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Wei A, Tang YL, Tang SC, Zhang XY, Ren JY, Shi L, Cui XW, Zhang CX. A model based on C-TIRADS combined with SWE for predicting Bethesda I thyroid nodules. Front Oncol 2024; 14:1421088. [PMID: 39281385 PMCID: PMC11393783 DOI: 10.3389/fonc.2024.1421088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/06/2024] [Indexed: 09/18/2024] Open
Abstract
Objectives This study aimed to explore the performance of a model based on Chinese Thyroid Imaging Reporting and Data Systems (C-TIRADS), clinical characteristics, and shear wave elastography (SWE) for the prediction of Bethesda I thyroid nodules before fine needle aspiration (FNA). Materials and methods A total of 267 thyroid nodules from 267 patients were enrolled. Ultrasound and SWE were performed for all nodules before FNA. The nodules were scored according to the 2020 C-TIRADS, and the ultrasound and SWE characteristics of Bethesda I and non-I thyroid nodules were compared. The independent predictors were determined by univariate analysis and multivariate logistic regression analysis. A predictive model was established based on independent predictors, and the sensitivity, specificity, and area under the curve (AUC) of the independent predictors were compared with that of the model. Results Our study found that the maximum diameter of nodules that ranged from 15 to 20 mm, the C-TIRADS category <4C, and E max <52.5 kPa were independent predictors for Bethesda I thyroid nodules. Based on multiple logistic regression, a predictive model was established: Logit (p) = -3.491 + 1.630 × maximum diameter + 1.719 × C-TIRADS category + 1.046 × E max (kPa). The AUC of the model was 0.769 (95% CI: 0.700-0.838), which was significantly higher than that of the independent predictors alone. Conclusion We developed a predictive model for predicting Bethesda I thyroid nodules. It might be beneficial to the clinical optimization of FNA strategy in advance and to improve the accurate diagnostic rate of the first FNA, reducing repeated FNA.
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Affiliation(s)
- An Wei
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Ultrasound, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yu-Long Tang
- Department of Thyroid Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi-Chu Tang
- Department of Medical Ultrasound, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xian-Ya Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Yu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Long Shi
- Department of Medical Ultrasound, Jingmen People's Hospital, Jingmen, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao-Xue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Lv Y, Zhang L, Liu Y, Shuai P, Li Y, Li J, Zhao Y, Wu Y, Zhang D, Xiang Q. Serum trace elements show association with thyroperoxidase autoantibodies in Thyroid Imaging Reporting and Data System (TI-RADS) 4 nodules. Sci Rep 2024; 14:19813. [PMID: 39191901 PMCID: PMC11350144 DOI: 10.1038/s41598-024-70860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 08/21/2024] [Indexed: 08/29/2024] Open
Abstract
Thyroid nodule (TN) has been becoming a great concern worldwide due to its high incidence. Although some studies have reported associations between trace elements exposure and the risk of TNs, the linkage was not inconclusive. The present study aimed to identify the association of selected serum trace elements (Ca, Mg, V, Fe, Co, Cu, Zn, Se, Mn and Mo) with TNs among general adults. A cross-sectional study was conducted in January 2021 in Chengdu, China. 1282 subjects completed the questionnaire and gave at least one human biological material after an overnight fast, venous blood, and urine, including 377 TN participants defined through ultrasound. Various trace elements in serum specimens were determined by inductively coupled plasma mass spectrometry. Thyroid functions were tested by chemiluminescent microparticle immunoassay (CMIA). The associations between trace elements levels and the risk of TNs were examined by restricted cubic splines (RCS) regression and bayesian kernel machine regression (BKMR) models. TNs were more common in females (P < 0.001) and in the elderly (P < 0.001) and that they were also frequently associated with fertility, marital status, annual household income, drinking, anxiety, vitamin supplement, tea consumption, hypertension and hyperlipidemia. After adjusting for confounders by a propensity score matching model, the association between trace elements concentrations and TNs risk was found to be statistically insignificant in the RCS (P for nonlinear > 0.05) and BKMR models. FT3 or T4 (total or free) increased significantly with increasing total trace elements mixture levels. In TI-RADS-4 TN subjects, TPO-Ab level increased significantly with increasing total trace elements mixture levels in the high-dose range. Ca, Zn, Mo at their 75th percentile showed positive individual effects on TPO-Ab, which was examined to be interactive. The detection of trace elements for TNs in general adults may be of no significance, but once individuals classified as TI-RADS-4 TNs are detected with abnormal TPO-Ab, Ca, Zn and Mo level are recommended to measure. The substantive association on it still needs to be continuously explored in the future.
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Affiliation(s)
- Yu Lv
- Public Health Department, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, 32 West Section 2, 1st Ring Road, Chengdu, 610072, China
| | - Lei Zhang
- NHC Key Laboratory of Food Safety Risk Assessment, Chinese Academy of Medical Science Research Unit (No. 2019RU014), China National Center for Food Safety Risk Assessment, No. 7 Panjiayuan Nanli, Beijing, 100021, China.
| | - Youren Liu
- Health Management Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, 32 West Section 2, 1st Ring Road, Chengdu, 610072, China
| | - Ping Shuai
- Health Management Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, 32 West Section 2, 1st Ring Road, Chengdu, 610072, China
| | - Yingying Li
- Health Management Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, 32 West Section 2, 1st Ring Road, Chengdu, 610072, China
| | - Jingguang Li
- NHC Key Laboratory of Food Safety Risk Assessment, Chinese Academy of Medical Science Research Unit (No. 2019RU014), China National Center for Food Safety Risk Assessment, No. 7 Panjiayuan Nanli, Beijing, 100021, China
| | - Yunfeng Zhao
- NHC Key Laboratory of Food Safety Risk Assessment, Chinese Academy of Medical Science Research Unit (No. 2019RU014), China National Center for Food Safety Risk Assessment, No. 7 Panjiayuan Nanli, Beijing, 100021, China
| | - Yongning Wu
- NHC Key Laboratory of Food Safety Risk Assessment, Chinese Academy of Medical Science Research Unit (No. 2019RU014), China National Center for Food Safety Risk Assessment, No. 7 Panjiayuan Nanli, Beijing, 100021, China
| | - Dingding Zhang
- Sichuan Provincial Key Laboratory for Disease Gene Study, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, 32 West Section 2, 1st Ring Road, Chengdu, 610072, China.
| | - Qian Xiang
- Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, 32 West Section 2, 1st Ring Road, Chengdu, 610072, China.
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Alexis M, Ginzberg SP, Soegaard Ballester JM, Mandel SJ, Langer JE, Kelz RR, Wachtel H. Assessing the Frequency of Deferrable Thyroid Nodule Biopsies to De-escalate Low-Value Care. Endocr Pract 2024; 30:305-310. [PMID: 38160939 PMCID: PMC10990838 DOI: 10.1016/j.eprac.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Thyroid nodules are common, yet fewer than 1 in 10 harbors malignancy. When present, thyroid cancer is typically indolent with excellent survival. Therefore, patients who are not candidates for thyroid cancer treatment due to comorbid disease may not require further thyroid nodule evaluation. The goal of this study was to determine the rate of deferrable thyroid nodule biopsies in patients with limited life expectancy. METHODS We identified patients who underwent thyroid fine needle aspiration (FNA) between 2015 and 2018 at our institution. The primary outcome was the number of deferrable FNAs, defined as FNAs performed in patients who died within 2 years after biopsy. Secondary outcomes included cytologic Bethesda score, procedure costs, and final diagnosis on surgical pathology. Multivariable logistic and Cox proportional hazards regressions were used to evaluate factors associated with FNA in patients with limited life expectancy. RESULTS A total of 2565 FNAs were performed. Most patients were female (79%), and 37 (1.5%) patients died within 2 years. Nonthyroid specialists were significantly more likely to order deferrable FNAs (odds ratio 4.13, P < .001). Of the patients who died within 2 years, most (78%) had a concomitant diagnosis of nonthyroid cancer, and 4 went on to have thyroid surgery (Bethesda scores: 3, 4, 4, and 6). Spending associated with deferrable FNAs and subsequent surgery totaled over $98 000. CONCLUSIONS Overall, the rate of deferrable thyroid nodule biopsies was low. However, there is an opportunity to reduce low-value biopsies in patients with a concurrent nonthyroid cancer by partnering with oncology providers.
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Affiliation(s)
- Maya Alexis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara P Ginzberg
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Susan J Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jill E Langer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Wang F, Lin Y, Xu J, Wei F, Huang S, Wen S, Zhou H, Jiang Y, Wang H, Ling W, Li X, Yang X. Risk of papillary thyroid carcinoma and nodular goiter associated with exposure to semi-volatile organic compounds: A multi-pollutant assessment based on machine learning algorithms. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 915:169962. [PMID: 38219999 DOI: 10.1016/j.scitotenv.2024.169962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Exposure to semi-volatile organic compounds (SVOCs) may link to thyroid nodule risk, but studies of mixed-SVOCs exposure effects are lacking. Traditional analytical methods are inadequate for dealing with mixed exposures, while machine learning (ML) seems to be a good way to fill the gaps in the field of environmental epidemiology research. OBJECTIVES Different ML algorithms were used to explore the relationship between mixed-SVOCs exposure and thyroid nodule. METHODS A 1:1:1 age- and gender-matched case-control study was conducted in which 96 serum SVOCs were measured in 50 papillary thyroid carcinoma (PTC), 50 nodular goiters (NG), and 50 controls. Different ML techniques such as Random Forest, AdaBoost were selected based on their predictive power, and variables were selected based on their weights in the models. Weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) were used to assess the mixed effects of the SVOCs exposure on thyroid nodule. RESULTS Forty-three of 96 SVOCs with detection rate >80 % were included in the analysis. ML algorithms showed a consistent selection of SVOCs associated with thyroid nodule. Fluazifop-butyl and fenpropathrin are positively associated with PTC and NG in single compound models (all P < 0.05). WQS model shows that exposure to mixed-SVOCs was associated with an increased risk of PTC and NG, with the mixture dominated by fenpropathrin, followed by fluazifop-butyl and propham. In the BKMR model, mixtures showed a significant positive association with thyroid nodule risk at high exposure levels, and fluazifop-butyl showed positive effects associated with PTC and NG. CONCLUSION This study confirms the feasibility of ML methods for variable selection in high-dimensional complex data and showed that mixed exposure to SVOCs was associated with increased risk of PTC and NG. The observed association was primarily driven by fluazifop-butyl and fenpropathrin. The findings warranted further investigation.
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Affiliation(s)
- Fei Wang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yuanxin Lin
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Jianing Xu
- Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China; School of Electronic Engineering, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Fugui Wei
- Department of Head and Neck Surgery, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Simei Huang
- School of Science, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Shifeng Wen
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Huijiao Zhou
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yuwei Jiang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Haoyu Wang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Wenlong Ling
- Department of Thyroid Surgery, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Xiangzhi Li
- Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China; Department of Public Health, School of Medicine, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Xiaobo Yang
- Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory on Precise Prevention and Treatment for Thyroid Tumor, The Second Affiliated Hospital, Guangxi University of Science and Technology, Liuzhou, Guangxi, China.
