system with the use of a deep learning algorithm to improve the diagnostic accuracy of ultrasound-guided fine-needle aspiration (FNA). Methods A total of 138 thyroid nodules were collected from 124 patients and diagnosed by an expert, a novice, and the Thyroid Imaging Reporting and Data System (TI-RADS). Diagnostic efficiency and feasibility were compared among the expert, novice, and CAD system. The application of the CAD system to enhance the diagnostic efficiency of novices was assessed. Moreover, with the experience of the expert as the gold standard, the values of features detected by the CAD system were also analyzed. The efficiency of FNA was compared among the expert, novice, and CAD system to determine whether the CAD system is helpful for the management of FNA. Result In total, 56 malignant and 82 benign thyroid nodules were collected from the 124 patients (mean age, 46.4 ± 12.1 years; range, 12–70 years). The diagnostic area under the curve of the CAD system, expert, and novice were 0.919, 0.891, and 0.877, respectively (p < 0.05). In regard to feature detection, there was no significant differences in the margin and composition between the benign and malignant nodules (p > 0.05), while echogenicity and the existence of echogenic foci were of great significance (p < 0.05). For the recommendation of FNA, the results showed that the CAD system had better performance than the expert and novice (p < 0.05). Conclusions Precise diagnosis and recommendation of FNA are continuing hot topics for thyroid nodules. The CAD system based on deep learning had better accuracy and feasibility for the diagnosis of thyroid nodules, and was useful to avoid unnecessary FNA. The CAD system is potentially an effective auxiliary approach for diagnosis and asymptomatic screening, especially in developing areas.
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Affiliation(s)
- Xiaowen Liang
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingmin Huang
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongyi Cai
- Department of Ultrasound, Liwan Center Hospital of Guangzhou, Guangzhou, China
| | - Jianyi Liao
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, China
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12
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Scappaticcio L, Maiorino MI, Iorio S, Docimo G, Longo M, Grandone A, Luongo C, Cozzolino I, Piccardo A, Trimboli P, Miraglia Del Giudice E, Esposito K, Bellastella G. Exploring the Performance of Ultrasound Risk Stratification Systems in Thyroid Nodules of Pediatric Patients. Cancers (Basel) 2021; 13:cancers13215304. [PMID: 34771467 PMCID: PMC8582568 DOI: 10.3390/cancers13215304] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Neck ultrasound (nUS) is the cornerstone of clinical management of thyroid nodules in pediatric patients, as well as adults. The current study was carried out to explore and compare the diagnostic performance of the main US-based risk stratification systems (RSSs) (i.e., the American College of Radiology (ACR), European (EU), Korean (K) TI-RADSs and ATA US RSS criteria) for detecting malignant thyroid lesions in pediatric patients. We conducted a retrospective analysis of consecutive children and adolescents who received a diagnosis of thyroid nodule. We included subjects with age <19 years having thyroid nodules with benign cytology/histology or final histological diagnosis. We excluded subjects with (a) a previous malignancy, (b) a history of radiation exposure, (c) cancer genetic susceptibility syndromes, (d) lymph nodes suspicious for metastases of thyroid cancer at nUS, (e) a family history of thyroid cancer, or (f) cytologically indeterminate nodules without histology and nodules with inadequate cytology. We included 41 nodules in 36 patients with median age 15 years (11-17 years). Of the 41 thyroid nodules, 29 (70.7%) were benign and 12 (29.3%) were malignant. For both ACR TI-RADS and EU-TIRADS, we found a sensitivity of 41.7%. Instead, for both K-TIRADS and ATA US RSS, we found a sensitivity of 50%. The missed malignancy rate for ACR-TIRADS and EU-TIRADS was 58.3%, while that for K-TIRADS and ATA US RSS was 50%. The unnecessary FNA prevalence for ACR TI-RADS and EU-TIRADS was 58.3%, while that for K-TIRADS and ATA US RSS was 76%. Our findings suggest that the four US-based RSSs (i.e., ACR-TIRADS, EU-TIRADS, K-TIRADS, and ATA US RSS) have suboptimal performance in managing pediatric patients with thyroid nodules, with one-half of cancers without indication for FNA according to their recommendations.
