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Atweh L, Al-Hadidi A, Singh J, Alzahrani R, Kersey K, Bobbey A, Hoffman R, Aldrink JH, Shah S. Quality Improvement Methodology to Improve Standardized Reporting of Pediatric Thyroid Ultrasounds Using TI-RADS. J Pediatr Surg 2024; 59:731-736. [PMID: 38168549 DOI: 10.1016/j.jpedsurg.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/12/2023] [Accepted: 11/12/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND/PURPOSE The process of evaluating pediatric thyroid nodules at our institution was inconsistent with a high rate of negative biopsies raising concern of appropriate patient selection for biopsy. Our aim was to institute a standardized risk stratification reporting system for thyroid nodules to increase utilization and agreement of TI-RADS reporting at our institution. METHODS Radiology report data were collected and analyzed as part of a quality improvement project. A standardized TI-RADS dictation template was created, ultrasound technicians were trained, a multi-disciplinary conference initiated, and education provided for radiologists and clinicians. Control charts were used to track utilization and agreement of scoring of TI-RADS reporting based upon review by a radiologist trained in TI-RADS scoring. RESULTS From January 2019 to January 2021, 218 patients with a thyroid nodule had a thyroid ultrasound performed at our institution. TI-RADS was utilized in 0 % (0 of 57) of children in the four months prior to project initiation. Following creation of the template, utilization increased to 65 % (39 of 60) over 5 months. Utilization further increased after the first training conference and was maintained above 90 % for 13 months. Ultrasound reports were in agreement in 46.7 % (28 of 60) of children initially. Agreement in reporting improved to 71.4 % (10 of 14) in the 3 months following the first training and to 78.4 % (58 of 74) over 12 months. Agreement in reporting was maintained at 80 % in the following 6 months. CONCLUSIONS A quality improvement initiative can improve utilization and agreement of scoring using the TI-RADS system in pediatrics. This may ultimately reduce unnecessary biopsies and sedation in children. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Quality Improvement.
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de Carlos J, Garcia J, Basterra FJ, Pineda JJ, Dolores Ollero M, Toni M, Munarriz P, Anda E. Interobserver variability in thyroid ultrasound. Endocrine 2024:10.1007/s12020-024-03731-5. [PMID: 38372907 DOI: 10.1007/s12020-024-03731-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Ultrasound evaluation of thyroid nodules is the preferred technique, but it is dependent on operator interpretation, leading to inter-observer variability. The current study aimed to determine the inter-physician consensus on nodular characteristics, risk categorization in the classification systems, and the need for fine needle aspiration puncture. METHODS Four endocrinologists from the same center blindly evaluated 100 ultrasound images of thyroid nodules from 100 different patients. The following ultrasound features were evaluated: composition, echogenicity, margins, calcifications, and microcalcifications. Nodules were also classified according to ATA, EU-TIRADS, K-TIRADS, and ACR-TIRADS classifications. Krippendorff's alpha test was used to assess interobserver agreement. RESULTS The interobserver agreement for ultrasound features was: Krippendorff's coefficient 0.80 (0.71-0.89) for composition, 0.59 (0.47-0.72) for echogenicity, 0.73 (0.57-0.88) for margins, 0.55 (0.40-0.69) for calcifications, and 0.50 (0.34-0.67) for microcalcifications. The concordance for the classification systems was 0.7 (0.61-0.80) for ATA, 0.63 (0.54-0.73) for EU-TIRADS, 0.64 (0.55-0.73) for K-TIRADS, and 0.68 (0.60-0.77) for K-TIRADS. The concordance in the indication of fine needle aspiration puncture (FNA) was 0.86 (0.71-1), 0.80 (0.71-0.88), 0.77 0.67-0.87), and 0.73 (0.64-0.83) for systems previously described respectively. CONCLUSIONS Interobserver agreement was acceptable for the identification of nodules requiring cytologic study using various classification systems. However, limited concordance was observed in risk stratification and many ultrasonographic characteristics of the nodules.
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Affiliation(s)
- Joaquín de Carlos
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | - Javier Garcia
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Francisco Javier Basterra
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
- Universidad Pública de Navarra, Pamplona, Navarra, Spain
| | - Jose Javier Pineda
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - M Dolores Ollero
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Marta Toni
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
- Universidad Pública de Navarra, Pamplona, Navarra, Spain
| | - Patricia Munarriz
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Emma Anda
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
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Barinov L, Jairaj A, Middleton WD, D M, Beland, Kirsch J, Filice RW, Reverter JL, Arguelles I, Grant EG. Improving the Efficacy of ACR TI-RADS Through Deep Learning-Based Descriptor Augmentation. J Digit Imaging 2023; 36:2392-2401. [PMID: 37580483 PMCID: PMC10584788 DOI: 10.1007/s10278-023-00884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/16/2023] Open
Abstract
Thyroid nodules occur in up to 68% of people, 95% of which are benign. Of the 5% of malignant nodules, many would not result in symptoms or death, yet 600,000 FNAs are still performed annually, with a PPV of 5-7% (up to 30%). Artificial intelligence (AI) systems have the capacity to improve diagnostic accuracy and workflow efficiency when integrated into clinical decision pathways. Previous studies have evaluated AI systems against physicians, whereas we aim to compare the benefits of incorporating AI into their final diagnostic decision. This work analyzed the potential for artificial intelligence (AI)-based decision support systems to improve physician accuracy, variability, and efficiency. The decision support system (DSS) assessed was Koios DS, which provides automated sonographic nodule descriptor predictions and a direct cancer risk assessment aligned to ACR TI-RADS. The study was conducted retrospectively between (08/2020) and (10/2020). The set of cases used included 650 patients (21% male, 79% female) of age 53 ± 15. Fifteen physicians assessed each of the cases in the set, both unassisted and aided by the DSS. The order of the reading condition was randomized, and reading blocks were separated by a period of 4 weeks. The system's impact on reader accuracy was measured by comparing the area under the ROC curve (AUC), sensitivity, and specificity of readers with and without the DSS with FNA as ground truth. The impact on reader variability was evaluated using Pearson's correlation coefficient. The impact on efficiency was determined by comparing the average time per read. There was a statistically significant increase in average AUC of 0.083 [0.066, 0.099] and an increase in sensitivity and specificity of 8.4% [5.4%, 11.3%] and 14% [12.5%, 15.5%], respectively, when aided by Koios DS. The average time per case decreased by 23.6% (p = 0.00017), and the observed Pearson's correlation coefficient increased from r = 0.622 to r = 0.876 when aided by Koios DS. These results indicate that providing physicians with automated clinical decision support significantly improved diagnostic accuracy, as measured by AUC, sensitivity, and specificity, and reduced inter-reader variability and interpretation times.
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Affiliation(s)
- Lev Barinov
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | | | | | | | - Beland
- Warren Alpert Medical School, Providence, RI, USA
| | | | - Ross W Filice
- MedStar Georgetown University Hospital, Washington, DC, USA
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Nagendra L, Pappachan JM, Fernandez CJ. Artificial intelligence in the diagnosis of thyroid cancer: Recent advances and future directions. Artif Intell Cancer 2023; 4:1-10. [DOI: 10.35713/aic.v4.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
The diagnosis and management of thyroid cancer is fraught with challenges despite the advent of innovative diagnostic, surgical, and chemotherapeutic modalities. Challenges like inaccuracy in prognostication, uncertainty in cytopathological diagnosis, trouble in differentiating follicular neoplasms, intra-observer and inter-observer variability on ultrasound imaging preclude personalised treatment in thyroid cancer. Artificial intelligence (AI) is bringing a paradigm shift to the healthcare, powered by quick advancement of the analytic techniques. Several recent studies have shown remarkable progress in thyroid cancer diagnostics based on AI-assisted algorithms. Application of AI techniques in thyroid ultrasonography and cytopathology have shown remarkable impro-vement in sensitivity and specificity over the traditional diagnostic modalities. AI has also been explored in the development of treatment algorithms for indeterminate nodules and for prognostication in the patients with thyroid cancer. The benefits of high repeatability and straightforward implementation of AI in the management of thyroid cancer suggest that it holds promise for clinical application. Limited clinical experience and lack of prospective validation studies remain the biggest drawbacks. Developing verified and trustworthy algorithms after extensive testing and validation using prospective, multi-centre trials is crucial for the future use of AI in the pipeline of precision medicine in the management of thyroid cancer.
