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Ye M, Wu S, Zhou Q, Wang F, Chen X, Gong X, Wu W. Association between macrocalcification and papillary thyroid carcinoma and corresponding valuable diagnostic tool: retrospective study. World J Surg Oncol 2023; 21:149. [PMID: 37194091 DOI: 10.1186/s12957-023-03016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/08/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Microcalcifications are suggested to be an indicator of thyroid malignancy, especially for papillary thyroid carcinoma (PTC), nonetheless, the association between macrocalcification and PTC is underexplored. Furthermore, screening methods like ultrasonography and ultrasound-guided fine needle aspiration biopsy (US-FNAB) are limited in evaluating macro-calcified thyroid nodules. Thus, we aimed to investigate the relationship between macrocalcification and PTC. We also explored the diagnostic efficiency of US-FNAB and proto-Oncogene Proteins B-raf V600E (BRAF V600E) mutation in macro-calcified thyroid nodules evaluation. METHODS A retrospective research of 2645 thyroid nodules from 2078 participants was performed and divided into three groups as non-, micro-, and macro-calcified for further PTC incidence comparison. Besides, a total of 100 macro-calcified thyroid nodules with both results of US-FNAB and BRAF V600E mutation were screened out for subsequent evaluation of diagnostic efficiency. RESULTS Compared to non-calcification, macrocalcification showed a significantly higher incidence of PTC (31.5% vs. 23.2%, P<0.05). Additionally, when compared with a single US-FNAB, the combination of US-FNAB and BRAF V600E mutation showed better diagnostic efficiency in diagnosing macro-calcified thyroid nodule (area under the curve (AUC) 0.94 vs. 0.84, P=0.03), with a significantly higher sensitivity (100.0% vs. 67.2%, P<0.01) and a comparable standard of specificity (88.9% vs. 100.0%, P=0.13). CONCLUSIONS Occurrence of macrocalcification in thyroid nodules may suggest a high risk of PTC, and the combination of US-FNAB and BRAF V600E showed a greater value in identifying macro-calcified thyroid nodules, especially with significantly higher sensitivity. TRIAL REGISTRATION The Ethics Committee of The First Affiliated Hospital of Wenzhou Medical University (2018-026).
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Affiliation(s)
- Mengyao Ye
- Department of Endocrinology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang, 325015, China
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, China
| | - Shan Wu
- Department of Endocrinology, People's Hospital of Yuhuan, Taizhou, Zhejiang, 318000, China
| | - Qi Zhou
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, China
| | - Fang Wang
- Departments of Pathology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, China
| | - Xiaojun Chen
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, China
| | - Xiaohua Gong
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, China.
| | - Wenjun Wu
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325015, China.
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Li W, Hong T, Fang J, Liu W, Liu Y, He C, Li X, Xu C, Wang B, Chen Y, Sun C, Li W, Kang W, Yin C. Incorporation of a machine learning pathological diagnosis algorithm into the thyroid ultrasound imaging data improves the diagnosis risk of malignant thyroid nodules. Front Oncol 2022; 12:968784. [PMID: 36568189 PMCID: PMC9774948 DOI: 10.3389/fonc.2022.968784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022] Open
Abstract
Objective This study aimed at establishing a new model to predict malignant thyroid nodules using machine learning algorithms. Methods A retrospective study was performed on 274 patients with thyroid nodules who underwent fine-needle aspiration (FNA) cytology or surgery from October 2018 to 2020 in Xianyang Central Hospital. The least absolute shrinkage and selection operator (lasso) regression analysis and logistic analysis were applied to screen and identified variables. Six machine learning algorithms, including Decision Tree (DT), Extreme Gradient Boosting (XGBoost), Gradient Boosting Machine (GBM), Naive Bayes Classifier (NBC), Random Forest (RF), and Logistic Regression (LR), were employed and compared in constructing the predictive model, coupled with preoperative clinical characteristics and ultrasound features. Internal validation was performed by using 10-fold cross-validation. The performance of the model was measured by the area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, F1 score, Shapley additive explanations (SHAP) plot, feature importance, and correlation of features. The best cutoff value for risk stratification was identified by probability density function (PDF) and clinical utility curve (CUC). Results The malignant rate of thyroid nodules in the study cohort was 53.2%. The predictive models are constructed by age, margin, shape, echogenic foci, echogenicity, and lymph nodes. The XGBoost model was significantly superior to any one of the machine learning models, with an AUC value of 0.829. According to the PDF and CUC, we recommended that 51% probability be used as a threshold for determining the risk stratification of malignant nodules, where about 85.6% of patients with malignant nodules could be detected. Meanwhile, approximately 89.8% of unnecessary biopsy procedures would be saved. Finally, an online web risk calculator has been built to estimate the personal likelihood of malignant thyroid nodules based on the best-performing ML-ed model of XGBoost. Conclusions Combining clinical characteristics and features of ultrasound images, ML algorithms can achieve reliable prediction of malignant thyroid nodules. The online web risk calculator based on the XGBoost model can easily identify in real-time the probability of malignant thyroid nodules, which can assist clinicians to formulate individualized management strategies for patients.