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Affiliation(s)
- Lorenzo Scappaticcio
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.I.M.); (S.I.); (M.L.); (G.B.)
- Correspondence: ; Tel.: +39-3293154461
| | - Maria Ida Maiorino
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.I.M.); (S.I.); (M.L.); (G.B.)
| | - Sergio Iorio
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.I.M.); (S.I.); (M.L.); (G.B.)
| | - Giovanni Docimo
- Division of Thyroid Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Miriam Longo
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.I.M.); (S.I.); (M.L.); (G.B.)
| | - Anna Grandone
- Department of Woman, Child, General and Specialized Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.G.); (C.L.); (E.M.D.G.)
| | - Caterina Luongo
- Department of Woman, Child, General and Specialized Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.G.); (C.L.); (E.M.D.G.)
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Regional Hospital of Lugano, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child, General and Specialized Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.G.); (C.L.); (E.M.D.G.)
| | - Katherine Esposito
- Department of Medical and Advanced Surgical Sciences, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (M.I.M.); (S.I.); (M.L.); (G.B.)
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Zhou Q, Wu W, Wang F, Gong X, Chen X. Ultrasound-Guided Fine-Needle Aspiration with or without Negative Pressure for Different Types of Thyroid Nodules. Int J Gen Med 2021; 14:5475-5481. [PMID: 34531675 PMCID: PMC8439625 DOI: 10.2147/ijgm.s317087] [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: 04/22/2021] [Accepted: 08/27/2021] [Indexed: 11/23/2022] Open
Abstract
Object To evaluate the effects of ultrasound-guided fine-needle aspiration with or without negative pressure (FNA+P or FNA-P) on diagnosis of thyroid nodules. Methods A prospective randomized study was performed. Patients (n=1374, female=1094, 79.6%, male=280, 20.4%, age=48.7±12.5 yr) with thyroid nodules were randomly divided into FNA-P (n=774, 56.3%) and FNA+P (600, 43.7%) groups. Thyroid nodules were diagnosed by FNA-P or FNA+P, in the left (n=640, 46.6%) and right (n=734, 53.4%). Results The thyroid nodules were diagnosed as microcalcification (n=751, 54.7%), coarse calcification (n=404, 29.4%), peripheral calcification (n=101, 7.4%) and mixed micro + coarse calcification (n=118, 8.6%). Based on Bethesda classification criteria, the thyroid nodules were cataloged as type I (n=217,15.8%), II (n=467, 34.0%), III (n=151, 11.0%), V (n=333, 24.2%), and VI (n=206, 15.0%). There were no significant differences between experimental groups diagnosed by FNA-P or FNA+P. Conclusion The results suggest that fine-needle aspiration with or without negative pressure does not significantly affect the sensitivity of thyroid nodule diagnosis.