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Affiliation(s)
- Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College & JSS Academy of Higher Education and Research Center, Mysore 570015, India
| | - Joseph M Pappachan
- Department of Endocrinology & Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, M15 6BH, United Kingdom
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Cornelius James Fernandez
- Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, PE21 9QS PE21 9QS, United Kingdom
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Yadav N, Dass R, Virmani J. Objective assessment of segmentation models for thyroid ultrasound images. J Ultrasound 2023; 26:673-685. [PMID: 36195781 PMCID: PMC10469139 DOI: 10.1007/s40477-022-00726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
Ultrasound features related to thyroid lesions structure, shape, volume, and margins are considered to determine cancer risk. Automatic segmentation of the thyroid lesion would allow the sonographic features to be estimated. On the basis of clinical ultrasonography B-mode scans, a multi-output CNN-based semantic segmentation is used to separate thyroid nodules' cystic & solid components. Semantic segmentation is an automatic technique that labels the ultrasound (US) pixels with an appropriate class or pixel category, i.e., belongs to a lesion or background. In the present study, encoder-decoder-based semantic segmentation models i.e. SegNet using VGG16, UNet, and Hybrid-UNet implemented for segmentation of thyroid US images. For this work, 820 thyroid US images are collected from the DDTI and ultrasoundcases.info (USC) datasets. These segmentation models were trained using a transfer learning approach with original and despeckled thyroid US images. The performance of segmentation models is evaluated by analyzing the overlap region between the true contour lesion marked by the radiologist and the lesion retrieved by the segmentation model. The mean intersection of union (mIoU), mean dice coefficient (mDC) metrics, TPR, TNR, FPR, and FNR metrics are used to measure performance. Based on the exhaustive experiments and performance evaluation parameters it is observed that the proposed Hybrid-UNet segmentation model segments thyroid nodules and cystic components effectively.
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Affiliation(s)
- Niranjan Yadav
- Department of Electronics and Communication Engineering, Deenbandhu Chhotu Ram University of Science and Technology Murthal, Sonepat, 131039 India
| | - Rajeshwar Dass
- Department of Electronics and Communication Engineering, Deenbandhu Chhotu Ram University of Science and Technology Murthal, Sonepat, 131039 India
| | - Jitendra Virmani
- Central Scientific Instruments Organization, Council of Scientific and Industrial Research, Chandigarh, 160030 India
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Pirola I, Rotondi M, Di Lodovico E, Pezzaioli LC, Agosti B, Castellano M, Ferlin A, Cappelli C. When and why patients drop out from benign thyroid nodules follow-up: a single centre experience. Endocrine 2023; 79:512-516. [PMID: 36434324 PMCID: PMC9988786 DOI: 10.1007/s12020-022-03256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Drop-out in clinical long-term follow-up is a general problem that is potentially harmful to patients. No data about patients that drop out from thyroid ultrasound follow-up is available literature. The aim of the present retrospective study was to evaluate the characteristics of patients that dropped out from ultrasound thyroid nodule follow-up. PATIENTS AND METHODS We reviewed medical records of all consecutive patients who underwent a fine needle aspiration from January 2007 to March 2009 in our department. All the patients with benign nodule(s) were recommended annual ultrasounds; patients who had dropped out from follow-up were included and a telephone interview was obtained to evaluate the reasons for dropping out. RESULTS 289/966 (30%) of patients with benign nodules dropped out during follow-up; 94% of them within the first 5 years. Phone interviews were obtained from 201/289 (70%) of the patients. In the 57% of cases, the main declared reason for dropping out was nodular dimension stability during the first 2-3 years; 8.7% of them had forgotten about the appointment; 6.4% of subjects claimed to check only serum TSH, and 3.2% stated that they would undergo an ultrasound only if the nodule(s) were symptomatic. Finally, 10.7% patients continued follow-up in other centres. CONCLUSION we showed that a third of patients miss their thyroid ultrasound follow-ups, and that the major cause is the low perceived threat coming from the disease. As a certain amount of drop-out is inevitable, attempting to reinforce our patients' awareness regarding their own health state is mandatory. TRIAL REGISTRATION Trial registration: no. 4084.
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Affiliation(s)
- Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - Elena Di Lodovico
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Letizia Chiara Pezzaioli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Barbara Agosti
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Alberto Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, 25123, Brescia, Italy.
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Ze Y, Shao F, Feng X, Shen S, Bi Y, Zhu D, Zhang X. Effect of liver dysfunction on outcome of radioactive iodine therapy for Graves' disease. BMC Endocr Disord 2022; 22:319. [PMID: 36522617 PMCID: PMC9753361 DOI: 10.1186/s12902-022-01242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Liver dysfunction is a common complication of Graves' disease (GD) that may be caused by excessive thyroid hormone (TH) or anti-thyroid drugs (ATDs). Radioactive iodine (RAI) therapy is one of the first-line treatments for GD, but it is unclear whether it is safe and effective in patients with liver dysfunction. 510 consecutive patients with GD receiving first RAI were enrolled in the study, and followed up at 3-, 6- and 12-month. Liver dysfunction was recorded in 222 (43.5%) patients. GD patients with liver dysfunction had higher serum levels of free triiodothyronine (FT3) (median 27.6 vs. 20.6 pmol/L, p < 0.001) and free thyroxine (FT4) (median 65.4 vs. 53.5 pmol/L, p < 0.001) levels than those with normal liver function. Binary logistic regression analysis showed that duration of disease (OR = 0.951, 95% CI: 0.992-0.980, p = 0.001) and male gender (OR = 1.106, 95% CI: 1.116-2.384; p = 0.011) were significant differential factors for liver dysfunction. Serum TSH levels were higher in patients with liver dysfunction at all 3 follow-up time points (p = 0.014, 0.008, and 0.025 respectively). FT3 level was lower in patients with liver dysfunction at 3-month follow-up (p = 0.047), but the difference disappeared at 6 and 12 months (p = 0.351 and 0.264 respectively). The rate of euthyroidism or hypothyroidism was higher in patients with liver dysfunction than in those with normal liver function at 3 months (74.5% vs 62.5%; p = 0.005) and 6 months (82.1% vs 69.1%; p = 0.002) after RAI treatment, but the difference did not persist at 12-month follow-up (89.6% vs 83.2%, p = 0.081).There were no statistically significant differences in treatment efficacy (94.48% vs 90.31%, p = 0.142), incidence of early-onset hypothyroidism (87.73% vs 83.67%, p = 0.277), and recurrence rate (4.91% vs 7.14%, p = 0.379) between the 2 groups at 12-month follow-up. In conclusion, the efficacy of RAI was comparable in GD patients with liver dysfunction and those with normal liver function.
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Affiliation(s)
- Yuyang Ze
- Department of Endocrinology, Drum Tower Hospital affiliated to Nanjing University Medical School, Branch of National Clinical Research Centre for Metabolic Diseases; Endocrine and Metabolic Disease Medical Center, Drum Tower Hospital affiliated to Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, Jiangsu, China
- Department of Endocrinology and Metabolism, the Fifth People's Hospital of Suzhou Wujiang, No. 555, Xinyou Road, Suzhou, 215200, China
| | - Fei Shao
- Department of Endocrinology, Drum Tower Hospital affiliated to Nanjing University Medical School, Branch of National Clinical Research Centre for Metabolic Diseases; Endocrine and Metabolic Disease Medical Center, Drum Tower Hospital affiliated to Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, Jiangsu, China
- Department of Endocrinology and Metabolism, Langxi Hospital of Traditional Chinese Medicine, No. 99 Tingzishan Road, Jianping Town, Langxi County, Xuancheng City, 242100, Anhui, China
| | - Xuefeng Feng
- Department of Nuclear Medicine, Drum Tower Hospital affiliated to Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, China
| | - Shanmei Shen
- Department of Endocrinology, Drum Tower Hospital affiliated to Nanjing University Medical School, Branch of National Clinical Research Centre for Metabolic Diseases; Endocrine and Metabolic Disease Medical Center, Drum Tower Hospital affiliated to Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, Jiangsu, China
| | - Yan Bi
- Department of Endocrinology, Drum Tower Hospital affiliated to Nanjing University Medical School, Branch of National Clinical Research Centre for Metabolic Diseases; Endocrine and Metabolic Disease Medical Center, Drum Tower Hospital affiliated to Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, Jiangsu, China
| | - Dalong Zhu
- Department of Endocrinology, Drum Tower Hospital affiliated to Nanjing University Medical School, Branch of National Clinical Research Centre for Metabolic Diseases; Endocrine and Metabolic Disease Medical Center, Drum Tower Hospital affiliated to Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, Jiangsu, China.
| | - Xiaowen Zhang
- Department of Endocrinology, Drum Tower Hospital affiliated to Nanjing University Medical School, Branch of National Clinical Research Centre for Metabolic Diseases; Endocrine and Metabolic Disease Medical Center, Drum Tower Hospital affiliated to Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, Jiangsu, China.