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Giovanella L, Campennì A, Tuncel M, Petranović Ovčariček P. Integrated Diagnostics of Thyroid Nodules. Cancers (Basel) 2024; 16:311. [PMID: 38254799 PMCID: PMC10814240 DOI: 10.3390/cancers16020311] [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: 12/23/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Thyroid nodules are common findings, particularly in iodine-deficient regions. Our paper aims to revise different diagnostic tools available in clinical thyroidology and propose their rational integration. We will elaborate on the pros and cons of thyroid ultrasound (US) and its scoring systems, thyroid scintigraphy, fine-needle aspiration cytology (FNAC), molecular imaging, and artificial intelligence (AI). Ultrasonographic scoring systems can help differentiate between benign and malignant nodules. Depending on the constellation or number of suspicious ultrasound features, a FNAC is recommended. However, hyperfunctioning thyroid nodules are presumed to exclude malignancy with a very high negative predictive value (NPV). Particularly in regions where iodine supply is low, most hyperfunctioning thyroid nodules are seen in patients with normal thyroid-stimulating hormone (TSH) levels. Thyroid scintigraphy is essential for the detection of these nodules. Among non-toxic thyroid nodules, a careful application of US risk stratification systems is pivotal to exclude inappropriate FNAC and guide the procedure on suspicious ones. However, almost one-third of cytology examinations are rendered as indeterminate, requiring "diagnostic surgery" to provide a definitive diagnosis. 99mTc-methoxy-isobutyl-isonitrile ([99mTc]Tc-MIBI) and [18F]fluoro-deoxy-glucose ([18F]FDG) molecular imaging can spare those patients from unnecessary surgeries. The clinical value of AI in the evaluation of thyroid nodules needs to be determined.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco SA, Clinica Moncucco, 6900 Lugano, Switzerland
- Clinic for Nuclear Medicine, University Hospital Zürich, 8004 Zürich, Switzerland
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98100 Messina, Italy;
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, 06230 Ankara, Turkey;
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10 000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
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Lai M, Feng B, Yao J, Wang Y, Pan Q, Chen Y, Chen C, Feng N, Shi F, Tian Y, Gao L, Xu D. Value of Artificial Intelligence in Improving the Accuracy of Diagnosing TI-RADS Category 4 Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2413-2421. [PMID: 37652837 DOI: 10.1016/j.ultrasmedbio.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Considerable heterogeneity is observed in the malignancy rates of thyroid nodules classified as category 4 according to the Thyroid Imaging Reporting and Data System (TI-RADS). This study was aimed at comparing the diagnostic performance of artificial intelligence algorithms and radiologists with different experience levels in distinguishing benign and malignant TI-RADS 4 (TR4) nodules. METHODS Between January 2019 and September 2022, 1117 TR4 nodules with well-defined pathological findings were collected for this retrospective study. An independent external data set of 125 TR4 nodules was incorporated for testing purposes. Traditional feature-based machine learning (ML) models, deep convolutional neural networks (DCNN) models and a fusion model that integrated the prediction outcomes from all models were used to classify benign and malignant TR4 nodules. A fivefold cross-validation approach was employed, and the diagnostic performance of each model and radiologists was compared. RESULTS In the external test data set, the area under the receiver operating characteristic curve (AUROC) of the three DCNN-based secondary transfer learning models-InceptionV3, DenseNet121 and ResNet50-were 0.852, 0.837 and 0.856, respectively. These values were higher than those of the three traditional ML models-logistic regression, multilayer perceptron and random forest-at 0.782, 0.790, and 0.767, respectively, and higher than that of an experienced radiologist (0.815). The fusion diagnostic model we developed, with an AUROC of 0.880, was found to outperform the experienced radiologist in diagnosing TR4 nodules. CONCLUSION The integration of artificial intelligence algorithms into medical imaging studies could improve the accuracy of identifying high-risk TR4 nodules pre-operatively and have significant clinical application potential.
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Affiliation(s)
- Min Lai
- Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Taizhou Cancer Hospital, Taizhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China
| | - Bojian Feng
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Jincao Yao
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Yifan Wang
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China
| | - Qianmeng Pan
- Taizhou Cancer Hospital, Taizhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China
| | - Yuhang Chen
- Zhejiang Gongshang University, Hangzhou, China
| | - Chen Chen
- Taizhou Cancer Hospital, Taizhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China; Graduate School, Wannan Medical College, Wuhu, China
| | - Na Feng
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China
| | - Fang Shi
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, China
| | - Yuan Tian
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, China
| | - Lu Gao
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, China
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou, China; Taizhou Cancer Hospital, Taizhou, China; Key Laboratory of Minimally Invasive Interventional Therapy and Big Data Artificial Intelligence in Medicine of Taizhou, Taizhou, China; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China.
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Yan Y, Dong J, Li S, Yang G, Huang K, Tian W, Su J, Zhang Z. Risk factors associated with the prevalence of thyroid nodules in adults in Northeast China: a cross-sectional population-based study. BMJ Open 2023; 13:e069390. [PMID: 37907298 PMCID: PMC10619099 DOI: 10.1136/bmjopen-2022-069390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES This study examined the association between anthropometric measurements, lifestyle factors and the prevalence of thyroid nodules among adults in Northeast China. DESIGN We employed a cross-sectional approach involving a questionnaire survey, which focused on participants' living habits, and a physical examination that included anthropometry and ultrasound imaging. SETTING The data were procured during multiple trips by medical teams from the first hospital of China Medical University to towns in Northeast China. PARTICIPANTS Of the 1092 participants, 489 did not have thyroid nodules (mean age: 54.02±11.49 years; 297 females (60.7%)), 99 had single thyroid nodules (mean age: 58.19±10.77 years; 59 females (59.6%)) and 504 had multiple thyroid nodules (mean age: 60.05±10.68 years; 394 females (78.2%)). Inclusion criteria mandated participants be over 20 years old without other medical conditions. We excluded individuals who had undergone surgical resection for thyroid nodules. RESULTS The prevalence of thyroid nodules was significantly associated with being female (OR 2.569, 95% CI 1.937 to 3.405, p<0.001) and increased age (OR 1.054, 95% CI 1.041 to 1.066, p<0.001). This association was more pronounced in those with multiple thyroid nodules. For males under 60, non-smoking was inversely correlated with the prevalence of multiple thyroid nodules (OR 0.321, 95%CI 0.149 to 0.69, p<0.05). For females under 60, diastolic blood pressure (DBP) was significantly linked with the prevalence of thyroid nodules (OR 0.978, 95% CI 2.614 to 2.705, p<0.05). CONCLUSIONS Besides gender and age, the prevalence of thyroid nodules in Northeast China correlates with smoking habits and DBP.
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Affiliation(s)
- Yudie Yan
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Junhe Dong
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shufeng Li
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guochun Yang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kunbo Huang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wen Tian
- Department of Geriatric, the First Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China
| | - Jingtong Su
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Zhen Zhang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Jin Z, Pei S, Shen H, Ouyang L, Zhang L, Mo X, Chen Q, You J, Zhang S, Zhang B. Comparative Study of C-TIRADS, ACR-TIRADS, and EU-TIRADS for Diagnosis and Management of Thyroid Nodules. Acad Radiol 2023; 30:2181-2191. [PMID: 37230821 DOI: 10.1016/j.acra.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 05/27/2023]
Abstract
RATIONALE AND OBJECTIVES Chinese Thyroid Imaging Reporting and Data Systems (C-TIRADS) was developed to provide a more simplified tool for stratifying thyroid nodules. Here we aimed to validate the efficacy of C-TIRADS in distinguishing benign from malignant and in guiding fine-needle aspiration biopsies in comparison with the American College of Radiology TIRADS (ACR-TIRADS) and European TIRADS (EU-TIRADS). MATERIALS AND METHODS This study retrospectively included 3438 thyroid nodules (≥10 mm) in 3013 patients (mean age, 47.1 years ± 12.9) diagnosed between January 2013 and November 2019. Ultrasound features of the nodules were evaluated and categorized according to the lexicons of the three TIRADS. We compared these TIRADS by using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), sensitivity, specificity, net reclassification improvement (NRI), and unnecessary fine-needle aspiration biopsy (FNAB) rate. RESULTS Of the 3438 thyroid nodules, 707 (20.6%) were malignant. C-TIRADS showed higher discrimination performance (AUROC, 0.857; AUPRC, 0.605) than ACR-TIRADS (AUROC, 0.844; AUPRC, 0.567) and EU-TIRADS (AUROC, 0.802; AUPRC, 0.455). The sensitivity of C-TIRADS (85.3%) was lower than that of ACR-TIRADS (89.1%) but higher than that of EU-TIRADS (78.4%). The specificity of C-TIRADS (76.9%) was similar to that of EU-TIRADS (78.9%) and higher than that of ACR-TIRADS (69.5%). The unnecessary FNAB rate was lowest with C-TIRADS (21.2%), followed by ACR-TIRADS (41.7%) and EU-TIRADS (58.3%). C-TIRADS obtained significant NRI for recommending FNAB over ACR-TIRADS (19.0%, P < 0.001) and EU-TIRADS (25.5%, P < 0.001). CONCLUSION C-TIRADS may be a clinically applicable tool to manage thyroid nodules, which warrants thorough tests in other geographic settings.
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Affiliation(s)
- Zhe Jin
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.)
| | - Shufang Pei
- Department of Ultrasound, Guangdong Provincial People's Hospital/ Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China (S.P.)
| | - Hui Shen
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.)
| | - Lizhu Ouyang
- Department of Ultrasound, Shunde Hospital of Southern Medical University, Foshan, China (L.O.)
| | - Lu Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.)
| | - Xiaokai Mo
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.)
| | - Qiuying Chen
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.)
| | - Jingjing You
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.)
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.)
| | - Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (Z.J., H.S., L.Z., X.M., Q.C., J.Y., S.Z., B.Z.).
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9
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Yang L, Li C, Chen Z, He S, Wang Z, Liu J. Diagnostic efficiency among Eu-/C-/ACR-TIRADS and S-Detect for thyroid nodules: a systematic review and network meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1227339. [PMID: 37720531 PMCID: PMC10501732 DOI: 10.3389/fendo.2023.1227339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Background The performance in evaluating thyroid nodules on ultrasound varies across different risk stratification systems, leading to inconsistency and uncertainty regarding diagnostic sensitivity, specificity, and accuracy. Objective Comparing diagnostic performance of detecting thyroid cancer among distinct ultrasound risk stratification systems proposed in the last five years. Evidence acquisition Systematic search was conducted on PubMed, EMBASE, and Web of Science databases to find relevant research up to December 8, 2022, whose study contents contained elucidation of diagnostic performance of any one of the above ultrasound risk stratification systems (European Thyroid Imaging Reporting and Data System[Eu-TIRADS]; American College of Radiology TIRADS [ACR TIRADS]; Chinese version of TIRADS [C-TIRADS]; Computer-aided diagnosis system based on deep learning [S-Detect]). Based on golden diagnostic standard in histopathology and cytology, single meta-analysis was performed to obtain the optimal cut-off value for each system, and then network meta-analysis was conducted on the best risk stratification category in each system. Evidence synthesis This network meta-analysis included 88 studies with a total of 59,304 nodules. The most accurate risk category thresholds were TR5 for Eu-TIRADS, TR5 for ACR TIRADS, TR4b and above for C-TIRADS, and possible malignancy for S-Detect. At the best thresholds, sensitivity of these systems ranged from 68% to 82% and specificity ranged from 71% to 81%. It identified the highest sensitivity for C-TIRADS TR4b and the highest specificity for ACR TIRADS TR5. However, sensitivity for ACR TIRADS TR5 was the lowest. The diagnostic odds ratio (DOR) and area under curve (AUC) were ranked first in C-TIRADS. Conclusion Among four ultrasound risk stratification options, this systemic review preliminarily proved that C-TIRADS possessed favorable diagnostic performance for thyroid nodules. Systematic review registration https://www.crd.york.ac.uk/prospero, CRD42022382818.