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Affiliation(s)
- Qi Zhou
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, People's Republic of China
| | - Wenjun Wu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, People's Republic of China
| | - Fang Wang
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, People's Republic of China
| | - Xiaohua Gong
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, People's Republic of China
| | - Xiaojun Chen
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, People's Republic of China
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Russ G, Trimboli P, Buffet C. The New Era of TIRADSs to Stratify the Risk of Malignancy of Thyroid Nodules: Strengths, Weaknesses and Pitfalls. Cancers (Basel) 2021; 13:cancers13174316. [PMID: 34503125 PMCID: PMC8430750 DOI: 10.3390/cancers13174316] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary The aim of this review is to provide the reader with a comprehensive overview of thyroid imaging and reporting data systems used for thyroid nodules, so as to understand how nodules are scored with all existing systems. Both ultrasound based risk stratification systems and indications for fine-needle aspirations are described. Systems are compared by analyzing their strengths and weaknesses. Studies show satisfactory sensitivities and specificities for the diagnosis of malignancy for all systems, and none of them have shown a real significant advantage over the others in terms of raw diagnostic value. Interobserver agreement is also very similar for all systems, fairly adequate to robust. Dimensional cut-offs for fine-needle aspiration are quite similar and all RSSs seem to reduce effectively the number of unnecessary FNAs. Merging all existing systems in a common international one is desirable. Abstract Since 2009, thyroid imaging reporting and data systems (TI-RADS) have been playing an increasing role in the field of thyroid nodules (TN) imaging. Their common aims are to provide sonologists of varied medical specialties and clinicians with an ultrasound (US) based malignancy risk stratification score and to guide decision making of fine-needle aspiration (FNA). Schematically, all TI-RADSs scores can be classified as either pattern-based or point-based approaches. The main strengths of these systems are their ability (i) to homogenize US TN descriptions among operators, (ii) to facilitate and shorten communication on the malignancy risk of TN between sonologists and clinicians, (iii) to provide quantitative ranges of malignancy risk assessment with high sensitivity and negative predictive values, and (iv) to reduce the number of unnecessary FNAs. Their weaknesses are (i) the remaining inter-observer discrepancies and (ii) their insufficient sensitivity for the diagnosis of follicular cancers and follicular variant of papillary cancers. Most common pitfalls are degenerating shrinking nodules and confusion between individual and coalescent nodules. The benefits of all TI-RADSs far outweigh their shortcomings, explaining their rising use, but the necessity to improve and merge the different existing systems remains.
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Affiliation(s)
- Gilles Russ
- Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, Thyroid and Endocrine Tumors Unit, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, F-75013 Paris, France;
- Correspondence:
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Camille Buffet
- Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, Thyroid and Endocrine Tumors Unit, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, F-75013 Paris, France;
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Giovanella L, Avram A, Clerc J. Molecular Imaging for Thyrotoxicosis and Thyroid Nodules. J Nucl Med 2021; 62:20S-25S. [PMID: 34230069 DOI: 10.2967/jnumed.120.246017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