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Affiliation(s)
- Wanying Li
- Center for Management and Follow-up of Chronic Diseases, Xianyang Central Hospital, Xianyang, China
| | - Tao Hong
- Pediatric Surgery Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Jianqiang Fang
- Ultrasound Interventional Department, Xianyang Central Hospital, Xianyang, China,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Wencai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuwen Liu
- Department of Chronic Disease and Endemic Disease Control Branch, Xiamen Municipal Center for Disease Control and Prevention, Xiamen, China
| | - Cunyu He
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Xinxin Li
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Chan Xu
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Bing Wang
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Yuanyuan Chen
- School of Statistics, RENMIN University of China, Beijing, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Wenle Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China,*Correspondence: Chengliang Yin, ; Wei Kang, ; Wenle Li,
| | - Wei Kang
- Department of Mathematics, Physics and Interdisciplinary Studies, Guangzhou Laboratory, Guangzhou, Guangdong, China,*Correspondence: Chengliang Yin, ; Wei Kang, ; Wenle Li,
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macao, Macao SAR, China,*Correspondence: Chengliang Yin, ; Wei Kang, ; Wenle Li,
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Li R, Liang Z, Wang X, Chen L. Role of echogenic foci in ultrasonographic risk stratification of thyroid nodules: Echogenic focus scoring in the American College of Radiology Thyroid Imaging Reporting and Data System. Front Oncol 2022; 12:929500. [PMID: 36106124 PMCID: PMC9465029 DOI: 10.3389/fonc.2022.929500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although echogenic foci may raise malignancy rates in thyroid nodules, the association between peripheral calcification or macrocalcification and thyroid carcinoma is controversial. We evaluated the malignancy probability of various echogenic foci and explored whether the method of determining a thyroid nodule’s point score in the echogenic focus category of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) is reasonable. Methods We retrospectively evaluated 819 patients with 852 nodules. The patterns of echogenic foci on ultrasonography were classified into the following four categories: punctate echogenic foci, macrocalcification, peripheral calcification, and multiple different types of echogenic foci. The core needle biopsy results were divided into two groups: benign and malignant or suspicious for malignancy. Results Among the 852 nodules, 471 (55.3%) had echogenic foci on ultrasonography. Of these nodules, there was no significant statistical difference in the malignant or suspicious for malignancy rate between nodules with peripheral calcification and those with macrocalcification [40.0% (8/20) vs. 30.6% (11/36), respectively; p = 0.474]. The incidence of malignancy or suspicious for malignancy for nodules with peripheral calcification, macrocalcification, or multiple different types of echogenic foci was significantly lower than the incidence for punctate echogenic foci alone, with odds ratios of 0.265 [95% confidence interval (CI): 0.105–0.667; p = 0.005], 0.175 (95% CI: 0.083–0.368; p = 0.000), and 0.256 (95% CI: 0.136–0.482; p = 0.000), respectively. Conclusion We found no significant statistical difference in the risk of malignancy or suspicious for malignancy rate between peripheral calcification and macrocalcification in thyroid nodules. We observed that nodules with multiple different types of echogenic foci were not associated with higher malignant or suspicious for malignancy rates compared with nodules with punctate echogenic foci alone.