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Affiliation(s)
- Longtao Yang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cong Li
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhe Chen
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shaqi He
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyuan Wang
- Department of Ultrasound, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
- Department of Radiology Quality Control Center in Hunan Province, Changsha, China
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10
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Zhang X, Wang X, Liu J, Xu Y, Zhang J, Li Q. Relationship between complications of type 2 diabetes and thyroid nodules. Curr Med Res Opin 2023; 39:1069-1075. [PMID: 37469040 DOI: 10.1080/03007995.2023.2239029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/08/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Recent evidence suggests that diabetes is a risk factor for thyroid nodules. However, the relationship between complications of type 2 diabetes and the risk of thyroid nodules remains unclear. This present study aims to investigate the association between thyroid nodules and complications of type 2 diabetes. METHODS This retrospective study collected 4696 adult inpatients with type 2 diabetes between January 2021 and December 2021. The complications examined in this paper included diabetic nephropathy, peripheral neuropathy, eye disorder, and peripheral vascular disease. RESULTS A total of 4696 patients with type 2 diabetes participated in the study, of whom 19.6% had thyroid nodules. Among all the complications, eye disorder had the highest incidence of thyroid nodules (incidence rate, 29.4%; 95% CI, 26.23%-32.51%). The prevalence of thyroid nodules was lower among patients without complications (incidence rate, 14.1%; 95% CI, 12.48% -15.67%) compared to patients who had complications (incidence rate, 23.1%; 95% CI, 21.59%-24.68%) (p < 0.001). Logistic regression revealed that peripheral neuropathy (adjusted OR, 1.6; 95% CI, 1.4-1.9), eye disorder (adjusted OR, 1.8; 95% CI, 1.5-2.2), and peripheral vascular disease (adjusted OR, 1.8; 95% CI, 1.6-2.1) were all significantly associated with an increased risk of thyroid nodules. However, no significant correlation was found between diabetic nephropathy and the risk of thyroid nodules. CONCLUSION One of the key findings of this study is that type 2 diabetes without complications is negatively correlated with the risk of thyroid nodules, while several complications are associated with a significantly increased risk of thyroid nodules.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Jian Liu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuying Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiwei Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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11
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Song Z, Li Q, Zhang D, Li X, Yu J, Liu Q, Li Z, Huang J, Zhang X, Tang Z. Nomogram based on spectral CT quantitative parameters and typical radiological features for distinguishing benign from malignant thyroid micro-nodules. Cancer Imaging 2023; 23:13. [PMID: 36703218 PMCID: PMC9878766 DOI: 10.1186/s40644-023-00525-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To analyse the predictive effect of a nomogram combining dual-layer spectral computed tomography (DSCT) quantitative parameters with typical radiological features in distinguishing benign micro-nodule from thyroid microcarcinoma (TMC). METHODS Data from 342 instances with thyroid micro-nodules (≤1 cm) who underwent DSCT (benign group: n = 170; malignant group: n = 172) were reviewed. Typical radiological features including micro-calcification and enhanced blurring, and DSCT quantitative parameters including attenuation on virtual monoenergetic images (40 keV, 70 keV and 100 keV), the slope of the spectral HU curve (λHU), normalized iodine concentration (NIC), and normalized effective atomic number (NZeff) in the arterial phase (AP) and venous phase (VP), were measured and compared between the benign and malignant groups. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of significant quantitative DSCT parameters or the models combining DSCT parameters respectively and typical radiological features based on multivariate logistic regression (LR) analysis. A nomogram was developed using predictors with the highest diagnostic performance in the above model, as determined by multivariate LR analysis. RESULTS The DSCT parameter APλHU showed the greatest diagnostic efficiency in identifying patients with TMC, with an area under the ROC curve (AUC) of 0.829, a sensitivity and specificity of 0.738 and 0.753, respectively. Then, APλHU was combined with the two radiological features to construct the DSCT-Radiological nomogram, which had an AUC of 0.858, a sensitivity of 0.791 and a specificity of 0.800. The calibration curve of the nomogram demonstrated that the prediction result was in good agreement with the actual observation. The decision curve revealed that the nomogram can result in a greater net benefit than the all/none-intervention strategy for all threshold probabilities. CONCLUSION As a valid and visual noninvasive prediction tool, the DSCT-Radiological nomogram incorporating DSCT quantitative parameters and radiological features shows favourable predictive efficiency for identifying benign and malignant thyroid micro-nodules.
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Affiliation(s)
- Zuhua Song
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Qian Li
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Qian Liu
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Zongwen Li
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Jie Huang
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Xiaodi Zhang
- Philips Healthcare, Chengdu branch, Chengdu, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
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12
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Gao X, Ran X, Ding W. The progress of radiomics in thyroid nodules. Front Oncol 2023; 13:1109319. [PMID: 36959790 PMCID: PMC10029726 DOI: 10.3389/fonc.2023.1109319] [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: 11/27/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Due to the development of Artificial Intelligence (AI), Machine Learning (ML), and the improvement of medical imaging equipment, radiomics has become a popular research in recent years. Radiomics can obtain various quantitative features from medical images, highlighting the invisible image traits and significantly enhancing the ability of medical imaging identification and prediction. The literature indicates that radiomics has a high potential in identifying and predicting thyroid nodules. So in this article, we explain the development, definition, and workflow of radiomics. And then, we summarize the applications of various imaging techniques in identifying benign and malignant thyroid nodules, predicting invasiveness and metastasis of thyroid lymph nodes, forecasting the prognosis of thyroid malignancies, and some new advances in molecular level and deep learning. The shortcomings of this technique are also summarized, and future development prospects are provided.
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Affiliation(s)
| | - Xuan Ran
- *Correspondence: Wei Ding, ; Xuan Ran,
| | - Wei Ding
- *Correspondence: Wei Ding, ; Xuan Ran,
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13
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Lian D, Chen W, Chen G, Liu C, Du D, Zhang N. Comparison between cutting versus retraction of anterior cervical musculature during endoscopic thyroidectomy. Medicine (Baltimore) 2022; 101:e29673. [PMID: 36401391 PMCID: PMC9678569 DOI: 10.1097/md.0000000000029673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
To compare the different techniques of managing the anterior cervical muscle group during endoscopic thyroidectomy via the trans-thoraco-areolar approach. A total of 90 patients with thyroid tumors less than 3 cm were evaluated. The time for each intraoperative step, total surgery duration, intraoperative blood loss volume, pathology results, number of lymph nodes dissected and patient satisfaction with esthetics were assessed. Intraoperative blood loss volume, drainage volume on the first postoperative day, number of lymph nodes dissected in the central region, postoperative hospitalization duration, number of transient laryngeal nerve palsy cases, and number of transient hypocalcemia cases were similar between the muscle transection (MT) and muscle retraction (MR) groups. The MT group had significantly higher postoperative pain scores after 12 hours, but pain scores at 48 hours postoperatively were not significantly different between the 2 groups. In the unilateral thyroidectomy subgroup, the durations of isthmus resection, freeing the lateral thyroid, exposing the laryngeal recurrent nerve, and management of the inferior pole were similar for both muscle management methods. The muscle dissection and suture time was significantly longer for the MT group than that for the MR group; in contrast, the upper pole management time of the muscle resection group was significantly shorter. In the bilateral resection subgroup, both muscle management methods required similar durations for managing the contralateral upper pole after ipsilateral thyroidectomy. However, intraoperative blood loss was significantly higher for MR than for MT, while postoperative pain was relatively mild. In the malignant tumor subgroup, duration of inferior thyroid pole management was significantly less for MT than for MR. There are significant differences between the 2 muscle management methods in handling and suturing muscles. Both methods have satisfactory postoperative outcomes for resection of thyroid nodules with diameters ≤3 cm. For tumors located in the upper pole, transection of the anterior cervical muscles confers higher feasibility of the thyroidectomy technique; however, suturing becomes difficult in such scenarios.
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Affiliation(s)
- Dongbo Lian
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Weijian Chen
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Guanyang Chen
- Department of Gastroenterology, Liver and Gallbladder Surgery, Peking University Ninth School of Clinical Medicine, Beijing, PR China
| | - Chen Liu
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Dexiao Du
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Nengwei Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
- *Correspondence: Nengwei Zhang, Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, PR China (e-mail: )
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Seminati D, Mane E, Ceola S, Casati G, Putignano P, Garancini M, Gatti A, Leni D, Pincelli AI, Fusco N, L’Imperio V, Pagni F. An Indeterminate for Malignancy FNA Report Does Not Increase the Surgical Risk of Incidental Thyroid Carcinoma. Cancers (Basel) 2022; 14:cancers14215427. [PMID: 36358845 PMCID: PMC9657155 DOI: 10.3390/cancers14215427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Incidental thyroid carcinomas (ITCs) are a fairly frequent finding in daily routine practice, with papillary thyroid microcarcinoma being the most frequent entity. In our work, we isolated incidental cases arising in thyroids removed for other cytologically indeterminate and histologically benign nodules. We retrospectively retrieved cases with available thyroid Fine Needle Aspiration (FNA, 3270 cases), selecting those with an indeterminate cytological diagnosis (Bethesda classes III−IV, 652 cases). Subsequently, we restricted the analysis to surgically treated patients (163 cases) finding an incidental thyroid carcinoma in 22 of them. We found a 13.5% ITC rate, with ITCs representing 46.8% of all cancer histologically diagnosed in this indeterminate setting. Patients received a cytological diagnosis of Bethesda class III and IV in 41% and 59% of cases, respectively. All ITC cases turned out to be papillary thyroid microcarcinomas; 36% of cases were multifocal, with foci bilaterally detected in 50% of cases. We found an overall ITC rate concordant with the literature and with our previous findings. The assignment of an indeterminate category to FNA did not increase the risk of ITCs in our cohort. Rather, a strong statistical significance (p < 0.01) was found comparing the larger size of nodules that underwent FNA and the smaller size of their corresponding ITC nodule.
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Affiliation(s)
- Davide Seminati
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
- Correspondence:
| | - Eltjona Mane
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Stefano Ceola
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Gabriele Casati
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Pietro Putignano
- Endocrinology, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | | | - Andrea Gatti
- Surgery, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Davide Leni
- Radiology ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | | | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Vincenzo L’Imperio
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Fabio Pagni
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
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15
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Zhu X, Wang J, Wang YC, Zhu ZF, Tang J, Wen XW, Fang Y, Han J. Quantitative differentiation of malignant and benign thyroid nodules with multi-parameter diffusion-weighted imaging. World J Clin Cases 2022; 10:8587-8598. [PMID: 36157818 PMCID: PMC9453341 DOI: 10.12998/wjcc.v10.i24.8587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/25/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The value of conventional magnetic resonance imaging in the differential diagnosis of thyroid nodules is limited; however, the value of multi-parameter diffusion-weighted imaging (DWI) in the quantitative evaluation of thyroid nodules has not been well determined.
AIM To determine the utility of multi-parametric DWI including mono-exponential, bi-exponential, stretched exponential, and kurtosis models for the differentiation of thyroid lesions.
METHODS Seventy-nine patients (62 with benign and 17 with malignant nodules) underwent multi-b value diffusion-weighted imaging of the thyroid. Multiple DWI parameters were obtained for statistical analysis.
RESULTS Good agreement was found for diffusion parameters of thyroid nodules. Malignant lesions displayed lower diffusion parameters including apparent diffusion coefficient (ADC), the true diffusion coefficient (D), the perfusion fraction (f), the distributed diffusion coefficient (DDC), the intravoxel water diffusion heterogeneity (α) and kurtosis model-derived ADC (Dapp), and higher apparent diffusional kurtosis (Kapp) than benign entities (all P < 0.01), except for the pseudodiffusion coefficient (D*) (P > 0.05). The area under the ROC curve (AUC) of the ADC(0 and 1000) was not significantly different from that of the ADC(0 and 2000), ADC(0 to 2000), ADC(0 to 1000), D, DDC, Dapp and Kapp (all P > 0.05), but was significantly higher than the AUC of D*, f and α (all P < 0.05) for differentiating benign from malignant lesions.
CONCLUSION Multiple DWI parameters including ADC, D, f, DDC, α, Dapp and Kapp could discriminate benign and malignant thyroid nodules. The metrics including D, DDC, Dapp and Kapp provide additional information with similar diagnostic performance of ADC, combination of these metrics may contribute to differentiate benign and malignant thyroid nodules. The ADC calculated with higher b values may not lead to improved diagnostic performance.