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Xiang Z, Zhuo Q, Zhao C, Deng X, Zhu T, Wang T, Jiang W, Lei B. Self-supervised multi-modal fusion network for multi-modal thyroid ultrasound image diagnosis. Comput Biol Med 2022; 150:106164. [PMID: 36240597 DOI: 10.1016/j.compbiomed.2022.106164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/11/2022] [Accepted: 10/01/2022] [Indexed: 12/07/2022]
Abstract
Ultrasound is a typical non-invasive diagnostic method often used to detect thyroid cancer lesions. However, due to the limitations of the information provided by ultrasound images, shear wave elastography (SWE) and color doppler ultrasound (CDUS) are also used clinically to assist in diagnosis, which makes the diagnosis time-consuming, labor-intensive, and highly subjective process. Therefore, automatic diagnosis of benign and malignant thyroid nodules is beneficial for the clinical diagnosis of the thyroid. To this end, based on three modalities of gray-scale ultrasound images(US), SWE, and CDUS, we propose a deep learning-based multi-modal feature fusion network for the automatic diagnosis of thyroid disease based on the ultrasound images. First, three ResNet18s initialized by self-supervised learning are used as branches to extract the image information of each modality, respectively. Then, a multi-modal multi-head attention branch is used to remove the common information of three modalities, and the knowledge of each modal is combined for thyroid diagnosis. At the same time, to better integrate the features between modalities, a multi-modal feature guidance module is also proposed to guide the feature extraction of each branch and reduce the difference between each-modal feature. We verify the multi-modal thyroid ultrasound image diagnosis method on the self-collected dataset, and the results prove that this method could provide fast and accurate assistance for sonographers in diagnosing thyroid nodules.
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Affiliation(s)
- Zhuo Xiang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, China
| | - Qiuluan Zhuo
- Huazhong University of Science and Technology Union Shenzhen Hospital, Department of Ultrasound, China
| | - Cheng Zhao
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, China
| | - Xiaofei Deng
- Huazhong University of Science and Technology Union Shenzhen Hospital, Department of Ultrasound, China
| | - Ting Zhu
- Huazhong University of Science and Technology Union Shenzhen Hospital, Department of Ultrasound, China
| | - Tianfu Wang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, China
| | - Wei Jiang
- Huazhong University of Science and Technology Union Shenzhen Hospital, Department of Ultrasound, China.
| | - Baiying Lei
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, China.
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Li XL, Sun YK, Wang Q, Chen ZT, Qian ZB, Guo LH, Xu HX. Synchronous tele-ultrasonography is helpful for a naive operator to perform high-quality thyroid ultrasound examinations. Ultrasonography 2022; 41:650-660. [PMID: 35773182 PMCID: PMC9532195 DOI: 10.14366/usg.21204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/05/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose This study investigated the value of synchronous tele-ultrasonography (TUS) for naive operators in thyroid ultrasonography (US) examinations. Methods Ninety-seven patients were included in this prospective, parallel-controlled trial. Thyroid scanning and diagnosis were completed by resident A independently, resident B with guidance from a US expert through synchronous TUS, and an on-site US expert. The on-site expert’s findings constituted the reference standard. Two other off-site US experts analyzed all data in a blind manner. Inter-operator consistency between the two residents and the on-site US expert for thyroid size measurements, nodule measurements, nodule features, American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) categories, and image quality was compared. Two questionnaires were completed to evaluate the clinical benefit. Results Resident B detected more nodules consistent with the on-site expert than resident A did (89.4% vs. 56.5%, P<0.001). Resident B achieved excellent consistency with the on-site expert in terms of ACR TI-RADS categories, nodule composition, shape, echogenic foci, and vascularity (all intra-class correlation coefficients [ICCs] >0.75), while resident A achieved lower consistency in ACR TI-RADS categories, composition, echogenicity, margin, echogenic foci, and vascularity (all ICCs 0.40-0.75). Residents A and B had excellent consistency in target nodule measurements (all ICCs >0.75). Resident B achieved better performance than resident A for gray values, time gain compensation, depth, color Doppler adjustment, and the visibility of key information (all P<0.05). Furthermore, 61.9% (60/97) of patients accepted synchronous TUS, and 59.8% (58/97) patients were willing to pay for it. Conclusion Synchronous TUS can help inexperienced residents achieve comparable thyroid diagnostic capability to a US expert.
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Affiliation(s)
- Xiao-Long Li
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yi-Kang Sun
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Qiao Wang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zi-Tong Chen
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhe-Bin Qian
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Le-Hang Guo
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Affiliation(s)
- Krupa R Patel
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
| | - Mary E Cunnane
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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11
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Marini TJ, Weiss SL, Gupta A, Zhao YT, Baran TM, Garra B, Shafiq I, Oppenheimer DC, Egoavil MS, Ortega RL, Quinn RA, Kan J, Dozier AM, Tamayo L, Carlotto C, Castaneda B. Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas. J Endocrinol Invest 2021; 44:2699-2708. [PMID: 33970434 PMCID: PMC8572222 DOI: 10.1007/s40618-021-01584-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. METHODS The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. RESULTS Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen's kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. CONCLUSION Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.
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Affiliation(s)
- T J Marini
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - S L Weiss
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - A Gupta
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Y T Zhao
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - T M Baran
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - B Garra
- Medical Imaging Ministries of the Americas, 10810 Lake Minneola Shores, Clermont, FL, 34711, USA
| | - I Shafiq
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - D C Oppenheimer
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - M S Egoavil
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - R L Ortega
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - R A Quinn
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - J Kan
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - A M Dozier
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - L Tamayo
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - C Carlotto
- Medical Innovation and Technology, Calle Los Libertadores 635, 15046, San Isidro, Peru
| | - B Castaneda
- Pontifica Universidad Catolica del Peru, Av. Universitaria 1801, 15088, San Miguel, Peru.
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12
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Yeste Fernández D, Vega Amenabar E, Coma Muñoz A, Arciniegas Vallejo L, Clemente León M, Planes-Conangla M, Iglesias Felip C, Sábado Álvarez C, Guillén Burrieza G, Campos-Martorell A. Ultrasound criteria (EU-TIRADS) to identify thyroid nodule malignancy risk in adolescents. Correlation with cyto-histological findings. Endocrinol Diabetes Nutr (Engl Ed) 2021; 68:728-734. [PMID: 34924161 DOI: 10.1016/j.endien.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Thyroid nodule (TN) harbouring a thyroid carcinoma are more common in paediatric than adult patients. In paediatric population, the evaluation of a TN should require specific paediatric tools for its diagnostic and therapeutic management. High-resolution ultrasonography and cytological evaluation after fine-needle aspiration biopsy (FNAB) remain the cornerstones of evaluation of TN. OBJECTIVES To evaluate in paediatric TN for the first time the usefulness and precision of the ultrasound criteria defined by the "Thyroid Imaging Reporting and Data System (EU-TIRADS) 2017 in adults" to establish the ultrasound indication for the practice of FNAB and stratify the risk of malignancy. PATIENTS AND METHODS 24 paediatric patients under age 18 years with thyroid nodules were attended in the last 15 years, 24 of them (31 nodules; age: 15.2 ± 2.2 years; 18 women) met the inclusion criteria: FNAB with Bethesda classification and ultrasound with EU-TIRADS score. EU-TIRADS score were evaluated retrospectively. Fourteen patients underwent surgery and the definitive histological diagnosis was obtained, this allowed the calculations of sensitivity, specificity and positive and negative predictive values of the EU-TIRADS and Bethesda classification. Data on the largest diameters of the nodules were collected. RESULTS Of the overall 31 nodules, the distribution by EU-TIRADS (T) category was: T1 (3.2%), T2: 2 (6.4%), T3: 7 (22.6%), T4: 16 (51.6%) and T5: 5 (16.1%). All malignant nodules were included in EU-TIRADS category 4 or 5. By the other hand, 13 of the 25 benign nodules were also included in the EU-TIRADS 4 category, and one in the 5. The distribution by categories of Bethesda's classification (B): BI: 6 (19.4%), BII: 14 (45.2%), BIII: 5 (16.1%), BIV: 2 (6.5%), BV: 0 and BVI: 4 (12.9%). The pathological diagnosis of the 14 patients who underwent surgery was: 6 papillary carcinomas and 8 with benign lesions: 6 nodular hyperplasia and 2 follicular adenoma. The percentage of malignancy was 42%. The sensitivity of the EU-TIRADS classification to detect malignant nodules was 100%, the specificity was 25%, PPV 44% and NPV 100%. The sensitivity of the Bethesda classification to detect malignant nodules was 86%, the specificity was 75%, PPV 67% and NPV 90%. The analysis of the largest diameter of the nodules did not show statistically significant differences between benign and malignant lesions. CONCLUSIONS EU-TIRADS for ultrasonographic criteria classification in combination with the clinical history is an adequate and reproducible method to estimate suspicion of malignancy of paediatric TN. It is also a reliable diagnostic tool to decide which nodules will be candidates for FNAB.