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Shi M, Nong D, Xin M, Lin L. Accuracy of Ultrasound Diagnosis of Benign and Malignant Thyroid Nodules: A Systematic Review and Meta-Analysis. Int J Clin Pract 2022; 2022:5056082. [PMID: 36160289 PMCID: PMC9489364 DOI: 10.1155/2022/5056082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Distinguishing between benign and malignant thyroid nodules remains difficult. Ultrasound has been established as a non-invasive and relatively simple imaging technique for thyroid nodules. This study aimed to assess the diagnostic accuracy of conventional ultrasound and ultrasound elastography for the differentiation between benign and malignant thyroid nodules by meta-analyzing published studies. METHODS Literature was retrieved from the PubMed and Embase databases from inception to May 31, 2022. The literature was screened using inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS2) scale was used to assess the quality of the included literature. Publication bias of the included studies was assessed by Deek's funnel plot. Heterogeneity tests were performed using Cochrane Q statistic and I2 statistic. RESULTS Finally, 9 articles were included. The meta-analysis showed that the combined sensitivity and specificity of ultrasound for the diagnosis of thyroid nodules were 0.88 [95% CI (0.83-0.91)] and 0.86 [95% CI (0.79-0.90)], respectively. The area under the curve (AUC) of the summary receiver operating characteristic curve (SROC) was 0.92 [95% CI (0.90-0.94)]. There was no significant publication bias in this study. Discussion. Existing evidence shows that ultrasound has a certain accuracy in diagnosing benign and malignant thyroid nodules, providing a scientific basis for thyroid assessment and diagnosis.
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Affiliation(s)
- Mei Shi
- Department of Ultrasonic Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, China
| | - Dandan Nong
- Department of Ultrasonic Medicine, Baisha Li Autonomous County People's Hospital, Baisha 572800, China
| | - Minhui Xin
- Department of Ultrasonic Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, China
| | - Lifei Lin
- Department of Ultrasonic Medicine, Sanya Women and Children's Hospital Managed by Shanghai Children's Medical Center, Sanya 572000, China
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Abstract
Benign or malignant thyroid nodules are common in adults. Fine needle aspiration biopsy is the gold standard for diagnosis. Most thyroid nodules are benign. Ultrasound imaging is the optimal noninvasive imaging modality to determine which nodules demonstrate malignant features. The American College of Radiology Thyroid Imaging Reporting and Data System committee published a standardized approach to classifying nodules on ultrasound. The ultrasound features in this system are categorized as benign, minimally suspicious, moderately suspicious, or highly suspicious for malignancy. Applying the Thyroid Imaging Reporting and Data System results in a meaningful decrease in the number of thyroid nodules biopsied.
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Lu C, Wang Y, Yu M. Is ultrasonographic evaluation sensitive enough to detect multicentric papillary thyroid carcinoma? Gland Surg 2020; 9:737-746. [PMID: 32775264 DOI: 10.21037/gs-20-487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to investigate the preoperative ultrasonographic (US) evaluation of multicentric papillary thyroid carcinoma (PTC) and to evaluate the association of US findings with lymph node metastasis and extracapsular extension in PTC. Methods Preoperative US evaluations of patients with PTC who underwent total thyroidectomy were retrospectively investigated. Pathological perspectives and US features of PTC were analyzed. The sensitivity of US in detecting multicentric PTC was evaluated. Results The present study included 89 PTC patients who underwent total thyroidectomy. In total, 164 nodules were detected by preoperative US. Significant differences in US pattern were found between benign and malignant nodules. Of the 89 patients with PTC, 33 (37.08%) cases were confirmed as multicentric PTC by operation and pathological examination, 22 (66.67%) of which were bilateral. Before surgery, only 23 patients were suspected as multicentric PTC based on US findings. Pathological examination revealed that malignant nodules in 17 (51.51%) patients with multicentric PTC had been missed by preoperative US. The malignant nodules that went undetected by US were micronodulars (1-4 mm). Furthermore, ultrasonography was less sensitive for the diagnosis of metastatic lymph nodes in the neck. US had more than 80% sensitivity for detection of extracapsular extension of cases. Conclusions US evaluation is not sensitive enough to detect multicentric PTC. The minute size of some nodules in multicentric PTC, may lead to them being missed by US evaluation. Ultrasonography is an optional tool for the detection of extracapsular extension, but it is less sensitive for diagnosing lymph node metastasis.