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Affiliation(s)
- Xiang Zhu
- Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jia Wang
- Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yan-Chun Wang
- Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Ze-Feng Zhu
- Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jian Tang
- Department of Head and Neck Surgery, the First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Xiao-Wei Wen
- Department of Pathology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Ying Fang
- Department of Pathology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jun Han
- Department of Radiology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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Santos MT, Rodrigues BM, Shizukuda S, Oliveira AF, Oliveira M, Figueiredo DLA, Melo GM, Silva RA, Fainstein C, Dos Reis GF, Corbo R, Ramos HE, Camacho CP, Vaisman F, Vaisman M. Clinical decision support analysis of a microRNA-based thyroid molecular classifier: A real-world, prospective and multicentre validation study. EBioMedicine 2022; 82:104137. [PMID: 35785619 PMCID: PMC9254359 DOI: 10.1016/j.ebiom.2022.104137] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marcos Tadeu Santos
- Research and Development (R&D), Onkos Molecular Diagnostics, Ribeirão Preto, SP, Brazil; Molecular Oncology Research Centre, Barretos Cancer Hospital, Barretos, SP, Brazil.
| | | | - Satye Shizukuda
- Research and Development (R&D), Onkos Molecular Diagnostics, Ribeirão Preto, SP, Brazil
| | - Andrei Félix Oliveira
- Research and Development (R&D), Onkos Molecular Diagnostics, Ribeirão Preto, SP, Brazil
| | - Miriane Oliveira
- Research and Development (R&D), Onkos Molecular Diagnostics, Ribeirão Preto, SP, Brazil
| | | | - Giulianno Molina Melo
- Otorhinolaryngology, Head and Neck Surgery, Paulista Medical School/UNIFESP, São Paulo, SP, Brazil; Head and Neck Surgery, The Portuguese Beneficence of São Paulo (BP), São Paulo, SP, Brazil
| | | | - Claudio Fainstein
- General Surgery, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | | | - Rossana Corbo
- Endocrinology, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | | | | | - Fernanda Vaisman
- Endocrinology, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil; Endocrinology, Medical School, Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mário Vaisman
- Endocrinology, Medical School, Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, RJ, Brazil
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Jiang L, Chen J, Huang H, Wu J, Zhang J, Lan X, Liu D, Zhang J. Comparison of the Differential Diagnostic Performance of Intravoxel Incoherent Motion Imaging and Diffusion Kurtosis Imaging in Malignant and Benign Thyroid Nodules. Front Oncol 2022; 12:895972. [PMID: 35936691 PMCID: PMC9354485 DOI: 10.3389/fonc.2022.895972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to compare the diagnostic capacity between IVIM and DKI in differentiating malignant from benign thyroid nodules. Material and Methods This study is based on magnetic resonance imaging data of the thyroid with histopathology as the reference standard. Spearman analysis was used to assess the relationship of IVIM-derived parameters D, f, D* and the DKI-derived parameters Dapp and Kapp. The parameters of IVIM and DKI were compared between the malignant and benign groups. Binary logistic regression analysis was performed to establish the diagnostic model, and receiver operating characteristic (ROC) curve analysis was subsequently performed. The DeLong test was used to compare the diagnostic effectiveness of different prediction models. Spearman analysis was used to assess the relationship of Ki-67 expression and parameters of IVIM and DKI. Results Among the 93 nodules, 46 nodules were malignant, and 47 nodules were benign. The Dapp of DKI-derived parameter was related to the D (P < 0.001, r = 0.863) of IVIM-derived parameter. The Kapp of DKI-derived parameter was related to the D (P < 0.001, r = -0.831) of IVIM-derived parameters. The malignant group had a significantly lower D value (P < 0.001) and f value (P = 0.013) than the benign group. The malignant group had significantly higher Kapp and lower Dapp values (all P < 0.001). The D+f had an area under the curve (AUC) of 0.951. The Dapp+Kapp had an AUC of 0.943. The D+f+Dapp+Kapp had an AUC of 0.954. The DeLong test showed no statistical significance among there prediction models. The D (P = 0.007) of IVIM-derived parameters and Dapp (P = 0.045) of DKI-derived parameter were correlated to the Ki-67 expression. Conclusions IVIM and DKI were alternative for each other in in differentiating malignant from benign thyroid nodules.
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Affiliation(s)
- Liling Jiang
- Department of Radiology, Cancer Hospital, Chongqing University, Chongqing, China
| | - Jiao Chen
- Department of Radiology, Cancer Hospital, Chongqing University, Chongqing, China
| | - Haiping Huang
- Department of Pathology, Cancer Hospital, Chongqing University, Chongqing, China
| | - Jian Wu
- Head and Neck Cancer Center, Cancer Hospital, Chongqing University, Chongqing, China
| | - Junbin Zhang
- Head and Neck Cancer Center, Cancer Hospital, Chongqing University, Chongqing, China
| | - Xiaosong Lan
- Department of Radiology, Cancer Hospital, Chongqing University, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Cancer Hospital, Chongqing University, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Cancer Hospital, Chongqing University, Chongqing, China
- *Correspondence: Jiuquan Zhang,
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Zhang Z, Lin N. Clinical diagnostic value of American College of Radiology thyroid imaging report and data system in different kinds of thyroid nodules. BMC Endocr Disord 2022; 22:145. [PMID: 35642030 PMCID: PMC9158315 DOI: 10.1186/s12902-022-01053-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the diagnostic value of American College of Radiology (ACR) score and ACR Thyroid Imaging Report and Data System (TI-RADS) for benign nodules, medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) through comparing with Kwak TI-RADS. METHODS Five hundred nine patients diagnosed with PTC, MTC or benign thyroid nodules were included and classified into the benign thyroid nodules group (n = 264), the PTC group (n = 189) and the MTC group (n = 56). The area under the curve (AUC) values were analyzed and the receiver operator characteristic (ROC) curves were drawn to compare the diagnostic efficiencies of ACR score, ACR TI-RADS and KWAK TI-RADS on benign thyroid nodules, MTC and PTC. RESULTS The AUC values of ACR score, ACR TI-RADS and Kwak TI-RADS for distinguishing malignant nodules from benign nodules were 0.914 (95%CI: 0.886-0.937), 0.871 (95%CI: 0.839-0.899) and 0.885 (95%CI: 0.854-0.911), respectively. In distinguishing of patients with MTC from PTC, the AUC values of ACR score, ACR TI-RADS and Kwak TI-RADS were 0.650 (95%CI: 0.565-0.734), 0.596 (95%CI: 0.527-0.664), and 0.613 (95%CI: 0.545-0.681), respectively. The AUC values of ACR score, ACR TI-RADS and Kwak TI-RADS for the discrimination of patients with MTC, PTC or benign nodules from patients without MTC, PTC or benign nodules were 0.899 (95%CI: 0.882-0.915), 0.865 (95%CI: 0.846-0.885), and 0.873 (95%CI: 0.854-0.893), respectively. CONCLUSION The ACR score performed the best, followed ex aequo by the ACR and Kwak TI-RADS in discriminating patients with malignant nodules from benign nodules and patients with MTC from PTC.
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Affiliation(s)
- Ziwei Zhang
- Ultrasonography Department, Fujian Provincial Hospital, 134 Fuzhou East Street, Fuzhou, 350001, China
| | - Ning Lin
- Ultrasonography Department, Fujian Provincial Hospital, 134 Fuzhou East Street, Fuzhou, 350001, China.
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Manta R, Delbart W, Duran Derijckere I, Quiriny M, Demetter P, Flamen P, Karfis I. Suspicious cold thyroid nodule with intense focal 68Ga-DOTATATE uptake: a case report. Eur J Hybrid Imaging 2022; 6:8. [PMID: 35437615 PMCID: PMC9016104 DOI: 10.1186/s41824-022-00126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
A 51-year-old male was found with bilateral thyroid nodules on ultrasonography neck imaging. The largest nodule, measuring 23 × 26 × 35 mm, was located in the left lobe and was classified as EU-TIRADS 4. Thyroid function tests were normal, as were serum levels of parathormone, Chromogranin A, carcinoembryonic antigen and calcitonin. The nodule was cold on thyroid scintigraphy. Fine-needle aspiration of the nodule did not demonstrate cellular atypia. High focal uptake was found on both 111In-DTPA-octreotide scintigraphy and 68Ga-DOTATATE PET/CT. Histopathological analysis showed a microfollicular adenoma without malignancy. Immunohistochemical staining did not suggest neuroendocrine neoplasia or C cell hyperplasia. However, high expression of somatostatin receptor 2 (SSTR2) was observed in the microfollicular adenoma compared to the surrounding healthy tissue, with predominant localization in the endothelial cells and at the secretory pole of the thyroid epithelial cells in contact with blood vessels. High focal thyroid uptake on 68Ga-DOTATATE PET/CT can be observed in benign thyroid nodules due to an overexpression of SSTR by endothelial cells. However, incidental focal thyroid uptake on SSTR imaging requires further investigations to rule out thyroid malignancy.
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Abou Shaar B, Meteb M, Awad El-Karim G, Almalki Y. Reducing the Number of Unnecessary Thyroid Nodule Biopsies With the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS). Cureus 2022; 14:e23118. [PMID: 35425684 PMCID: PMC9004328 DOI: 10.7759/cureus.23118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Thyroid nodules are exceedingly common, occurring in up to 76% of adults. Less than 10% are palpable, and the majority are detected incidentally with an estimated prevalence of 68%, 25%, and 18% using ultrasound (US), CT, and MRI, respectively. The rising use of imaging over the last four decades has led to a significant increase in nodule detection or ‘over-identification,’ fine-needle aspiration (FNA), a higher reported incidence of thyroid cancer, and thyroidectomy. The purpose of this study is to provide a descriptive experience with thyroid nodule FNAs one year prior and one year after the implementation of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) at a prototypical community hospital. Methods A total of 104 patients with 114 thyroid nodules underwent US-guided FNA at Bluewater Health from January 1, 2018, to March 31, 2020, with available cytological results (The Bethesda System). The study population was divided into two cohorts (January 1, 2018, to December 31, 2018 - ‘local best practice cohort’, and March 1, 2019, to March 31, 2020 - ‘ACR TI-RADS cohort’) based on the implementation of the ACR TI-RADS guidelines in March 2019. Results The local best practice cohort (January 1, 2018, to December 31, 2018) comprised 57 thyroid nodules in 52 patients (mean age 66 ± 12; 40 Women). The ACR TI-RADS cohort (March 1, 2019, to March 31, 2020) comprised 57 thyroid nodules in 52 patients (mean age 61 ± 16; 41 Women). There were no statistical differences with respect to age, gender, or thyroid nodule location. Our results show a dramatic decrease in the number of unnecessary FNAs if ACR TI-RADS was implemented from January to December 2018. Thirty (52.6%) of the previously sampled thyroid nodules using the local best practice guidelines would have been followed as per ACR TI-RADS. Conclusion ACR TI-RADS is a reliable classification system in routine practice that significantly reduces the number of unnecessary thyroid FNAs with higher specificity compared to local best practice guidelines.
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21
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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: 2.0] [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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22
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Zhang X, Ze Y, Sang J, Shi X, Bi Y, Shen S, Zhang X, Zhu D. Risk factors and diagnostic prediction models for papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:938008. [PMID: 36133306 PMCID: PMC9483149 DOI: 10.3389/fendo.2022.938008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/15/2022] [Indexed: 12/07/2022] Open
Abstract
Thyroid nodules (TNs) represent a common scenario. More accurate pre-operative diagnosis of malignancy has become an overriding concern. This study incorporated demographic, serological, ultrasound, and biopsy data and aimed to compare a new diagnostic prediction model based on Back Propagation Neural Network (BPNN) with multivariate logistic regression model, to guide the decision of surgery. Records of 2,090 patients with TNs who underwent thyroid surgery were retrospectively reviewed. Multivariate logistic regression analysis indicated that Bethesda category (OR=1.90, P<0.001), TIRADS (OR=2.55, P<0.001), age (OR=0.97, P=0.002), nodule size (OR=0.53, P<0.001), and serum levels of Tg (OR=0.994, P=0.004) and HDL-C (OR=0.23, P=0.001) were statistically significant independent differentiators for patients with PTC and benign nodules. Both BPNN and regression models showed good accuracy in differentiating PTC from benign nodules (area under the curve [AUC], 0.948 and 0.924, respectively). Notably, the BPNN model showed a higher specificity (88.3% vs. 73.9%) and negative predictive value (83.7% vs. 45.8%) than the regression model, while the sensitivity (93.1% vs. 93.9%) was similar between two models. Stratified analysis based on Bethesda indeterminate cytology categories showed similar findings. Therefore, BPNN and regression models based on a combination of demographic, serological, ultrasound, and biopsy data, all of which were readily available in routine clinical practice, might help guide the decision of surgery for TNs.