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Affiliation(s)
- Diego Yeste Fernández
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain.
| | - Elizabeth Vega Amenabar
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Ana Coma Muñoz
- Servicio Radiología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Larry Arciniegas Vallejo
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - María Clemente León
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Marina Planes-Conangla
- Servicio Radiología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Carmela Iglesias Felip
- Servicio Anatomía Patológica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Constantino Sábado Álvarez
- Servicio Oncohematología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Gabriela Guillén Burrieza
- Servicio Cirugía Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
| | - Ariadna Campos-Martorell
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, Spain
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13
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Albani V, Vale LD, Pearce M, Ostroumova E, Liutsko L. Aspects of economic costs and evaluation of health surveillance systems after a radiation accident with a focus on an ultrasound thyroid screening programme for children. Environ Int 2021; 156:106571. [PMID: 33975128 DOI: 10.1016/j.envint.2021.106571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Health surveillance initiatives targeted at populations evacuated from, and residing in, areas affected by radiation contamination were implemented by international institutions as well as national and local governments after the nuclear accidents of Chernobyl and Fukushima Dai-ichi nuclear power plants. Most of these initiatives included a component of childhood thyroid cancer monitoring, with the more comprehensive schemes corresponding to national programmes of health monitoring for adults and children around general health and wellbeing. This article provides a short overview of available data on the costs and resources associated with surveillance responses to two recent nuclear accidents: Chernobyl and the Fukushima Dai-Ichi nuclear plant accidents. Moreover, because the balance of costs and benefits of health surveillance after a nuclear accident can influence decisions on implementation, we also present a brief overview of the principles of economic evaluation for collecting and presenting data on costs and outcomes of a surveillance programme after a nuclear accident. We apply these principles in a balance sheet analysis of a post-accident ultrasound thyroid screening programme for children.
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Affiliation(s)
- Viviana Albani
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Luke D Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark Pearce
- Health Protection Research Unit for Chemical & Radiation Threats and Hazards, Newcastle University, Newcastle upon Tyne, United Kingdom
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14
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Edwards MK, Iñiguez-Ariza NM, Singh Ospina N, Lincango-Naranjo E, Maraka S, Brito JP. Inappropriate use of thyroid ultrasound: a systematic review and meta-analysis. Endocrine 2021; 74:263-269. [PMID: 34379311 DOI: 10.1007/s12020-021-02820-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Nearly half the cases of thyroid cancer, a malignancy rapidly rising in incidence within the United States, are attributable to small and asymptomatic papillary thyroid cancers that will not increase mortality. A primary driver of thyroid cancer overdiagnosis is ultrasound use. It is therefore valuable to understand how inappropriate use of thyroid ultrasound is defined, analyze the current evidence for its frequency, and identify interventions to lessen misuse. METHODS Ovid MEDLINE(R), Ovid EMBASE, and Scopus databases were searched from inception to June 2020 for studies assessing inappropriate use of thyroid ultrasound. Reviewers, working independently and in duplicate, evaluated studies for inclusion, extracted data, and graded risk of bias. We used a random-effects model with a generalized linear mixed approach to calculate the mean overall proportion estimates of inappropriate use. RESULTS Seven studies (total n = 1573) met the inclusion criteria with moderate to high risk of bias. Inappropriate thyroid ultrasound use was described variably, using published practice guidelines, third-party expert reviewers, or author interpretations of the literature. The overall frequency of inappropriate thyroid ultrasound use was 46% (95% CI 15-82%; n = 388) and 34% (95% CI 16-57%; n = 190) among studies using guideline based definitions. The pooled frequency of iUS due to thyroid dysfunction (either hypothyroidism or thyrotoxicosis) was 17% (95% CI 7-37%; n = 191) and the frequency of iUS due to nonspecific symptoms without a palpable mass was 11% (95% CI 5-22%; n = 124). No study examined interventions to address inappropriate use. CONCLUSIONS Low quality evidence suggests that inappropriate use of thyroid ultrasound is common. Interventional studies aiming to decrease the inappropriate use of thyroid ultrasound are urgently needed.
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Affiliation(s)
- Matthew K Edwards
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Naykky Singh Ospina
- University of Florida, Division of Endocrinology, Department of Medicine, Gainesville, FL, USA
| | - Eddy Lincango-Naranjo
- Mayo Clinic, Knowledge and Evaluation Research Unit, 200 First Street Southwest, Rochester, MN, 55905, USA
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Juan P Brito
- Mayo Clinic, Knowledge and Evaluation Research Unit, 200 First Street Southwest, Rochester, MN, 55905, USA.
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
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15
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Kang S, Kwon SK, Choi HS, Kim MJ, Park YJ, Park DJ, Cho SW. Comparison of Korean vs. American Thyroid Imaging Reporting and Data System in Malignancy Risk Assessment of Indeterminate Thyroid Nodules. Endocrinol Metab (Seoul) 2021; 36:1111-1120. [PMID: 34674501 PMCID: PMC8566128 DOI: 10.3803/enm.2021.1208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/06/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The management of cytologically indeterminate thyroid nodules is challenging for clinicians. This study aimed to compare the diagnostic performance of the Korean Thyroid Imaging Reporting and Data Systems (K-TIRADS) with that of the American College of Radiology (ACR)-TIRADS for predicting the malignancy risk of indeterminate thyroid nodules. METHODS Thyroid nodules diagnosed by fine-needle aspiration (FNA) followed by surgery or core needle biopsy at a single referral hospital were enrolled. RESULTS Among 200 thyroid nodules, 78 (39.0%) nodules were classified as indeterminate by FNA (Bethesda category III, IV, and V), and 114 (57.0%) nodules were finally diagnosed as malignancy by surgery or core needle biopsy. The area under the curve (AUC) was higher for FNA than for either TIRADS system in all nodules, while all three methods showed similar AUCs for indeterminate nodules. However, for Bethesda category III nodules, applying K-TIRADS 5 significantly increased the risk of malignancy compared to a cytological examination alone (50.0% vs. 26.5%, P=0.028), whereas applying ACR-TIRADS did not lead to a change. CONCLUSION K-TIRADS and ACR-TIRADS showed similar diagnostic performance in assessing indeterminate thyroid nodules, and K-TIRADS had beneficial effects for malignancy prediction in Bethesda category III nodules.
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Affiliation(s)
- Sunyoung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu,
Korea
| | - Seul Ki Kwon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu,
Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon,
Korea
| | - Min Joo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
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16
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Kouatcheu SD, Marko J, Tamura D, Khan SG, Lee CR, DiGiovanna JJ, Kraemer KH. Thyroid nodules in xeroderma pigmentosum patients: a feature of premature aging. J Endocrinol Invest 2021; 44:1475-1482. [PMID: 33155181 PMCID: PMC8096868 DOI: 10.1007/s40618-020-01451-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/12/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Xeroderma pigmentosum (XP) is an autosomal recessive disease with defective DNA repair, a markedly increased risk of skin cancer, and premature aging. Reports from North Africa have described thyroid nodules in XP patients, but thyroid nodule prevalence has never been determined in XP patients enrolled in our natural history study at the National Institutes of Health (NIH). METHODS We performed thyroid ultrasound examinations on all 29 XP patients examined from 2011 to 2019 and assessed nodule malignancy using the Thyroid Imaging Reporting and Data System. Thyroid nodule prevalence was also obtained from comparison cohorts. DNA sequencing was performed on thyroid tissue from XP patients who had surgery for thyroid cancer. RESULTS Thyroid nodules were identified in 18/29 XP patients (62%). The median age of patients with thyroid nodules in our XP cohort (20 years) was younger than that of three comparison groups: 36 years (California study-208 subjects), 48 years (Korean study-24,757 subjects), and 52 years (NIH-682 research subjects). Multiple (2-4) thyroid nodules were found in 12/18 (67%) of the patients with nodules. Autopsy examination revealed follicular adenomas in 4/8 (50%) additional XP patients. DNA sequencing revealed rare mutations in two other XP patients with papillary thyroid cancer. CONCLUSIONS XP patients have an increased incidence of thyroid nodules at an early age in comparison to the general population. These finding confirm another premature aging feature of XP.