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Affiliation(s)
- Congqing Lu
- Ultrasound Section, First People's Hospital, Lianyungang 222000, China
| | - Yan Wang
- Ultrasound Section, First People's Hospital, Lianyungang 222000, China
| | - Ming Yu
- Ultrasound Section, First People's Hospital, Lianyungang 222000, China
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A case of mixed-pattern calcifications in multinodular goiter associated with a benign diagnosis. Int J Surg Case Rep 2019; 60:46-48. [PMID: 31202997 PMCID: PMC6580326 DOI: 10.1016/j.ijscr.2019.05.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022] Open
Abstract
Calcified nodules in a goiter are often found when performing an ultrasound of the neck. Analysis of different calcification patterns could contribute to discriminating between nodules. Mixed pattern calcifications is not so frequent and not interpreted. We believe that a better radiologic evaluation setting of thyroid nodules needs to be performed.
Background Calcified nodules are often found in a goiter when performing an ultrasound of the neck. An analysis of different calcification patterns could contribute to discriminating between nodules with a lower malignancy risk and those with a higher malignancy risk. In certain cases, the results of a simple cytological analysis of a nodule are not specific enough to be completely trusted. Case presentation We present the case of a goiter with a mixed calcification pattern, including a type of calcification that is strongly associated with a malignant diagnosis, for which a completely benign diagnosis was determined. Conclusion We believe that further studies examining a combination of ultrasound (US) and computed tomography (CT) scan presentations of thyroid nodules need to be performed.
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Peripheral Thyroid Nodule Calcifications on Sonography: Evaluation of Malignant Potential. AJR Am J Roentgenol 2019; 213:672-675. [PMID: 31166754 DOI: 10.2214/ajr.18.20799] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study is to assess the association of thyroid cancer with sonographic features of peripheral calcifications. MATERIALS AND METHODS. We retrospectively reviewed patients who had a total of 97 thyroid nodules with peripheral calcifications who underwent ultrasound-guided fine-needle aspiration from 2008 to 2018. Three board-certified radiologists evaluated the nodules for features of peripheral calcifications: the percentage of the nodule involved by peripheral calcifications, whether the calcifications were continuous or discontinuous, the visibility of internal components of the nodule, and the presence of extrusion of soft tissue beyond the calcifications. The correlation of peripheral calcification parameters with the rate of thyroid nodule malignancy was evaluated. In addition, the interobserver agreement between readers was assessed with Cohen kappa coefficient. RESULTS. Of the 97 nodules with peripheral calcifications, 27% (n = 26) were found to be malignant on biopsy. The continuity of peripheral calcifications, visibility of internal components, and extrusion of soft tissue beyond the calcification rim showed no significant association with benign or malignant nodules. Readers had good agreement on peripheral calcification continuity (κ = 0.63; 95% CI, 0.53-0.73) and moderate agreement on internal component visibility (κ = 0.43; 95% CI, 0.35-0.51) and percentage of the nodule involved by rim calcifications (κ = 0.52; 95% CI, 0.44-0.59). There was fair agreement for extranodular soft-tissue extrusion (κ = 0.32, 95% CI, 0.24-0.39). CONCLUSION. Peripheral rim calcifications are highly associated with malignancy. However, specific peripheral rim calcification features do not aid in distinguishing benign from malignant nodules, which may in part be caused by high interobserver variability.