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Affiliation(s)
- Xiaowen Zhang
- Department of Endocrinology and Metabolism, Endocrine and Metabolic Disease Medical Center, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Yuyang Ze
- Department of Endocrinology and Metabolism, The Fifth People’s Hospital of Suzhou Wujiang, Suzhou, China
| | - Jianfeng Sang
- Department of Thyroid Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Xianbiao Shi
- Department of Thyroid Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Yan Bi
- Department of Endocrinology and Metabolism, Endocrine and Metabolic Disease Medical Center, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Shanmei Shen
- Department of Endocrinology and Metabolism, Endocrine and Metabolic Disease Medical Center, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Xinlin Zhang
- Department of Cardiology, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
- *Correspondence: Xinlin Zhang, ; Dalong Zhu,
| | - Dalong Zhu
- Department of Endocrinology and Metabolism, Endocrine and Metabolic Disease Medical Center, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
- *Correspondence: Xinlin Zhang, ; Dalong Zhu,
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23
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Thyroid Disease. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Sifontes-Dubón M, García-López JM, González-Ortega N, Pazos-Couselo M. Evaluation of a Clinical Pathway for Thyroid Nodular Disease: Timings and Delays in the Diagnosis and Treatment of Thyroid Cancer. J Clin Med 2021; 10:jcm10235681. [PMID: 34884383 PMCID: PMC8658455 DOI: 10.3390/jcm10235681] [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: 09/30/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Due to the high prevalence of nodular thyroid disease in the general population and the need to rule out malignant tumours, a clinical pathway for nodular thyroid disease was created at our tertiary-level hospital. Our study aimed to quantify timings and delays in diagnosis and treatment in this clinical pathway, specifically for patients who were diagnosed with thyroid cancer. Methods: A retrospective review was conducted of patients who were newly diagnosed with thyroid cancer and who had been previously evaluated in the clinical pathway for nodular thyroid disease at our institution during 2015–2017. Patient demographics, previous diagnostic studies, cytological results, tumour details and key dates were analysed to identify wait times in diagnosis and treatment. Results: Forty patients with thyroid cancer were included. The diagnostic delay had a median time of 60 days, and the treatment delay was dependent on cytopathological results. The main cause for delay in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. In the treatment phase, patients with a cytological result of Bethesda III, V or VI underwent surgery at the suggested time, while those in the Bethesda II or IV category did not. Conclusions: The major delay found in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. We are not suggesting that this step must be eliminated, though the implementation of routine ultrasonography in a thyroid clinic can help identify patients who need more urgent evaluation for fine needle aspiration cytology. In our hospital, decision for surgery is based mainly on the cytopathological report. Imaging studies and/or molecular testing could be considered to reduce treatment delays.
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Affiliation(s)
- Mildred Sifontes-Dubón
- Doctoral Programme in Medicine Clinical Research, International PhD School of the University of Santiago de Compostela (EDIUS), 15782 Santiago de Compostela, Spain
- Endocrinology Department, Mateu Orfila General Hospital, 07703 Mahón, Spain
- Correspondence: or ; Tel.: +34-971487325
| | - Jose Manuel García-López
- Endocrinology Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - Marcos Pazos-Couselo
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
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25
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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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Yang P, Huang J, Wang Z, Qian L. A predictive model and survival analysis for local recurrence in differentiated thyroid carcinoma. Minerva Endocrinol (Torino) 2021; 47:286-294. [PMID: 34528778 DOI: 10.23736/s2724-6507.21.03393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Local recurrence (LR) is associated with poor outcome in patients with differentiated thyroid carcinoma (DTC). The aim of this study was to explore potential risk factors for LR and build a predictive model. METHODS The medical data of patients who were diagnosed with DTC after initial surgery in three medical centers (2000-2018) were reviewed. Detailed clinicopathologic characteristics of all cases were identified. RESULTS Multiple factors, including extrathyroidal extension (ETE), histology, symptoms, multifocality, and tumor diameter, were significantly different between the LR and no evidence of disease groups in univariate and multivariate analysis (P ˂ 0.05). Tumor diameter, symptoms, and ETE made the greatest contributions to prognosis according to decision tree analysis and random forest algorithm. The predictive model constructed from these data achieved 98.7% accuracy of classification. A five-fold cross-validation confirmed that the model has 84.7%-89.7% accuracy of classification. Additionally, symptoms and ETE were independent predictors on survival analysis (P ˂ 0.05). CONCLUSIONS This study optimized the weight of risk factors, including tumor diameter, symptoms, ETE, and multifocality, in predicting LR in patients with DTC. Our predictive model provides a strong tool to distinguish between high-risk and low-risk DTC.
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Affiliation(s)
- PeiPei Yang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - JiuPing Huang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - ZhenDong Wang
- Department of Interventional Ultrasound, First Medical Center of Chinese People's Liberation Army, General Hospital, Beijing, China
| | - LinXue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China -
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27
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Lin R, Fogarty CE, Ma B, Li H, Ni G, Liu X, Yuan J, Wang T. Identification of ferroptosis genes in immune infiltration and prognosis in thyroid papillary carcinoma using network analysis. BMC Genomics 2021; 22:576. [PMID: 34315405 PMCID: PMC8314640 DOI: 10.1186/s12864-021-07895-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common thyroid cancer. While many patients survive, a portion of PTC cases display high aggressiveness and even develop into refractory differentiated thyroid carcinoma. This may be alleviated by developing a novel model to predict the risk of recurrence. Ferroptosis is an iron-dependent form of regulated cell death (RCD) driven by lethal accumulation of lipid peroxides, is regulated by a set of genes and shows a variety of metabolic changes. To elucidate whether ferroptosis occurs in PTC, we analyse the gene expression profiles of the disease and established a new model for the correlation. METHODS The thyroid carcinoma (THCA) datasets were downloaded from The Cancer Genome Atlas (TCGA), UCSC Xena and MisgDB, and included 502 tumour samples and 56 normal samples. A total of 60 ferroptosis related genes were summarised from MisgDB database. Gene set enrichment analysis (GSEA) and Gene set variation analysis (GSVA) were used to analyse pathways potentially involving PTC subtypes. Single sample GSEA (ssGSEA) algorithm was used to analyse the proportion of 28 types of immune cells in the tumour immune infiltration microenvironment in THCA and the hclust algorithm was used to conduct immune typing according to the proportion of immune cells. Spearman correlation analysis was performed on the ferroptosis gene expression and the correlation between immune infiltrating cells proportion. We established the WGCNA to identify genes modules that are highly correlated with the microenvironment of immune invasion. DEseq2 algorithm was further used for differential analysis of sequencing data to analyse the functions and pathways potentially involving hub genes. GO and KEGG enrichment analysis was performed using Clusterprofiler to explore the clinical efficacy of hub genes. Univariate Cox analysis was performed for hub genes combined with clinical prognostic data, and the results was included for lasso regression and constructed the risk regression model. ROC curve and survival curve were used for evaluating the model. Univariate Cox analysis and multivariate Cox analysis were performed in combination with the clinical data of THCA and the risk score value, the clinical efficacy of the model was further evaluated. RESULTS We identify two subtypes in PTC based on the expression of ferroptosis related genes, with the proportion of cluster 1 significantly higher than cluster 2 in ferroptosis signature genes that are positively associated. The mutations of Braf and Nras are detected as the major mutations of cluster 1 and 2, respectively. Subsequent analyses of TME immune cells infiltration indicated cluster 1 is remarkably richer than cluster 2. The risk score of THCA is in good performance evaluated by ROC curve and survival curve, in conjunction with univariate Cox analysis and multivariate Cox analysis results based on the clinical data shows that the risk score of the proposed model could be used as an independent prognostic indicator to predict the prognosis of patients with papillary thyroid cancer. CONCLUSIONS Our study finds seven crucial genes, including Ac008063.2, Apoe, Bcl3, Acap3, Alox5ap, Atxn2l and B2m, and regulation of apoptosis by parathyroid hormone-related proteins significantly associated with ferroptosis and immune cells in PTC, and we construct the risk score model which can be used as an independent prognostic index to predict the prognosis of patients with PTC.
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Affiliation(s)
- Ruoting Lin
- Department of Nuclear Medicine, The First Affiliated Hospital/Clinical Medical School, Guangdong Pharmaceutical University, Guangzhou, 510080, Guangdong, China
| | - Conor E Fogarty
- Genecology Research Centre, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
| | - Bowei Ma
- Department of TCM Resident Training, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Hejie Li
- Genecology Research Centre, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia
| | - Guoying Ni
- Department of Nuclear Medicine, The First Affiliated Hospital/Clinical Medical School, Guangdong Pharmaceutical University, Guangzhou, 510080, Guangdong, China.,Genecology Research Centre, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia.,Cancer Research Institute, First People's Hospital of Foshan, Foshan, 528000, Guangdong, China
| | - Xiaosong Liu
- Department of Nuclear Medicine, The First Affiliated Hospital/Clinical Medical School, Guangdong Pharmaceutical University, Guangzhou, 510080, Guangdong, China.,Genecology Research Centre, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia.,Cancer Research Institute, First People's Hospital of Foshan, Foshan, 528000, Guangdong, China
| | - Jianwei Yuan
- Department of Nuclear Medicine, The First Affiliated Hospital/Clinical Medical School, Guangdong Pharmaceutical University, Guangzhou, 510080, Guangdong, China.
| | - Tianfang Wang
- Genecology Research Centre, University of the Sunshine Coast, Maroochydore DC, QLD, 4558, Australia.
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Hekimsoy İ, Öztürk E, Ertan Y, Orman MN, Kavukçu G, Özgen AG, Özdemir M, Özbek SS. Diagnostic performance rates of the ACR-TIRADS and EU-TIRADS based on histopathological evidence. ACTA ACUST UNITED AC 2021; 27:511-518. [PMID: 34313236 DOI: 10.5152/dir.2021.20813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE In this study, we aimed to assess the effectiveness of malignancy stratification algorithms of the American College of Radiology (ACR) and European Thyroid Association (ETA) in the delineation of thyroid nodules using a database of nodules that were unequivocally diagnosed by means of histopathological examination and meticulously matched with the imaged nodules. METHODS A total of 165 patients having 251 thyroid nodules with histopathologically proven definitive diagnoses during a 5-year period were included in this study. All patients had preoperatively undergone ultrasonography (US) examination, and US characteristics of the thyroid nodules were retrospectively analyzed and assigned in compliance with the thyroid imaging reporting and data system categories recommended by the ACR (ACR-TIRADS) and ETA (EU-TIRADS). The diagnostic effectiveness in the delineation of thyroid nodules and unnecessary fine-needle aspiration (FNAB) rates were evaluated. RESULTS Overall, 189 nodules (75.30%) were diagnosed as benign, while 62 nodules (24.70%) were reported to be malignant based on histopathological assessment. Sensitivity and specificity rates were 71% and 75% for ACR-TIRADS and 73% and 80% for EU-TIRADS. The area under the curve values were 0.78 and 0.80 for ACR-TIRADS and EU-TIRADS, respectively. The unnecessary FNAB rates were 61% for ACR-TIRADS and 64% for EU-TIRADS as per the recommended criteria of each algorithm. CONCLUSION The diagnostic performance of both malignancy stratification systems was signified to be moderate and sufficient in a cohort of nodules with definite histopathological diagnosis. In light of our results, we demonstrated the strengths and weaknesses of the ACR- and EU-TIRADS for physicians who should be familiar with them for optimal management of thyroid nodules.