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Affiliation(s)
- S D Kouatcheu
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
- NIH Academy Enrichment Program, Bethesda, MD, USA
| | - J Marko
- Clinical Center, NIH, Bethesda, MD, USA
| | - D Tamura
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - S G Khan
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - C R Lee
- Laboratory of Pathology, CCR, NCI, NIH, Bethesda, MD, USA
| | - J J DiGiovanna
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - K H Kraemer
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.
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17
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Eilsberger F, Tuttle RM, Librizzi D, Pfestroff A, Luster M, Verburg FA. Perioperative diagnostics of patients referred for radioiodine therapy of differentiated thyroid carcinoma: referral center experience in an iodine-insufficient country. Endocrine 2021; 72:721-726. [PMID: 33135124 PMCID: PMC8159782 DOI: 10.1007/s12020-020-02509-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The interdisciplinary "Martinique-Principles" of four international professional societies concerned with the patient management of differentiated thyroid cancer (DTC) patients were agreed upon. Differences in perioperative diagnostics can lead to differences in clinical decision founding regarding the treatment of thyroid carcinoma. Our aim was to analyze the perioperative diagnostics of patients referred for postoperative I-131 therapy of DTC. METHODS We retrospectively examined the data of 142 patients who were referred to our center for the first course of postsurgical I-131 therapy. We extracted data on perioperative diagnostics. RESULTS Fine-needle biopsy (FNB) was performed in 27/142 patients. In 17 patients, FNB yielded findings suspicious of malignancy, in 3 patients a follicular lesion was reported. An intraoperative frozen section analysis was performed in 79/142 patients. 5/63 patients showed already a cytologically proven malignancy. In 10/79 patients, the frozen section had a nonmalignant result, although DTC was found on final assessment. In 2/79 patients, frozen section analysis was indecisive, although the final report confirmed DTC. In the remaining 67 patients, frozen section yielded DTC. CONCLUSIONS There is room for improvement in perioperative diagnostics surrounding thyroid surgery, currently many procedures are performed without adequate information on potential presence of thyroid cancer. More frequent use of FNB might be able to decrease the number of unnecessary thyroid surgeries, increased use of frozen section might decrease the number of second operations and might contribute to less discordance between experts in the field of DTC treatment.
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Affiliation(s)
- Friederike Eilsberger
- Department of Nuclear Medicine, University Hospital Marburg, 35043, Marburg, Germany.
| | - R Michael Tuttle
- Department of Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Damiano Librizzi
- Department of Nuclear Medicine, University Hospital Marburg, 35043, Marburg, Germany
| | - Andreas Pfestroff
- Department of Nuclear Medicine, University Hospital Marburg, 35043, Marburg, Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, 35043, Marburg, Germany
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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18
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Yeste Fernández D, Vega Amenabar E, Coma Muñoz A, Arciniegas Vallejo L, Clemente León M, Planes-Conangla M, Iglesias Felip C, Sábado Álvarez C, Guillén Burrieza G, Campos-Martorell A. Ultrasound criteria (EU-TIRADS) to identify thyroid nodule malignancy risk in adolescents. Correlation with cyto-histological findings. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00078-1. [PMID: 33888443 DOI: 10.1016/j.endinu.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/17/2020] [Accepted: 11/28/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Thyroid nodule (TN) harboring a thyroid carcinoma are more common in pediatric than adult patients. In pediatric population, the evaluation of a TN should require specific pediatric tools for its diagnostic and therapeutic management. High-resolution ultrasonography and cytological evaluation after fine-needle aspiration biopsy (FNAB) remain the cornerstones of evaluation of TN. OBJECTIVES To evaluate in pediatric TN for the first time the usefulness and precision of the ultrasound criteria defined by the"Thyroid Imaging Reporting and Data System (EU-TIRADS) 2017 in adults" to establish the ultrasound indication for the practice of FNAB and stratify the risk of malignancy. PATIENTS AND METHODS 24 pediatric patients under age 18 years with thyroid nodules were attended in the last 15 years, 24 of them (31 nodules; age: 15.2 ± 2.2 years; 18 women) met the inclusion criteria: FNAB with Bethesda classification and ultrasound with EU-TIRADS score. EU-TIRADS score were evaluated retrospectively. Fourteen patients underwent surgery and the definitive histological diagnosis was obtained, this allowed the calculations of sensitivity, specificity and positive and negative predictive values of the EU-TIRADS and Bethesda classification. Data on the largest diameters of the nodules were collected. RESULTS Of the overall 31 nodules, the distribution by EU-TIRADS (T) category was: T1 (3.2%), T2: 2 (6.4%), T3: 7 (22.6%), T4: 16 (51.6%) and T5: 5 (16.1%). All malignant nodules were included in EU-TIRADS category 4 or 5. By the other hand, 13 of the 25 benign nodules were also included in the EU-TIRADS 4 category, and one in the 5. The distribution by categories of Bethesda's classification (B): BI: 6 (19.4%), BII: 14 (45.2%), BIII: 5 (16.1%), BIV: 2 (6.5%), BV: 0 and BVI: 4 (12.9%). The pathological diagnosis of the 14 patients who underwent surgery was: 6 papillary carcinomas and 8 with benign lesions: 6 nodular hyperplasia and 2 follicular adenoma. The percentage of malignancy was 42%. The sensitivity of the EU-TIRADS classification to detect malignant nodules was 100%, the specificity was 25%, PPV 44% and NPV 100%. The sensitivity of the Bethesda classification to detect malignant nodules was 86%, the specificity was 75%, PPV 67% and NPV 90%. The analysis of the largest diameter of the nodules did not show statistically significant differences between benign and malignant lesions. CONCLUSIONS EU-TIRADS for ultrasonographic criteria classification in combination with the clinical history is an adequate and reproducible method to estimate suspicion of malignancy of pediatric TN. It is also a reliable diagnostic tool to decide which nodules will be candidates for FNAB.
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Affiliation(s)
- Diego Yeste Fernández
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España.
| | - Elizabeth Vega Amenabar
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
| | - Ana Coma Muñoz
- Servicio Radiología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
| | - Larry Arciniegas Vallejo
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
| | - María Clemente León
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
| | - Marina Planes-Conangla
- Servicio Radiología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
| | - Carmela Iglesias Felip
- Servicio Anatomía Patológica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
| | - Constantino Sábado Álvarez
- Servicio Oncohematología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
| | - Gabriela Guillén Burrieza
- Servicio Cirugía Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
| | - Ariadna Campos-Martorell
- Sección Endocrinología Pediátrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBER de Enfermedades Raras (CIBERER) ISCIII, EndoERN, Barcelona, España
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Pikis G, Kandaraki E, Lamnisos D, Abbara S, Kyriakou K, Economides A, Economides PA. Prevalence of thyroid carcinoma in nodules with thy 3 cytology: the role of preoperative ultrasonography and strain elastography. Thyroid Res 2021; 14:7. [PMID: 33836771 PMCID: PMC8033666 DOI: 10.1186/s13044-021-00098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) cytology, the gold standard in assessing thyroid nodules, is limited by its inability to determine the true risk of malignancy in Thy 3 nodules. Most patients with Thy3 cytology undergo surgery to establish a histologic diagnosis. The aims of this study were to evaluate the prevalence of malignancy in Thy3 nodules, to examine the ultrasound (US) characteristics that are associated with a high cancer risk and to assess the role of real-time strain elastography. METHODS Retrospective cohort study of 99 nodules with Thy3 cytology in 99 patients who underwent thyroidectomy over a three-year period. Grayscale US, Doppler and real-time strain elastography data were evaluated. RESULTS Eighty-one nodules (81.82%) were benign, 18 (18.18%) were malignant, and almost all were papillary thyroid carcinoma (PTC). Univariable analysis revealed irregular margins (p = 0.02), ill-defined borders (p ≤ 0.001), a taller than wide shape (p ≤ 0.001) and the elasticity score (p = 0.02) as significant predictors of malignancy. Multivariable analysis showed that ill-defined borders and the elasticity score were significant and independent factors associated with malignancy. All soft nodules (elasticity scores 1-2) were benign (sensitivity 100%, specificity 33%, NPV 100%, and PPV 23%). There was a higher rate of malignancy in Thy3a nodules than in Thy3f nodules (42.86% versus 11.54%) (p ≤ 0.001). CONCLUSIONS Irregular margins, ill-defined borders, a taller than wide shape and low elasticity were associated with malignancy. Elastography should be performed when evaluating Thy3 nodules.