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Wildman-Tobriner B, Buda M, Hoang JK, Middleton WD, Thayer D, Short RG, Tessler FN, Mazurowski MA. Using Artificial Intelligence to Revise ACR TI-RADS Risk Stratification of Thyroid Nodules: Diagnostic Accuracy and Utility. Radiology 2019; 292:112-119. [PMID: 31112088 DOI: 10.1148/radiol.2019182128] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Risk stratification systems for thyroid nodules are often complicated and affected by low specificity. Continual improvement of these systems is necessary to reduce the number of unnecessary thyroid biopsies. Purpose To use artificial intelligence (AI) to optimize the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS). Materials and Methods A total of 1425 biopsy-proven thyroid nodules from 1264 consecutive patients (1026 women; mean age, 52.9 years [range, 18-93 years]) were evaluated retrospectively. Expert readers assigned points based on five ACR TI-RADS categories (composition, echogenicity, shape, margin, echogenic foci), and a genetic AI algorithm was applied to a training set (1325 nodules). Point and pathologic data were used to create an optimized scoring system (hereafter, AI TI-RADS). Performance of the systems was compared by using a test set of the final 100 nodules with interpretations from the expert reader, eight nonexpert readers, and an expert panel. Initial performance of AI TI-RADS was calculated by using a test for differences between binomial proportions. Additional comparisons across readers were conducted by using bootstrapping; diagnostic performance was assessed by using area under the receiver operating curve. Results AI TI-RADS assigned new point values for eight ACR TI-RADS features. Six features were assigned zero points, which simplified categorization. By using expert reader data, the diagnostic performance of ACR TI-RADS and AI TI-RADS was area under the receiver operating curve of 0.91 and 0.93, respectively. For the same expert, specificity of AI TI-RADS (65%, 55 of 85) was higher (P < .001) than that of ACR TI-RADS (47%, 40 of 85). For the eight nonexpert radiologists, mean specificity for AI TI-RADS (55%) was also higher (P < .001) than that of ACR TI-RADS (48%). An interactive AI TI-RADS calculator can be viewed at http://deckard.duhs.duke.edu/∼ai-ti-rads . Conclusion An artificial intelligence-optimized Thyroid Imaging Reporting and Data System (TI-RADS) validates the American College of Radiology TI-RADS while slightly improving specificity and maintaining sensitivity. Additionally, it simplifies feature assignments, which may improve ease of use. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Benjamin Wildman-Tobriner
- From the Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27701 (B.W.T., M.B., J.K.H., R.G.S., M.A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., D.T.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.)
| | - Mateusz Buda
- From the Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27701 (B.W.T., M.B., J.K.H., R.G.S., M.A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., D.T.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.)
| | - Jenny K Hoang
- From the Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27701 (B.W.T., M.B., J.K.H., R.G.S., M.A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., D.T.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.)
| | - William D Middleton
- From the Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27701 (B.W.T., M.B., J.K.H., R.G.S., M.A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., D.T.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.)
| | - David Thayer
- From the Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27701 (B.W.T., M.B., J.K.H., R.G.S., M.A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., D.T.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.)
| | - Ryan G Short
- From the Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27701 (B.W.T., M.B., J.K.H., R.G.S., M.A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., D.T.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.)
| | - Franklin N Tessler
- From the Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27701 (B.W.T., M.B., J.K.H., R.G.S., M.A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., D.T.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.)
| | - Maciej A Mazurowski
- From the Department of Radiology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27701 (B.W.T., M.B., J.K.H., R.G.S., M.A.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M., D.T.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (F.N.T.)
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Abstract
The presence of a thyroid nodule may be recognized by the patient or the clinician on palpation of the neck or it may be an incidental finding during an imaging study for some other indication. The method of detection is less important, however, than distinguishing benign lesions from more aggressive neoplasms. This article outlines the diagnostic algorithm for the evaluation of thyroid nodules including biochemical testing, imaging, and, when appropriate, fine-needle aspiration. In addition, the authors review the natural history of benign nodules, follow-up strategies, and indications for repeat aspiration.
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Affiliation(s)
- Carolyn Maxwell
- Division of Endocrinology and Metabolism, Stony Brook University School of Medicine, 26 Research Way, East Setauket, NY 11733, USA
| | - Jennifer A Sipos
- Division of Endocrinology and Metabolism, The Ohio State University Wexner Medical Center, 1581 Dodd Drive, 5th Floor McCampbell Hall, South, Columbus, OH 43210, USA.
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Tessler FN, Middleton WD, Grant EG, Hoang JK. Re: ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol 2018; 15:381-382. [DOI: 10.1016/j.jacr.2017.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
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Re: "ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee". J Am Coll Radiol 2018; 15:380-381. [PMID: 29396122 DOI: 10.1016/j.jacr.2017.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 01/25/2023]
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Bilici S, Yigit O, Onur F, Hamit B, Nazli MA, Gunver F, Karagoz Y. Histopathological investigation of intranodular echogenic foci detected by thyroid ultrasonography. Am J Otolaryngol 2017; 38:608-613. [PMID: 28709635 DOI: 10.1016/j.amjoto.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the predictability of sonography for detection of calcifications in thyroid nodules by histopathologic examination and to demonstrate the association between calcification pattern and malignancy. METHODS We prospectively evaluated 81 dominant nodules from 81 patients. Thyroid glands were assessed preoperatively with thyroid ultrasonography, and the presence of sonographic calcification was specified as intranodular macro (coarse) and micro calcification. Micro and macro calcification in surgery specimens were specified postoperatively as present or absent in the histopathological evaluation. The correlation between sonographic and histopathologic calcifications and the relationship between malignancy and calcification patterns were determined. RESULTS Calcification was detected histopathologically in 66.7% of the sonographically calcified nodules and in 12.8% of the sonographically noncalcified nodules. The sensitivity and specificity of sonography for detecting histopathologic calcification were 84.8 and 70.8%, respectively, while positive and negative predictive values were 66.7 and 87.2%, respectively. The sonographical and histopathological outcomes for detection of macro and micro calcification showed 85 and 50% compatibility, respectively. The difference in malignancy rates between sonographic macro and micro calcified nodules was not significant (p=0.976). Histopathologic detection of calcification showed no significant difference between malignant and benign nodules (p=0.129). CONCLUSION Histopathology confirmed a high rate of sonographic macrocalcifications. The micro and macro patterns of sonographic calcification showed no particular association with thyroid malignancy. The preoperative risk of malignancy should be determined in conjunction with other known sonographic risk factors and diagnostic tests.