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Affiliation(s)
- İlhan Hekimsoy
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Egemen Öztürk
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Yeşim Ertan
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Nurullah Orman
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gülgün Kavukçu
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Gökhan Özgen
- Department of Internal Medicine, Ege University Faculty of Medicine, İzmir, Turkey
| | - Murat Özdemir
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Süha Süreyya Özbek
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
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Urinary Biomarkers of Phthalates Exposure, Blood Lead Levels, and Risks of Thyroid Nodules. TOXICS 2021; 9:toxics9030068. [PMID: 33810189 PMCID: PMC8005157 DOI: 10.3390/toxics9030068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/23/2022]
Abstract
Thyroid nodules (TNs) are becoming increasingly prevalent. However, few studies have reported the effects of phthalates and lead (Pb) on TNs. In this study, we aimed to explore the associations of phthalates and Pb with the risks of TN. We sex-age-matched 220 TNs patients and 220 healthy controls from Zhejiang Shangyu, China. We measured 13 phthalate metabolites in spot urine samples. Blood lead levels (BLLs) were determined by atomic absorption spectrometry. The multivariable logistic regression models were used to assess the associations between urinary phthalate metabolites and BLLs and the risks of TNs. We found BLLs were associated with increased risk of TNs in total population. Female-specific positive associations of mono-2-ethyl-5-carboxypentylphthalate (MECPP), mono-2-ethyl-5-hydroxyhexylphthalate (MEHHP), mono-2-ethyl-5-oxohexylphthalate (MEOHP), mono-2-carboxymethyl-hexyl phthalate (MCMHP), and mono-isononyl phthalate (MiNP) with increased risk of TNs were also observed. Moreover, the positive association between phthalates and TNs was modified by BLLs. At the highest tertile of BLLs, monoethylphthalate (MEP), MECPP, MEHHP, MEOHP, and MiNP were significantly associated with increased risk of TNs. Our results indicated that certain phthalate metabolites and BLLs may contribute to increased risks of TNs.
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Li X, Lan Y, Li N, Yan L, Xiao J, Zhang M, Luo Y. Ultrasound-Guided Thermal Ablation of Bethesda IV Thyroid Nodules: A Pilot Study. Front Endocrinol (Lausanne) 2021; 12:674970. [PMID: 34504471 PMCID: PMC8421723 DOI: 10.3389/fendo.2021.674970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of our study was to evaluate the effectiveness of thermal ablation (TA) for Bethesda IV thyroid nodules, and to compare TA and surgery in terms of treatment outcomes, complications, and costs. METHOD This study was approved by the local ethics committee. From January 2017 to December 2019, 30 patients elected TA and 31 patients elected surgery for treatment of Bethesda IV thyroid nodules. Demographics information and conventional ultrasound before treatment for each patient was obtained. For the TA group, the ablation extent was 3 mm beyond the edge of the tumor to prevent marginal residual and recurrence. Patients were followed up at 1, 3, and 6 months after intervention, and every 6 months thereafter. Postoperative complications, operation time, hospitalization time, blood loss, and incision length were recorded. RESULTS In the TA group, the volume reduction ratio (VRR) was 94.63 ± 8.99% (range:76%-100%) at the final follow-up. The mean follow-up time was 16.4 ± 5.2months (range:12-24 months). No recurrences, no metastatic lymph node, and no distant metastases were detected during follow-up. The TA group had fewer complications, shorter operation time, smaller incision length, less blood loss, shorter hospitalization time, and lower treatment costs compared to the surgery group (all P<0.001). CONCLUSIONS TA is technically feasible for the complete destruction of Bethesda IV thyroid nodules, and also safe and effective during the follow-up period, with high VRR and low complication rates, especially in patients who were ineligible for or refused surgery.
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Affiliation(s)
- Xinyang Li
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yu Lan
- Department of Ultrasound, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Mingbo Zhang,
| | - Yukun Luo
- School of Medicine, Nankai University, Tianjin, China
- Department of Ultrasound, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Yukun Luo, ; Mingbo Zhang,
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Zhang Y, Wu Q, Chen Y, Wang Y. A Clinical Assessment of an Ultrasound Computer-Aided Diagnosis System in Differentiating Thyroid Nodules With Radiologists of Different Diagnostic Experience. Front Oncol 2020; 10:557169. [PMID: 33042840 PMCID: PMC7518212 DOI: 10.3389/fonc.2020.557169] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/17/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction This study aimed to assess the diagnostic performance and the added value to radiologists of different levels of a computer-aided diagnosis (CAD) system for the detection of thyroid cancers. Methods 303 patients who underwent thyroidectomy from October 2018 to July 2019 were retrospectively reviewed. The diagnostic performance of the senior radiologist, the junior radiologist, and the CAD system were compared. The added value of the CAD system was assessed and subgroup analyses were performed according to the size of thyroid nodules. Results In total, 186 malignant thyroid nodules, and 179 benign thyroid nodules were included; 168 were papillary thyroid carcinoma (PTC), 7 were medullary thyroid carcinoma (MTC), 11 were follicular carcinoma (FTC), 127 were follicular adenoma (FA) and 52 were nodular goiters. The CAD system showed a comparable specificity as the senior radiologist (86.0% vs. 86.0%, p > 0.99), but a lower sensitivity and a lower area under the receiver operating characteristic (AUROC) curve (sensitivity: 71.5% vs. 95.2%, p < 0.001; AUROC: 0.788 vs. 0.906, p < 0.001). The CAD system improved the diagnostic sensitivities of both the senior and the junior radiologists (97.8% vs. 95.2%, p = 0.063; 88.2% vs. 75.3%, p < 0.001). Conclusion The use of the CAD system using artificial intelligence is a potential tool to distinguish malignant thyroid nodules and is preferable to serve as a second opinion for less experienced radiologists to improve their diagnosis performance.
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Affiliation(s)
- Yichun Zhang
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Qiong Wu
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yutong Chen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yan Wang
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai, China
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Tian X, Song Q, Xie F, Ren L, Zhang Y, Tang J, Zhang Y, Jin Z, Zhu Y, Zhang M, Luo Y. Papillary thyroid carcinoma: an ultrasound-based nomogram improves the prediction of lymph node metastases in the central compartment. Eur Radiol 2020; 30:5881-5893. [PMID: 32588211 DOI: 10.1007/s00330-020-06906-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/27/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To develop a nomogram based on postoperative clinical and ultrasound findings to quantify the probability of central compartment lymph node metastases (CLNM). METHODS A total of 952 patients with histologically confirmed papillary thyroid carcinoma (PTC) were included in this retrospective study and assigned to three groups based on sex and age. The strongest predictors for CLNM were selected according to ultrasound imaging features, and an ultrasound (US) signature was constructed. By incorporating clinical characteristics, a predictive model presented as a nomogram was developed, and its performance was assessed with respect to calibration, discrimination and clinical usefulness. RESULTS Predictors contained in the nomogram included US signature, US-reported LN status and age. The US signature was constructed with tumour size and microcalcification. The nomogram showed excellent calibration in the training dataset, with an AUC of 0.826 (95% CI, 0.765-0.887) for male patients, 0.818 (95% CI, 0.746-0.890) for young females and 0.808 (95% CI, 0.757-0.859) for elder females. For male and young female patients, application of the nomogram to the validation cohort revealed good discrimination, with AUCs of 0.813 (95% CI, 0.722-0.904) and 0.814 (95% CI, 0.712-0.915), respectively. Conversely, for elderly female patients, the nomogram failed to show good performance with an AUC of 0.742 (95% CI, 0.661-0.823). CONCLUSION This ultrasound-based nomogram may serve as a useful clinical tool to provide valuable information for treatment decisions, especially for male and younger female patients. KEY POINTS • Age, gender, US-reported LN status and US signature were the strongest predictors of CLNM in PTC patients and informed the development of a predictive nomogram. • Microcalcification was the strongest predictor in the US signature, as CLMN was identified in approximately 92% of patients characterised by diffuse microcalcification. • Stratified by sex and age, this nomogram achieved good performance in predicting CLNM, especially in male and young female patients. This prediction tool may be useful as an imaging marker for identifying CLNM preoperatively in PTC patients and as a guide for personalised treatment.
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Affiliation(s)
- Xiaoqi Tian
- Medical College of Nankai University, No.94, Weijin Road, Nankai District, Tianjin, 300071, People's Republic of China
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Qing Song
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
- Department of Ultrasound, Seventh Medical Center of the PLA General Hospital, Beijing, People's Republic of China
| | - Fang Xie
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Ling Ren
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Ying Zhang
- Medical College of Nankai University, No.94, Weijin Road, Nankai District, Tianjin, 300071, People's Republic of China
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Yan Zhang
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Zhuang Jin
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Yaqiong Zhu
- Medical College of Nankai University, No.94, Weijin Road, Nankai District, Tianjin, 300071, People's Republic of China
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Mingbo Zhang
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Yukun Luo
- Medical College of Nankai University, No.94, Weijin Road, Nankai District, Tianjin, 300071, People's Republic of China.
- Department of Ultrasound, Chinese PLA General Hospital, No.28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China.
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Li J, Li H, Yang Y, Zhang X, Qian L. The KWAK TI-RADS and 2015 ATA guidelines for medullary thyroid carcinoma: Combined with cell block-assisted ultrasound-guided thyroid fine-needle aspiration. Clin Endocrinol (Oxf) 2020; 92:450-460. [PMID: 31665550 DOI: 10.1111/cen.14121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the value of the thyroid imaging reporting and data system proposed by Kwak (KWAK TI-RADS) and the 2015 American Thyroid Association (ATA) guidelines for diagnosis of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC). To confirm the role of cell block (CB)-assisted fine-needle aspiration (FNA) in final diagnosis of MTC. DESIGN Retrospective hospital-based cohort study. PATIENTS Ninety-three patients with 29 MTCs, 31 PTCs and 33 thyroid adenomas (TAs) who underwent thyroidectomy from January 2010 to May 2019 were retrospectively reviewed. The KWAK TI-RADS and ATA guidelines were used to assess each thyroid nodule. FNA, CB-assisted FNA and core needle biopsy (CNB) were performed in final diagnosis. RESULTS Age and ultrasound features (composition, echogenicity and shape) were significantly different between MTC and PTC. Sex and ultrasound features (echogenicity, margin and calcification) were significantly different between MTC and TA. The KWAK TI-RADS and ATA guidelines showed no significant difference for MTC (area under the curve [AUC]: 0.812 and 0.808; P = .37-.85) or PTC (AUC: 0.883 and 0.885; P = .25-.96). The KWAK TI-RADS and ATA guidelines showed high specificity and sensitivity for MTC (93.9% and 62.1%, 87.9% and 65.5%) and PTC (93.9% and 67.7%, 87.9% and 77.4%), respectively. For suspicious MTC (7 cases), CB-assisted FNA provide accuracy preoperative diagnosis. CONCLUSIONS Although the diagnostic performance of the TI-RADS and ATA guidelines is worse for MTC than PTC, the difference is not statistically significant. CB-assisted FNA should be performed in thyroid nodules with 4a or lower suspicion to avoid misdiagnosis of MTC.