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Affiliation(s)
- Giorgos Pikis
- European University Cyprus, 6 Diogenes Street, Engomi, 2404, Nicosia, Cyprus
| | - Eleni Kandaraki
- European University Cyprus, 6 Diogenes Street, Engomi, 2404, Nicosia, Cyprus
| | - Demetris Lamnisos
- European University Cyprus, 6 Diogenes Street, Engomi, 2404, Nicosia, Cyprus
| | - Sereen Abbara
- Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - Aliki Economides
- European University Cyprus, 6 Diogenes Street, Engomi, 2404, Nicosia, Cyprus.,Thyroid & Endocrinology Center, Engomi, Nicosia, Cyprus
| | - Panayiotis A Economides
- European University Cyprus, 6 Diogenes Street, Engomi, 2404, Nicosia, Cyprus. .,Thyroid & Endocrinology Center, Engomi, Nicosia, Cyprus.
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Scerrino G, Cocorullo G, Mazzola S, Melfa G, Orlando G, Laise I, Corigliano A, Lo Brutto D, Cipolla C, Graceffa G. Improving Diagnostic Performance for Thyroid Nodules Classified as Bethesda Category III or IV: How and by Whom Ultrasonography Should be Performed. J Surg Res 2021; 262:203-211. [PMID: 33610055 DOI: 10.1016/j.jss.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/30/2020] [Accepted: 12/04/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of this prospective study is to evaluate if the association of Bethesda system and a 3-categories Ultrasonography (US) risk stratification system proposed by the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi improves the performance of cytology alone in III or IV categories and if further variables such as US provider (radiologist; endocrinologist, or endocrine surgeon both coming from a dedicated team) influence the accuracy of the diagnostic. METHODS 570 consecutive patients with complete clinical records, affected by Bethesda III or IV nodules, have been addressed to two public referral surgical centers of Western Sicily. Age, sex, autoimmunity, nodule size, and US provider were recorded. Fisher's exact test was used for the univariate analysis; Odd's ratios were calculated for the multivariate analysis. RESULTS 248 patients had malignancy at histology, 322 were benign. The mean age was 52 years for the malignancy group and 58 y for the benign group (P < 0.001). At univariate analysis, autoimmunity was correlated with benign group (P < 0.001), and US risk 2 and 3 were correlated with malignancy (nearly 10-folds, P < 0.001); In addition, no difference was found concerning nodule size. At multivariate analysis, US risk 2 and 3 were strong predictors of malignancy (P < 0.0001) especially if cytology was Bethesda IV; endocrinologist and surgeon were more accurate in predicting malignancy compared with the radiologist (P < 0.01). CONCLUSIONS In the context of indeterminate nodules, the American College of Endocrinology/American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi US risk stratification system strongly improves the results of Bethesda system especially when performed from dedicated endocrinologist or endocrine surgeon.
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Affiliation(s)
- Gregorio Scerrino
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy.
| | - Gianfranco Cocorullo
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Giuseppina Melfa
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Giuseppina Orlando
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Iole Laise
- Department of Surgical Oncology and Oral Sciences, Unit of Oncological Surgery, University of Palermo, Palermo, Italy
| | - Alessandro Corigliano
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Daniela Lo Brutto
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Calogero Cipolla
- Department of Surgical Oncology and Oral Sciences, Unit of Oncological Surgery, University of Palermo, Palermo, Italy
| | - Giuseppa Graceffa
- Department of Surgical Oncology and Oral Sciences, Unit of Oncological Surgery, University of Palermo, Palermo, Italy
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Couzins M, Forbes S, Vigneswaran G, Mitra I, Rutherford EE. Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines - Is there evidence of intra-and interobserver variability? Ultrasound 2020; 29:100-105. [PMID: 33995556 DOI: 10.1177/1742271x20971323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/05/2020] [Indexed: 11/15/2022]
Abstract
Introduction U-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability. Methods A total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss' kappa to assess interobserver variability and Cochran's Q test to determine any intraobserver variability. Results We found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss' kappa = 0.30, p <0.0001) and slight agreement in round 2 (Fleiss' kappa = 0.19, p < 0.0001). Cochran's Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all p>0.05). Conclusions We found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.
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Affiliation(s)
- Michael Couzins
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stuart Forbes
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Indu Mitra
- Chelsea and Westminster NHS Hospital, London, UK
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22
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Croce L, De Martinis L, Pinto S, Coperchini F, Dito G, Bendotti G, Pasquali D, Cappelli C, Latrofa F, Magri F, Chiovato L, Rotondi M. Compared with classic Hashimoto's thyroiditis, chronic autoimmune serum-negative thyroiditis requires a lower substitution dose of L-thyroxine to correct hypothyroidism. J Endocrinol Invest 2020; 43:1631-1636. [PMID: 32319047 DOI: 10.1007/s40618-020-01249-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Serum-negative-chronic-autoimmune-thyroiditis (SN-CAT) is considered a milder variant of classic Hashimoto's thyroiditis (CHT). However, its prevalence remains unknown and it is still unclear whether SN-CAT behaves differently in terms of L-thyroxine (LT4) substitution treatment of hypothyroidism. Aims of this study were to estimate the prevalence of SN-CAT in a large series of hypothyroid patients and to compare LT4 requirements in hypothyroid patients with SN-CAT and CHT. METHODS Five-hundred-eighty-one consecutive patients with primary-autoimmune-hypothyroidism were enrolled in a cross-sectional study. LT4 requirements and thyroid-volume changes were longitudinally evaluated in 49 hypothyroid patients with SN-CAT and in 98 sex and age-matched hypothyroid patients with CHT. RESULTS In our series the prevalence of SN-CAT was 20.8%. At diagnosis, patients in the CHT and SN-CAT groups had similar male/female ratio, age and BMI, while serum TSH and thyroid-volume were significantly greater in the CHT group. In the longitudinal study, during a follow-up of 8.9 ± 4.6 years, 8 out of 49 (16.3%) SN-CAT patients developed positive tests for of circulating TPO-Ab and/or Tg-Ab. Thyroid-volume significantly decreased in CHT patients, but not in those with SN-CAT. The maximum daily substitution dose of LT4 was smaller in SN-CAT patients as compared with the CHT ones. Multivariate analysis showed that age, BMI, basal TSH and thyroid antibody status independently and significantly predicted the maximum daily substitution dose of LT4. CONCLUSIONS SN-CAT accounts for a significant proportion of patients with autoimmune hypothyroidism. Compared with hypothyroid patients diagnosed with CHT, the SN-CAT ones require smaller doses of LT4 to correct their hypothyroidism.
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Affiliation(s)
- L Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
- PhD Course in Experimental Medicine, University of Pavia, 27100, Pavia, Italy
| | - L De Martinis
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - S Pinto
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - F Coperchini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - G Dito
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - G Bendotti
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | - D Pasquali
- Department of Advanced Medical and Surgical Science, A.O.U. Vanvitelli, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - C Cappelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - F Latrofa
- Department of Clinical and Experimental Medicine, University of Pisa, 56124, Pisa, Italy
| | - F Magri
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy.
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy.
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
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Abstract
Thyroid nodules are a common clinical problem encountered in an endocrine practice. More and more thyroid nodules are now being detected on unrelated imaging studies, leading to an increased diagnosis of low-risk thyroid cancers. There is therefore a greater emphasis on risk assessment based on clinical and sonographic features to avoid morbidity secondary to unnecessary therapy. Molecular diagnostics are also being widely used to further characterize indeterminate nodules. The American Thyroid Association and American College of Radiology-Thyroid Imaging Reporting and Data System guidelines are the most commonly used in clinical practice for risk assessment.
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Affiliation(s)
- Rajasree Nambron
- University of Alabama at Birmingham, UAB Multispecialty Clinic, 2119 East South Boulevard, Montgomery, AL 36116, USA
| | - Richard Rosenthal
- University of Alabama at Birmingham, The Kirklin Clinic of UAB Hospital, 2000 6th Avenue South, Birmingham, AL 35233, USA
| | - Deepti Bahl
- University of Alabama at Birmingham, 510 20th Street South, FOT 702, Birmingham, AL 35294-3407, USA.