After exclusion of exogenous iodine overload, radioiodine uptake (RAIU) testing with 123I or 131I enables the accurate evaluation and quantification of iodine uptake and kinetics within thyroid cells. In addition, scintigraphic evaluation with 123I or 99mTc-pertechnetate (99mTc04-) provides the topographic distribution of thyroid cell activity and allows the detection and localization of ectopic thyroid tissue. Destructive thyrotoxicosis is characterized by abolished or reduced uptake whereas productive thyrotoxicosis (i.e., hyperthyroidism "sensu strictu") is characterized by high RAIU with scintigraphically diffuse (i.e., Graves disease and diffuse thyroid autonomy) or focal (i.e., autonomously functioning thyroid nodules [AFTN]) overactivity. Accordingly, RAIU or thyroid scintigraphy are widely used to differentiate different causes of thyrotoxicosis. In addition, several radiopharmaceuticals are also available to help in differentiating benign from malignant thyroid nodules and inform clinical decision making. In fact, AFTNs can be safely excluded from fine-needle aspiration biopsy while either 99mTc-methoxyisobutylisonitrile (MIBI) and 18F-FDG may complement the work-up of cytologically indeterminate cold nodules and contribute to reducing the need for diagnostic lobectomies/thyroidectomies. Finally, RAIU studies are also useful for calculating the administered therapeutic activity of 131I to treat hyperthyroidism and euthyroid multinodular goiter. All considered, thyroid molecular imaging allows us to characterize molecular/functional aspects of different thyroid diseases, even before clinical symptoms become manifest and remains integral to properly managing such conditions. Our present paper summarizes basic concepts, clinical applications, and potential developments of thyroid molecular imaging in patients affected by thyrotoxicosis and thyroid nodules.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland;
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Anca Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan; and
| | - Jerome Clerc
- Department of Nuclear Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, DMU Imagina, University of Paris, Paris, France
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Luo P, Fang Z, Zhang P, Yang Y, Zhang H, Su L, Wang Z, Ren J. Radiomics Score Combined with ACR TI-RADS in Discriminating Benign and Malignant Thyroid Nodules Based on Ultrasound Images: A Retrospective Study. Diagnostics (Basel) 2021; 11:diagnostics11061011. [PMID: 34205943 PMCID: PMC8229428 DOI: 10.3390/diagnostics11061011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
This study aimed to explore the ability of combination model of ultrasound radiomics score (Rad-score) and the thyroid imaging, reporting and data system by the American College of Radiology (ACR TI-RADS) in predicting benign and malignant thyroid nodules (TNs). Up to 286 radiomics features were extracted from ultrasound images of TNs. By using the lowest probability of classification error and average correlation coefficients (POE + ACC) and the least absolute shrinkage and selection operator (LASSO), we finally selected four features to establish Rad-score (Vertl-RLNonUni, Vertl-GLevNonU, WavEnLH-s4 and WavEnHL-s5). DeLong’s test and decision curve analysis (DCA) showed that the method of combining Rad-score and ACR TI-RADS had the best performance (the area under the receiver operating characteristic curve (AUC = 0.913 (95% confidence interval (CI), 0.881–0.939) and 0.899 (95%CI, 0.840–0.942) in the training group and verification group, respectively), followed by ACR TI-RADS (AUC = 0.898 (95%CI, 0.863–0.926) and 0.870 (95%CI, 0.806–0.919) in the training group and verification group, respectively), and followed by Rad-score (AUC = 0.750 (95%CI, 0.704–0.792) and 0.750 (95%CI, 0.672–0.817) in the training group and verification group, respectively). We concluded that the ability of ultrasound Rad-score to distinguish benign and malignant TNs was not as good as that of ACR TI-RADS, and the ability of the combination model of Rad-score and ACR TI-RADS to discriminate benign and malignant TNs was better than ACR TI-RADS or Rad-score alone. Ultrasound Rad-score might play a potential role in improving the differentiation of malignant TNs from benign TNs.
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Affiliation(s)
- Peng Luo
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (P.L.); (P.Z.); (Y.Y.); (H.Z.); (L.S.); (Z.W.)
| | - Zheng Fang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China;
| | - Ping Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (P.L.); (P.Z.); (Y.Y.); (H.Z.); (L.S.); (Z.W.)
| | - Yang Yang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (P.L.); (P.Z.); (Y.Y.); (H.Z.); (L.S.); (Z.W.)
| | - Hua Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (P.L.); (P.Z.); (Y.Y.); (H.Z.); (L.S.); (Z.W.)
| | - Lei Su
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (P.L.); (P.Z.); (Y.Y.); (H.Z.); (L.S.); (Z.W.)
| | - Zhigang Wang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (P.L.); (P.Z.); (Y.Y.); (H.Z.); (L.S.); (Z.W.)
| | - Jianli Ren
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (P.L.); (P.Z.); (Y.Y.); (H.Z.); (L.S.); (Z.W.)