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Affiliation(s)
- Jianming Li
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huarong Li
- Department of Ultrasound, Aero-space Center Hospital, Beijing, China
| | - Yan Yang
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Zhang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Wei PY, Jiang ND, Xiang JJ, Xu CK, Ding JW, Wang HB, Luo DC, Han ZJ. Hounsfield Unit Values in ACR TI-RADS 4-5 Thyroid Nodules with Coarse Calcifications: An Important Imaging Feature Helpful for Diagnosis. Cancer Manag Res 2020; 12:2711-2717. [PMID: 32368148 PMCID: PMC7184120 DOI: 10.2147/cmar.s242524] [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: 12/16/2019] [Accepted: 04/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study is to investigate the diagnostic role of Hounsfield unit (HU) values on noncontrast computed tomography (CT) for differentiating benignity from malignancy in the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) 4-5 nodules with coarse calcifications. Patients and Methods CT images of 216 ACR TI-RADS 4-5 nodules with coarse calcifications from 207 patients who underwent surgery in our hospital between 2017 and 2019 were retrospectively reviewed. The average HU values (AHUVs) and maximum HU values (MHUVs) of the nodules were measured on noncontrast CT. The distribution of AHUVs and MHUVs in benign and malignant nodules with coarse calcifications was analyzed using the Mann-Whitney test. Receiver operating characteristic (ROC) curves were used to identify the best cut-off values. Diagnostic performances were assessed according to the area under the ROC curve (AUC), sensitivity and specificity. Results Of the 216 ACR TI-RADS 4-5 nodules with coarse calcifications, 170 were benign and 46 were malignant. The AHUVs of benign and malignant nodules were 791 HU [interquartile range (IQR), 543-1025 HU] and 486 HU (IQR, 406-670 HU), respectively (P < 0.001). The MHUVs of benign and malignant nodules were 1084 HU (IQR, 717-1477 HU) and 677 HU (IQR, 441-986 HU), respectively (P < 0.001). The AUCs for AHUVs and MHUVs for predicting benign nodules with coarse calcifications were 0.759 and 0.732, and the cut-off values were 627.5 HU and 806.0 HU, with sensitivities of 67.6% and 68.8% and specificities of 73.9% and 67.4%, respectively. The sensitivity and specificity of the combination were 68.8% and 76.1%. Conclusion AHUVs and MHUVs were helpful in differentiating benignity from malignancy in ACR TI-RADS 4-5 nodules with coarse calcifications. This may provide an important basis for reducing misdiagnosis and unnecessary aspiration or surgical trauma.
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Affiliation(s)
- Pei-Ying Wei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Nian-Dong Jiang
- Department of Radiology, Chunan County Hospital of Traditional Chinese Medicine, Hangzhou, People's Republic of China
| | - Jing-Jing Xiang
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Chen-Ke Xu
- Department of Medical Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jin-Wang Ding
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hai-Bin Wang
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ding-Cun Luo
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhi-Jiang Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Loomans-Kropp HA, Dunn BK, Kramer BS, Pinsky P. Thyroid Incidentalomas in Association With Low-Dose Computed Tomography in the National Lung Screening Trial. Am J Epidemiol 2020; 189:27-33. [PMID: 31595954 DOI: 10.1093/aje/kwz219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/18/2019] [Indexed: 02/06/2023] Open
Abstract
Advances in cancer screening methods have opened avenues for incidental findings and cancer overdiagnosis. We performed a secondary analysis of the National Lung Screening Trial (enrollment from 2002-2004), a randomized controlled trial comparing low-dose computed tomography (LDCT; n = 26,722) with chest radiography (CXR; n = 26,732) for lung cancer detection, to examine incidental findings related to thyroid cancer (ThCa). Three screening rounds were included, and median follow-up was 6.6 years for LDCT and 6.5 years for CXR. Radiologists reported lung and non-lung-related abnormalities. In the LDCT arm, 5.7%, 4.7%, and 4.5% of participants had abnormalities above the diaphragm (AADs) detected at baseline, year 1, and year 2, respectively, compared with 2.3%, 1.5%, and 1.3% in the CXR arm. In the LDCT arm, 205 AADs (7.0%) were thyroid-related. Overall, 60 ThCas were reported, 35 in the LDCT arm and 25 in the CXR arm (P = 0.2). In the LDCT arm, participants with a prior AAD had a 7.8-fold increased risk (95% confidence interval: 4.0, 15.1) of ThCa compared with those who did not have an AAD. Early and persistent excess of ThCas diagnosed earlier in the LDCT arm suggests overdiagnosis. The use of sensitive screening modalities for early detection of lung cancer might result in the discovery of thyroid incidentalomas.
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Affiliation(s)
- Holli A Loomans-Kropp
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
- Gastrointestinal and Other Cancers Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Barbara K Dunn
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Paul Pinsky
- Early Detection Research Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
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Jing QB, Tong HX, Tang WJ, Tian SD. Clinical Significance and Potential Regulatory Mechanisms of Serum Response Factor in 1118 Cases of Thyroid Cancer Based on Gene Chip and RNA-Sequencing Data. Med Sci Monit 2020; 26:e919302. [PMID: 31967986 PMCID: PMC6995247 DOI: 10.12659/msm.919302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Thyroid cancer (TC) is one of the most prevalent endocrine malignancies and there may be many unclarified molecular events and gene types involved in TC. The objective of this study was to assess the clinical implications and potential mechanisms of serum response factor (SRF) in TC. Material/Methods RNA-sequencing and gene chip data with TC expression were collected from The Cancer Genome Atlas/Genotype-Tissue Expression, Gene Expression Omnibus, ArrayExpress, Sequence Read Archive, and Oncomine. SRF expression of all TC and adjacent non-cancerous tissue were calculated using the t test, STATA, and Meta-DiSc. The related pathways of the potential SRF target genes and target miRNAs were explored. Dual-luciferase reporter assay was performed to validate the association between SRF and its putative miRNA. Results One RNA-sequencing and 15 gene chips were collected, and the pooled standardized mean difference of SRF was −1.00. Furthermore, the area under the curve of sROC of SRF in TC was 0.8251, indicating a dramatic decreased expression of SRF in TC tissues based on 1118 cases. The intersection of differentially expressed genes in TC, SRF co-expressed genes, and SRF potential target genes achieved from Cistrome Cancer led to 169 overlapped genes. miR-330-5p was predicted to target SRF, which was further confirmed by dual-luciferase reporter assay. Conclusions The reduction of SRF appears to play a crucial role in the origin of TC. These properties are accomplished by the target genes of SRF, as a transcription factor, or by the axes with the associated miRNAs.
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Affiliation(s)
- Qiang-Bin Jing
- Center of Medical Oncology, The First People's Hospital of Huaihua, Huaihua, Hunan, China (mainland)
| | - Hai-Xiao Tong
- Center of Medical Oncology, The First People's Hospital of Huaihua, Huaihua, Hunan, China (mainland)
| | - Wei-Jian Tang
- Center of Medical Oncology, The First People's Hospital of Huaihua, Huaihua, Hunan, China (mainland)
| | - Shao-Dong Tian
- Center of Medical Oncology, The First People's Hospital of Huaihua, Huaihua, Hunan, China (mainland)
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Schenke S, Klett R, Seifert P, Kreissl MC, Görges R, Zimny M. Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm). J Clin Med 2020; 9:E236. [PMID: 31963140 PMCID: PMC7019412 DOI: 10.3390/jcm9010236] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/30/2019] [Accepted: 01/10/2020] [Indexed: 12/18/2022] Open
Abstract
Due to the widespread use of ultrasound, small thyroid nodules (TNs) ≤ 10 mm are common findings. Standardized approaches for the risk stratification of TNs with Thyroid Imaging Reporting and Data Systems (TIRADS) were evaluated for the clinical routine. With TIRADS, the risk of malignancy in TNs is calculated by scoring the number or combination of suspicious ultrasound features, leading to recommendations for further diagnostic steps. However, there are only scarce data on the performance of TIRADS for small TNs. The aim was to compare three different TIRADS for risk stratification of small TNs in routine clinical practice. We conducted a retrospective cohort analysis of TNs ≤ 10 mm and their available histology. Nodules were classified according to three different TIRADS. In the study, 140 patients (n = 113 female) with 145 thyroid nodules (n = 76 malignant) were included. Most of the malignant nodules were papillary carcinoma (97%), and the remaining 3% were medullary carcinoma. For all tested TIRADS, the prevalence of malignancy rose with increasing category levels. The highest negative predictive value was found for ACR TI-RADS and the highest positive predictive value for Kwak-TIRADS. All tested variants of TIRADS showed comparable diagnostic performance for the risk stratification of small TNs. TIRADS seems to be a promising tool to reliably assess the risk of malignancy of small TNs.
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Affiliation(s)
- Simone Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, Leipziger Straße 44, 39120 Magdeburg, Germany;
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
| | - Rigobert Klett
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
| | - Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Am Klinikum 1 A4U1, 07740 Jena Lobeda-Ost, Germany;
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, Leipziger Straße 44, 39120 Magdeburg, Germany;
| | - Rainer Görges
- Department of Nuclear Medicine, Essen University Hospital, Hufelandstraße 55, 45122 Essen, Germany;
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
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Menning M. Thyroid Disease. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tappouni RR, Itri JN, McQueen TS, Lalwani N, Ou JJ. ACR TI-RADS: Pitfalls, Solutions, and Future Directions. Radiographics 2019; 39:2040-2052. [DOI: 10.1148/rg.2019190026] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Rafel R. Tappouni
- From the Department of Radiology, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157
| | - Jason N. Itri
- From the Department of Radiology, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157
| | - Teresa S. McQueen
- From the Department of Radiology, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157
| | - Neeraj Lalwani
- From the Department of Radiology, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157
| | - Jao J. Ou
- From the Department of Radiology, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157
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McGary CT, Shaw A. Educational Case: Cytology for Staging Neoplasia and Thyroid Neoplasms. Acad Pathol 2019; 6:2374289519851218. [PMID: 31218249 PMCID: PMC6560793 DOI: 10.1177/2374289519851218] [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: 01/04/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.
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Affiliation(s)
- Carl T McGary
- Department of Biomedical Sciences, University of Minnesota Medical School-Duluth Campus, Duluth, MN, USA
| | - Aubie Shaw
- Department of Biomedical Sciences, University of Minnesota Medical School-Duluth Campus, Duluth, MN, USA
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Wu G, Zheng H, Xu J, Guo Y, Zheng G, Ma C, Hao S, Liu X, Chen H, Wei S, Song X, Wang X. miR-429 suppresses cell growth and induces apoptosis of human thyroid cancer cell by targeting ZEB1. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:548-554. [PMID: 30849921 DOI: 10.1080/21691401.2018.1564320] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Thyroid cancer is now the most common endocrine malignancy and the effect of miR-429 in the development of thyroid cancer still need to be further investigated. The expression level of miR-429 was quantified by qPCR in both clinical samples and cultured cell lines. MTT, flow cytometry, migration analyses and Matrigel invasion assays were conducted to test the proliferation, apoptosis, migration and invasion of MiR-429 transfection in thyroid cancer cell lines. Luciferase activity assay and western blot were conducted to detect the direct effect of miR-429 on Zinc finger E-box-binding homeobox 1 (ZEB1) expression. In this study, it was found that miR-429 was frequently decreased in thyroid cancer tissues and cell lines. Transfection of miR-429 in thyroid cancer cell lines substantially suppressed cell proliferation, migration and invasion. Besides, miR-429 up-regulation would induce apoptosis in different cell lines. ZEB1 was identified as a direct target of miR-429 and miR-429 transfection could inhibit ZEB1 by direct binding to its 3'-untranslated region (3'-UTR). In conclusion, these data indicated that miR-429 could act as a tumour suppressor miRNA and contribute to the development and progression and metastasis of thyroid cancer.
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Affiliation(s)
- Guochang Wu
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Haitao Zheng
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Jie Xu
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Yawen Guo
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Guibin Zheng
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Ci Ma
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Shaolong Hao
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Xincheng Liu
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Huanjie Chen
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Shujian Wei
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Xicheng Song
- b Department of Otolaryngology-Head and Neck Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
| | - Xiaojie Wang
- a Department of Thyroid Surgery , The Affiliated Yantai Yuhuangding Hospital of Qingdao University , Yantai , China
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Abstract
This study aims to screen out significant ultrasonic features to establish different predictive models of thyroid nodules based on logistic regression, with different indicators being included and nodular size being differentiated, and then compare them.Ultrasonic features of 1906 thyroid nodules in 1761 patients who had undergone sonography and fine-needle aspiration or surgery in our hospital were retrospectively analyzed. According to nodule size and whether vascular or elastographic indicators being included or not, nodules were divided into 12 groups. By univariate and multivariate analysis, the significant sonographic features to diagnose nodules of each group were screened and compared. The logistic regression models were built, and the cutoff values were calculated. The diagnostic performance of newly established models was validated, and the best model was compared with the American College of Radiology Thyroid Imaging Reporting and Data System.Significant features used to diagnose nodules in all models were hypoechoic, irregular margin, and microcalcification. Predominantly solid was an important indicator to differentiate benign and malignant macronodules. A taller-than-wide shape was a significant indicator of malignant micronodules. Strain elastographic character did show diagnostic value. The area under the curve of logistic regression models for malignant risk prediction were all higher than 0.7, and the best one was model 7, but the diagnostic performance was significantly reduced when models performed bivariate prediction.The most valuable indicators of malignant thyroid nodules are hypoechoic, irregular margin, and microcalcification. New models are suitable for nodules of different sizes and with or without vascular or elastographic features being described.