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Kim E, Pudhucode R, Chen H, Lindeman B. Discordance Between the American Thyroid Association and the American College of Radiology Guideline Systems for Thyroid Nodule Biopsy. J Surg Res 2020; 255:469-474. [PMID: 32622161 DOI: 10.1016/j.jss.2020.05.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previously, fine-needle aspiration biopsy was recommended for any thyroid nodule >1.0 cm in size. In 2015, the American Thyroid Association (ATA) introduced a pattern-based approach for biopsy recommendations based on size and ultrasound (US) characteristics. In 2016, the American College of Radiology (ACR) published the Thyroid Imaging Reporting and Data System, using a point-based system that assesses risk of US characteristics. METHODS This study aims to compare recommendations for thyroid nodule biopsy between the ATA and ACR systems and identify outcomes of nodules with discordant recommendations (DRs). US characteristics, fine-needle aspiration biopsy, and surgical pathology results were evaluated for all patients with >1.0 cm thyroid nodules treated at a single tertiary-care institution from 2010 to 2018. RESULTS Inclusion criteria were met by 1100 nodules from 687 patients; 42.8% (n = 471) had DR between the ATA and ACR guidelines. All (100%) DR nodules were not recommended for biopsy by ACR, though 53% were recommended to have follow-up. A majority (79%) of DR nodules were recommended for biopsy by ATA, with the remaining 21% recommended for follow-up. Among surgically excised DR nodules (n = 292), 10.3% (n = 30) nodules were found to be malignant, with the vast majority (90.3%) being well-differentiated carcinoma. Among malignant nodules, the ACR would not have recommended biopsy or follow-up for 26.7% (n = 8). CONCLUSIONS The ACR classification system is more restrictive compared with the ATA system for recommending thyroid nodule biopsy. This discrepancy could result in confusion for clinicians and delay in diagnosis or therapy for patients with thyroid cancer.
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Affiliation(s)
- Eric Kim
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Herbert Chen
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brenessa Lindeman
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Sutton W, Canner JK, Rooper LM, Prescott JD, Zeiger MA, Mathur A. Is patient age associated with risk of malignancy in a ≥4 cm cytologically benign thyroid nodule? Am J Surg 2020; 221:111-116. [PMID: 32532458 DOI: 10.1016/j.amjsurg.2020.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Current data regarding the risk of malignancy in a large thyroid nodule with benign fine-needle aspiration biopsy(FNAB) is conflicting. We investigated the impact of patient age on the risk of malignancy in nodules≥4 cm with benign cytology. METHODS We performed a single-institution retrospective review of patients who underwent surgery from 07/2008-08/2019 for a cytologically benign thyroid nodule ≥4 cm. The relationship between malignant histopathology and patient and ultrasound features was assessed with multivariable logistic regression. RESULTS Of 474 nodules identified, 25(5.3%) were malignant on final pathology. In patients <55 years old, 21/273(7.7%) nodules were malignant, compared to 4/201(2.0%) in patients ≥55. Patient age ≥55 was independently associated with significantly lower risk of malignancy(OR:0.2,95%CI:0.1-0.7,p = 0.011). Increasing nodule size >4 cm and high-risk ultrasound features were not associated with risk of malignancy(OR:1.0,95%CI:0.7-1.4,p = 0.980, and OR:9.6,95%CI:0.9-107.8,p = 0.066, respectively). CONCLUSIONS Patients <55 years old are 3.7-fold more likely to have a falsely benign FNA biopsy in a nodule≥4 cm.
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Affiliation(s)
- Whitney Sutton
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joseph K Canner
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Lisa M Rooper
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jason D Prescott
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Martha A Zeiger
- Surgical Oncology Program, National Cancer Institute, National Institute of Health, Bethesda, MD, 20892, USA
| | - Aarti Mathur
- Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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Al Maawali A, Matheson C, Baird R, Blair G. The thyroid nodules in kids study (ThyNK study): An evaluation of clinical practice variation. J Pediatr Surg 2020; 55:950-953. [PMID: 32081357 DOI: 10.1016/j.jpedsurg.2020.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the management of thyroid nodules in children and assess clinical practice variation (CPV) using the 2015 American Thyroid Association (ATA) guidelines as a standard. METHODS Pediatric patients presenting to a tertiary care pediatric centre with a thyroid nodule from 2007 to 2017 were retrospectively analyzed. Demographic and disease specific information were collected. CPV and adherence to ATA guidelines were explored. RESULTS Of 86 patient records reviewed, 47 (55%) were managed operatively (mean age 14.4, 59F:27M). Fifteen patients (17%) had malignant pathology, and 11/15 (73%) were papillary carcinoma. Of the 47 operative patients, 7 (15%) had no preoperative ultrasound, and 12 patients (26%) did not have preoperative cytology. All patients with low TSH had scintigraphy appropriately performed, and 1 patient with high/normal TSH did not have a preoperative FNA obtained. All differentiated thyroid cancers were appropriately managed with hemithyroidectomy or total thyroidectomy based on pathology. Where CPV from the guidelines was noted, it was associated with complex presentation, the surgeon's decision to proceed to surgery directly, and/or rare pathologies. CONCLUSION The ATA guidelines provide a valuable framework for the management of pediatric thyroid nodules, but CPV persists given patient/disease complexity and heterogeneity. TYPE OF STUDY Case Series with No Comparison Groups. LEVEL OF EVIDENCE Level VI: Case series with no comparison groups.
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Affiliation(s)
- AlGhalya Al Maawali
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada
| | | | - Robert Baird
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada.
| | - Geoffrey Blair
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada
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Zhou H, Jin Y, Dai L, Zhang M, Qiu Y, Wang K, Tian J, Zheng J. Differential Diagnosis of Benign and Malignant Thyroid Nodules Using Deep Learning Radiomics of Thyroid Ultrasound Images. Eur J Radiol 2020; 127:108992. [PMID: 32339983 DOI: 10.1016/j.ejrad.2020.108992] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE We aimed to propose a highly automatic and objective model named deep learning Radiomics of thyroid (DLRT) for the differential diagnosis of benign and malignant thyroid nodules from ultrasound (US) images. METHODS We retrospectively enrolled and finally include US images and fine-needle aspiration biopsies from 1734 patients with 1750 thyroid nodules. A basic convolutional neural network (CNN) model, a transfer learning (TL) model, and a newly designed model named deep learning Radiomics of thyroid (DLRT) were used for the investigation. Their diagnostic accuracy was further compared with human observers (one senior and one junior US radiologist). Moreover, the robustness of DLRT over different US instruments was also validated. Analysis of receiver operating characteristic (ROC) curves were performed to calculate optimal area under it (AUC) for benign and malignant nodules. One observer helped to delineate the nodules. RESULTS AUCs of DLRT were 0.96 (95% confidence interval [CI]: 0.94-0.98), 0.95 (95% confidence interval [CI]: 0.93-0.97) and 0.97 (95% confidence interval [CI]: 0.95-0.99) in the training, internal and external validation cohort, respectively, which were significantly better than other deep learning models (P < 0.01) and human observers (P < 0.001). No significant difference was found when applying DLRT on thyroid US images acquired from different US instruments. CONCLUSIONS DLRT shows the best overall performance comparing with other deep learning models and human observers. It holds great promise for improving the differential diagnosis of benign and malignant thyroid nodules.
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Affiliation(s)
- Hui Zhou
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19 (A) Yuquan Road, Shijingshan District, Beijing, 100049, China
| | - Yinhua Jin
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China
| | - Lei Dai
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China
| | - Meiwu Zhang
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China
| | - Yuqin Qiu
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19 (A) Yuquan Road, Shijingshan District, Beijing, 100049, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19 (A) Yuquan Road, Shijingshan District, Beijing, 100049, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China.
| | - Jianjun Zheng
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China.