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Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol 2017; 14:587-595. [PMID: 28372962 DOI: 10.1016/j.jacr.2017.01.046] [Citation(s) in RCA: 1146] [Impact Index Per Article: 163.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/21/2016] [Accepted: 01/30/2017] [Indexed: 02/06/2023]
Abstract
classification that is widely used in breast imaging, their authors chose to apply the acronym TI-RADS, for Thyroid Imaging, Reporting and Data System. In 2012, the ACR convened committees to (1) provide recommendations for reporting incidental thyroid nodules, (2) develop a set of standard terms (lexicon) for ultrasound reporting, and (3) propose a TI-RADS on the basis of the lexicon. The committees published the results of the first two efforts in 2015. In this article, the authors present the ACR TI-RADS Committee's recommendations, which provide guidance regarding management of thyroid nodules on the basis of their ultrasound appearance. The authors also describe the committee's future directions.
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Affiliation(s)
- Franklin N Tessler
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Edward G Grant
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jenny K Hoang
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Lincoln L Berland
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sharlene A Teefey
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - John J Cronan
- Department of Diagnostic Imaging Brown University, Providence, Rhode Island
| | - Michael D Beland
- Department of Diagnostic Imaging Brown University, Providence, Rhode Island
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lynwood W Hammers
- Hammers Healthcare Imaging, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ulrike M Hamper
- Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Jill E Langer
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carl C Reading
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Leslie M Scoutt
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - A Thomas Stavros
- Department of Radiology, University of Texas Health Sciences Center, San Antonio, Texas
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15
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Lai XJ, Zhang B, Jiang YX, Li JC, Zhao RN, Yang X, Zhang Q, Zhang XY, Li WB, Zhu SL. High Risk of Lateral Nodal Metastasis in Lateral Solitary Solid Papillary Thyroid Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:75-81. [PMID: 26497768 DOI: 10.1016/j.ultrasmedbio.2015.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/26/2015] [Accepted: 09/04/2015] [Indexed: 06/05/2023]
Abstract
We explored the relationship between ultrasonic intra-thyroidal location and neck node metastasis pattern in solitary solid papillary thyroid cancer (PTC). Data on 186 patients were retrospectively reviewed. The association between several characteristics and neck node metastasis pattern were analyzed. Among the 186 thyroid nodules, age ≥45 y (p = 0.005), mass size ≥2 cm (p = 0.001), presence of calcifications (p < 0.001) and lateral nodal metastasis (p = 0.001) were significantly related to central nodal metastasis in multivariate analysis. Mass size ≥2 cm (p = 0.046) and central nodal metastasis (p = 0.002) were significantly related to lateral nodal metastasis in multivariate analysis. Location of an intra-thyroidal solitary solid PTC located non-adjacent to the trachea (lateral) was significantly related to lateral nodal metastasis (p = 0.043) compared with location of an intra-thyroidal solitary solid PTC adjacent to the trachea (medial or isthmus). Lateral lesions have a high risk of lateral nodal metastasis in solitary solid PTC.
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Affiliation(s)
- Xing-Jian Lai
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Bo Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Yu-Xin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China.
| | - Jian-Chu Li
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Rui-Na Zhao
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Xiao Yang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Qing Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Xiao-Yan Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Wen-Bo Li
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Shen-Ling Zhu
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
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