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Hu Y, Li N, Jiang P, Cheng L, Ding B, Liu XM, He K, Zhu YQ, Liu BL, Cao X, Zhou H, Mao XM. Elevated thyroglobulin level is associated with dysfunction of regulatory T cells in patients with thyroid nodules. Endocr Connect 2019; 8:309-317. [PMID: 30822273 PMCID: PMC6432874 DOI: 10.1530/ec-18-0545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/01/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Thyroid nodules are usually accompanied by elevated thyroglobulin (Tg) level and autoimmune thyroid diseases (AITDs). However, the relationship between Tg and AITDs is not fully understood. Dysfunction of regulatory T cells (Tregs) plays an important role in the development of AITDs. We aimed to evaluate the effects of Tg on the function of Tregs in patients with thyroid nodules. METHODS Tg levels and the functions of Tregs in peripheral blood and thyroid tissues of patients with thyroid nodules from Nanjing First Hospital were evaluated. The effects of Tg on the function of Tregs from healthy donors were also assessed in vitro. The function of Tregs was defined as an inhibitory effect of Tregs on the effector T cell (CD4+ CD25- T cell) proliferation rate. RESULTS The level of Tg in peripheral blood correlated negatively with the inhibitory function of Tregs (R = 0.398, P = 0.03), and Tregs function declined significantly in the high Tg group (Tg >77 μg/L) compared with the normal Tg group (11.4 ± 3.9% vs 27.5 ± 3.5%, P < 0.05). Compared with peripheral blood, the function of Tregs in thyroid declined significantly (P < 0.01), but the proportion of FOXP3+ Tregs in thyroid increased (P < 0.01). High concentration of Tg (100 μg/mL) inhibited the function of Tregs and downregulated FOXP3, TGF-β and IL-10 mRNA expression in Tregs in vitro. CONCLUSIONS Elevated Tg level could impair the function of Tregs, which might increase the risk of AITDs in patient with thyroid nodules.
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Affiliation(s)
- Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
- Department of Immunology, Nanjing Medical University, Jiangsu, China
| | - Na Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Peng Jiang
- Department of Thyroid and Breast Surgery, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Liang Cheng
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Xiao-Mei Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Ke He
- Department of Endocrinology, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangsu, China
| | - Yun-Qing Zhu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Bing-li Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Xin Cao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
| | - Hong Zhou
- Department of Immunology, Nanjing Medical University, Jiangsu, China
- Correspondence should be addressed to H Zhou or X-M Mao: or
| | - Xiao-Ming Mao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Jiangsu, China
- Correspondence should be addressed to H Zhou or X-M Mao: or
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Rahman ST, McLeod DSA, Pandeya N, Neale RE, Bain CJ, Baade P, Youl PH, Jordan SJ. Understanding Pathways to the Diagnosis of Thyroid Cancer: Are There Ways We Can Reduce Over-Diagnosis? Thyroid 2019; 29:341-348. [PMID: 30700206 DOI: 10.1089/thy.2018.0570] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of thyroid cancer has rapidly increased, and ecological evidence suggests this is due in some part to over-diagnosis. Understanding pathways to diagnosis could help determine whether unnecessary diagnosis can be avoided. METHODS A population-based sample (n = 1007) of thyroid cancer patients diagnosed between July 2013 and August 2016 was recruited from Queensland, Australia (response rate 67%). Information from structured telephone interviews was used to describe diagnostic pathways for thyroid cancer, to investigate factors associated with diagnostic pathways, and to assess the most prevalent modes of diagnoses by which the lowest-risk, potentially over-diagnosed thyroid cancers (intrathyroidal microcarcinomas) are detected. RESULTS Only 38% of participants presented with symptoms potentially related to thyroid cancer. Older age at diagnosis was associated with a lower prevalence of symptomatic diagnosis (prevalence ratio [PR] = 0.46 [confidence interval (CI) 0.31-0.68] for 70-79 vs. <30 years), as was frequent medical contact, while living in rural/regional areas was associated with a higher prevalence of symptomatic diagnosis (PR = 1.17 [CI 1.00-1.37] for rural/regional areas vs. major cities). Symptomatic diagnosis also occurred more for those whose tumors had adverse histopathological features (larger size, lymph node involvement, lymphovascular invasion). The likelihood of diagnosis of intrathyroidal microcarcinomas was greatest for those having surgical resection or monitoring for benign thyroid disease (PR = 3.87 [CI 2.81-5.32] and PR = 2.21 [CI 1.53-3.18], respectively). CONCLUSIONS A minority of newly detected thyroid cancer cases were diagnosed because of symptoms. Access to medical care and factors related to cancer aggressiveness were associated with how diagnoses occurred. The likelihood of diagnosing the lowest-risk thyroid cancers was higher in situations related to management of other thyroid conditions. Adherence to thyroid management guidelines could reduce some thyroid cancer over-diagnosis, but ultimately better diagnostic tools are needed to differentiate between indolent cancers and those of clinical significance.
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Affiliation(s)
- Sabbir T Rahman
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
- 2 School of Public Health, The University of Queensland, Brisbane, Australia
| | - Donald S A McLeod
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
- 3 Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nirmala Pandeya
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
| | - Rachel E Neale
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
- 2 School of Public Health, The University of Queensland, Brisbane, Australia
| | - Chris J Bain
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
| | - Peter Baade
- 4 Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia
- 5 Menzies Health Institute, Griffith University, Gold Coast, Australia
| | | | - Susan J Jordan
- 1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
- 2 School of Public Health, The University of Queensland, Brisbane, Australia
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Jatoi I, Anderson WF, Miller AB, Brawley OW. The history of cancer screening. Curr Probl Surg 2019; 56:138-163. [PMID: 30922446 DOI: 10.1067/j.cpsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology, Dale H. Dorn Endowed Chair in Surgery, University of Texas Health Science Center, San Antonio, TX.
| | - William F Anderson
- National Institutes of Health/National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MA
| | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Otis W Brawley
- Michael Bloomberg Distinguished Professor of Oncology and Public Health, Johns Hopkins University, Baltimore, MA
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dos Santos MT, Buzolin AL, Gama RR, da Silva ECA, Dufloth RM, Figueiredo DLA, Carvalho AL. Molecular Classification of Thyroid Nodules with Indeterminate Cytology: Development and Validation of a Highly Sensitive and Specific New miRNA-Based Classifier Test Using Fine-Needle Aspiration Smear Slides. Thyroid 2018; 28:1618-1626. [PMID: 30319072 PMCID: PMC6308280 DOI: 10.1089/thy.2018.0254] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Thyroid nodules can be identified in up to 68% of the population. Fine-needle aspiration (FNA) cytopathology classifies 20%-30% of nodules as indeterminate, and these are often referred for surgery due to the risk of malignancy. However, histological postsurgical reports indicate that up to 84% of cases are benign, highlighting a high rate of unnecessary surgeries. We sought to develop and validate a microRNA (miRNA)-based thyroid molecular classifier for precision endocrinology (mir-THYpe) with both high sensitivity and high specificity, to be performed on the FNA cytology smear slide with no additional FNA. Methods: The expression of 96 miRNA candidates from 39 benign/39 malignant thyroid samples, (indeterminate on FNA) was analyzed to develop and train the mir-THYpe algorithm. For validation, an independent set of 58 benign/37 malignant FNA smear slides (also classified as indeterminate) was used. Results: In the training set, with a 10-fold cross-validation using only 11 miRNAs, the mir-THYpe test reached 89.7% sensitivity, 92.3% specificity, 90.0% negative predictive value and 92.1% positive predictive value. In the FNA smear slide validation set, the mir-THYpe test reached 94.6% sensitivity, 81.0% specificity, 95.9% negative predictive value, and 76.1% positive predictive value. Bayes' theorem shows that the mir-THYpe test performs satisfactorily in a wide range of cancer prevalences. Conclusions: The presented data and comparison with other commercially available tests suggest that the mir-THYpe test can be considered for use in clinical practice to support a more informed clinical decision for patients with indeterminate thyroid nodules and potentially reduce the rates of unnecessary thyroid surgeries.
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Affiliation(s)
- Marcos Tadeu dos Santos
- Department of Research and Development, Onkos Molecular Diagnostics, Ribeirão Preto/SP, Brazil
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Address correspondence to: Marcos Tadeu dos Santos, PhD, Department of Research and Development, Onkos Molecular Diagnostics, (Startups incubator), 1805 Avenida Doutora Nadir Aguiar, SUPERA Innovation and Technology Park, Ribeirão Preto/SP 14056-680, Brazil
| | - Ana Lígia Buzolin
- Department of Research and Development, Onkos Molecular Diagnostics, Ribeirão Preto/SP, Brazil
| | - Ricardo Ribeiro Gama
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos/SP, Brazil
| | | | | | | | - André Lopes Carvalho
- Department of Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos/SP, Brazil
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos/SP, Brazil
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Polednik KM, Simpson MC, Adjei Boakye E, Mohammed KA, J Dombrowski J, Varvares MA, Osazuwa-Peters N. Radiation and Second Primary Thyroid Cancer Following Index Head and Neck Cancer. Laryngoscope 2018; 129:1014-1020. [PMID: 30208210 DOI: 10.1002/lary.27467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS Radiation is thought to increase risk of developing second primary thyroid cancer (SPTC). This study estimated the rate of SPTC following index head and neck cancer (HNC) and determined whether radiation treatment among HNC survivors increased SPTC risk. STUDY DESIGN Retrospective data analysis. METHOD The Surveillance, Epidemiology, and End Results database (1975-2014) was queried for cases of index HNC (N = 127,563) that developed SPTC. Adjusted multivariable competing risk proportional hazards model tested risk of developing a SPTC following index HNC. Sensitivity analyses using proportional hazards models were also performed restricting data to patients who 1) received both radiation and chemotherapy and 2) radiation alone. RESULTS Only 0.2% of index HNC survivors (n = 229) developed SPTC, yielding a rate of 26.1 per 100,000 person-years. For every increasing year of age at diagnosis, patients were 3% less likely to develop an SPTC (adjusted hazard ratio [aHR] = 0.97, 95% CI: 0.96-0.98). Males were also less likely to develop an SPTC (aHR = 0.73, 95% CI: 0.55-0.96). Radiation (aHR = 0.92, 95% CI: 0.68-1.25), surgery (aHR = 0.79, 95% CI: 0.56-1.11), and chemotherapy (aHR = 1.13, 95% CI: 0.76-1.69) were not significantly associated with developing SPTC. The sensitivity models also did not find an association between treatment and risk of SPTC. CONCLUSIONS Rate of developing SPTC following index HNC was very low, and previous exposure to radiation did not significantly increase risk in our study population. More studies are needed to understand the increasing incidence of thyroid cancer across the United States. LEVEL OF EVIDENCE NA Laryngoscope, 129:1014-1020, 2019.
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Affiliation(s)
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Eric Adjei Boakye
- Center for Health Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - Kahee A Mohammed
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.,Center for Health Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - John J Dombrowski
- Department of Radiation Oncology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.,Saint Louis University Cancer Center, St. Louis, Missouri.,Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, U.S.A
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