- Correspondence:
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Hürthle Cells on Fine-Needle Aspiration Cytology Are Important for Risk Assessment of Focally PET/CT FDG Avid Thyroid Nodules. Cancers (Basel) 2020; 12:cancers12123544. [PMID: 33260994 PMCID: PMC7761140 DOI: 10.3390/cancers12123544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022] Open
Abstract
Simple Summary PET/CT fluorodeoxyglucose (FDG) scans are routinely used in patients to detect signs of malignant tumours or evidence of inflammation in the body. A total of 1–2% of patients show focal thyroid gland FDG uptake and 35–40% are malignant. FDG also detects metabolically active lesions containing mitochondria, known as Hürthle cells. Over 3 years, 47 patients in one hospital were found to have focal thyroid gland uptake. A total of 18 (38.2%) of the patients had malignancy, 15 (31.9%) had benign lesions that contained Hürthle cells and 14 (29.8%) had focally increased thyroid gland FDG PET/CT uptake with no cause identified. Exclusion of the Hürthle cell patients increased the risk of malignancy of the remaining PET-positive nodules from 38% to 68%. It is important to recognize Hürthle cells on FNA cytology in FDG PET/CT-positive nodules as this affects the risk of malignancy and the clinical management of focally FDG PET/CT-positive nodules. Abstract This study assesses the role of [18F] FDG PET/CT, fine needle aspiration (FNA) cytology and ultrasound in the 1–2% of patients with focally positive thyroid nodules on FDG PET/CT. All FDG PET/CT scans with focally increased thyroid FDG PET/CT uptake performed over 37 months in one institution were matched to patients undergoing thyroid FNA. Diffuse FDG PET/CT uptake patients were excluded. A total of 47 patients showed focally increased thyroid uptake. Consistent with previous studies, 18 (38.2%) patients had malignancy—12 primary thyroid carcinoma, 1 parathyroid carcinoma, 3 metastatic carcinoma to the thyroid and 2 lymphoma. A total of 15 (31.9%) lesions categorized as non-malignant contained Hürthle cells/oncocytes. A total of 14 lesions (29.8%) had focally increased FDG PET/CT uptake with no specific cytological or histopathological cause identified. No focally PET avid Hürthle cell/oncocytic lesions were found to be malignant. Exclusion of oncocytic lesions increased the calculated risk of malignancy (ROM) of focally PET avid nodules from 38% to 68%. It may be useful to exclude focally FDG PET/CT avid Hürthle cell/oncocytic lesions, typically reported as follicular neoplasm or suspicious for a follicular neoplasm, Hürthle cell type (Oncocytic) type, RCPath Thy 3F: Bethesda IV or sometimes Thy 3a: Bethesda III FNAs) from ROM calculations. Oncocytic focally PET/CT FDG avid lesions appear of comparatively lower risk of malignancy and require investigation or operation but these lesions should be readily identified by FNA cytology on diagnostic work up of focally PET avid thyroid nodules.
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Rosario PW, de Castro Nicolau T. The value of ultrasonography for the indication of fine-needle aspiration in autonomous thyroid nodules. Diagn Cytopathol 2020; 49:363-366. [PMID: 33152168 DOI: 10.1002/dc.24659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The risk of malignancy in autonomous thyroid nodules is considered to be very low in adults and fine-needle aspiration (FNA) is not recommended in these cases; however, some studies contest this. Just as ultrasonography (US) has been used to select nonautonomous nodules with initial benign cytology that deserve FNA repetition, this method may also be useful to select autonomous nodules that are candidates for FNA. METHODS In this prospective study, FNA was obtained in 48 adults patients with autonomous solitary nodules >1 cm with suspicious US features (at least two of the following findings: hypoechogenicity, microcalcification, irregular margins, taller than wider shape, predominantly or exclusively central vascularization). RESULTS Cytology was benign in 28 patients (58.3%). Six patients (12.5%) had nondiagnostic cytology and histology revealed benign nodules in these cases. Cytology was indeterminate in nine other patients (18.5%). Of these, seven were adenomas and two were follicular carcinomas on histology. Finally, cytology suspicious for malignancy or malignant cytology was detected in five patients (10.4%), all of them confirmed histologically to be papillary carcinomas (the follicular variant in three). Thus, the frequency of malignancy was 14.6% (two follicular carcinomas and five papillary carcinomas), 8.3% in nodules with two suspicious findings vs 33.3% in nodules with ≥3 suspicious findings (P = .055). CONCLUSION The results suggest that the presence of ultrasonographic findings suspicious for malignancy in autonomous thyroid nodules >1 cm is a criterion for the indication of FNA.
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Affiliation(s)
- Pedro Weslley Rosario
- Santa Casa de Belo Horizonte (Endocrinology Department), Belo Horizonte, Minas Gerais, Brazil
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