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Yang GCH, Fried KO, Scognamiglio T. Can cytology and the Thyroid Imaging, Reporting, and Data System (TI-RADS) identify noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) before surgery? J Am Soc Cytopathol 2020; 9:159-165. [PMID: 32111537 DOI: 10.1016/j.jasc.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION In 2017, the American College of Radiology (ACR) created the Thyroid Imaging, Reporting, and Data System (TI-RADS) to select thyroid nodules for fine-needle aspiration (FNA). The objective of this study is to find out whether ACR TI-RADS is useful in triaging thyroid follicular cells with papillary-like nuclear features obtained by FNA to determine the extent of surgery. MATERIAL AND METHODS The grayscale ultrasound of 76 noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), 41 encapsulated (E), and 79 infiltrative (I) follicular variant (FV) of papillary thyroid carcinoma (PTC) were reviewed and assigned TI-RADS points and then suspicion levels. RESULTS Of the 39 tumors with high suspicion level, 32 were IFVPTC, and seven were EFVPTC. Of the 137 tumors with moderate suspicion level, 47 were IFVPTC, 34 were EFVPTC, and 56 were NIFTP. Of the 19 tumors with mild suspicion level, all were NIFTP. The only tumor with no suspicion was an NIFTP. IFVPTC had a significantly higher suspicion level than EFVPTC and NIFTP (P < 0.0001). The difference in suspicion level between EFVPTC and NIFTP is not statistically significant. None of the cases of NIFTP in the study had a high suspicion level. CONCLUSIONS The study demonstrates that cytology interpreted in the context of ACR TI-RADS suspicion levels can separate NIFTP from many IFVPTC and a few EFVPTC with overt invasion. PTC could be diagnosed in cytology if cells with papillary-like nuclear features derived from TR5 nodules. The nodules with TR4 or less that yield similar cells require surgical pathology to diagnose FVPTC with microscopic capsular or vascular invasions.
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Affiliation(s)
- Grace C H Yang
- Department of Pathology and Laboratory Medicine, Weil Cornell Medicine-New York Presbyterian Hospital, New York, New York.
| | | | - Theresa Scognamiglio
- Department of Pathology and Laboratory Medicine, Weil Cornell Medicine-New York Presbyterian Hospital, New York, New York
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Zhang C, Li BJ, Liu Z, Wang LL, Cheng W. Predicting the factors associated with central lymph node metastasis in clinical node-negative (cN0) papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol 2020; 277:1191-1198. [PMID: 31932880 DOI: 10.1007/s00405-020-05787-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/05/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of the present study was to investigate the risk factors associated with central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC). METHODS A total of 553 patients with PTMC confirmed by histological examination, who underwent thyroidectomy and central neck dissection (CND), were enrolled. The clinicopathological and ultrasonographic features from the patients were analyzed retrospectively. RESULTS PTMC patient age, Hashimoto thyroiditis (HT), tumor location, extrathyroidal extension (ETE), microcalcification and higher E values were correlated with the incidence of CLNM. Multivariate logistic regression analysis showed that age, HT, tumor location, ETE and Emax were related to the extent of CLNM. Chi-squared automatic interaction detection (CHAID) classification tree model showed that patients with tumor in upper/lower third combined ETE had a high risk of CLNM. Furthermore, cN0 PTMC patients with age ≤ 45 years and ETE had more extensive CLNM. CONCLUSION Our observations could be helpful for the assessment of prognostic factors of PTMC patients with CLNM.
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Affiliation(s)
- Cui Zhang
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin, 150081, China
| | - Bao-Jun Li
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Zhao Liu
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin, 150081, China
| | - Ling-Ling Wang
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin, 150081, China
| | - Wen Cheng
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin, 150081, China.
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Correia MM, Chammas MC, Zavariz JD, Arata A, Martins LC, Marui S, Pereira LAA. Evaluation of the effects of chronic occupational exposure to metallic mercury on the thyroid parenchyma and hormonal function. Int Arch Occup Environ Health 2020; 93:491-502. [PMID: 31832764 DOI: 10.1007/s00420-019-01499-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/28/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Experiments in animals exposed to mercury (Hg) in different chemical states have shown thyroid parenchymal and hormone alterations. However, these experiments did not allow the establishment of dose-response curves or provide an understanding of whether these Hg effects on the thyroid parenchyma occur in humans. OBJECTIVE To evaluate the association between chronic occupational exposure to metallic Hg and alterations in thyroid hormones and gland parenchyma 14 years after the last exposure. METHODS A cross-sectional study including 55 males exposed in the past to metallic Hg and 55 non-exposed males, paired by age, was conducted in the Hospital das Clínicas (Brazil) from 2016 to 2017. Serum concentrations of total and free triiodothyronine (TT3 and FT3), free thyroxine (FT4), thyrotropin (TSH), reverse T3 (RT3), selenium and antithyroid antibody titers were obtained. The Hg and iodine concentrations were measured in urine. The thyroid parenchyma was evaluated by B-mode ultrasonography with Doppler. The nodules with aspects suspicious for malignancy were submitted to aspiration puncture with a thin needle, and the cytology assessment was classified by the Bethesda system. The t test or Mann-Whitney test, Chi-square test and Spearman correlation were used to compare the exposed and non-exposed groups and examine the relationships between the variables. Univariate and multivariate logistic regression models were used to trace determinants of the risk of thyroid hormone alteration. Statistical significance was defined by p < 0.05. RESULTS The urinary Hg average was significantly higher in the exposed group than in the non-exposed group (p < 0.01). The mean TSH serum concentration in the exposed group was higher, with a statistically significant difference between the groups (p = 0.03). Serum concentrations of TSH exceeded the normality limit (4.20 µIU/ml) in 13 exposed individuals (27.3%) and 4 non-exposed individuals (7.3%), with a statistically significant association between the hormonal increase and exposure to Hg (p = 0.02). In the logistic regression model, exposure to Hg (yes or no) showed an odds ratio = 4.86 associated with an increase of TSH above the normal limit (p = 0.04). The serum concentrations of RT3 showed a statistically borderline difference between the groups (p = 0.06). There was no statistically significant difference between the mean TT3, FT3 and FT4 serum concentrations in the Hg-exposed group compared to the non-exposed group. The proportions of the echogenicity alterations were higher in the exposed group compared to the non-exposed group (27.3% versus 9.1%; p = 0.03). Papillary carcinomas were documented in three exposed individuals and one non-exposed individual. A follicular carcinoma was recorded in one non-exposed individual. CONCLUSIONS Due to the higher serum TSH concentration and the prevalence of parenchymal alterations in the Hg-exposed group, even after cessation of exposure, it is recommended that the thyroid status of exposed workers be followed for a long period.
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Lam CA, McGettigan MJ, Thompson ZJ, Khazai L, Chung CH, Centeno BA, McIver B, Valderrabano P. Ultrasound characterization for thyroid nodules with indeterminate cytology: inter-observer agreement and impact of combining pattern-based and scoring-based classifications in risk stratification. Endocrine 2019; 66:278-287. [PMID: 31300961 PMCID: PMC7771547 DOI: 10.1007/s12020-019-02000-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/29/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The American Thyroid Association (ATA) sonographic patterns stratify the risk of malignancy of cytologically indeterminate thyroid nodules (ITNs). This study aimed to (1) assess inter-observer agreement for sonographic features and patterns; (2) identify potential sources of disagreement; and (3) evaluate whether the number of suspicious features risk-stratifies non-ATA and high-suspicion patterns. METHODS Three observers independently reviewed the ultrasound images of 463 ITNs with histological follow-up consecutively evaluated between October 2008 and June 2015 at an academic cancer center. Each observer evaluated individual sonographic features. ATA sonographic patterns were derived from the interpretation of sonographic features. Nodules not fitting into any of the proposed patterns were clustered into a non-ATA pattern. RESULTS The inter-observer agreement for ATA sonographic patterns and echogenicity was fair, moderate for margins, good for composition and echogenic foci, and very good for extrathyroidal extension and lymph node metastasis. The interpretation of each sonographic feature was significantly different between observers, and there was complete disagreement in at least one of the features in 104 (22%) nodules. A total of 169 nodules (37%) were classified into the non-ATA pattern. The number of suspicious features allowed risk stratifying nodules with non-ATA and high-suspicion sonographic patterns. Most Non-invasive Follicular Thyroid Neoplasms with Papillary-like Nuclear Features had 0-1 suspicious features and none had >2. CONCLUSIONS Echogenicity interpretation was the greatest source of disagreement. The number of suspicious features risk-stratifies ITNs with non-ATA or high-suspicion patterns. Future studies attempting to objectivize the interpretation of echogenicity and heterogeneity are needed.
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Affiliation(s)
- Cesar A Lam
- Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
| | - Melissa J McGettigan
- Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Zachary J Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Barbara A Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Pablo Valderrabano
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km. 9,100, 28034, Madrid, Spain
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Liu C, Xie L, Kong W, Lu X, Zhang D, Wu M, Zhang L, Yang B. Prediction of suspicious thyroid nodule using artificial neural network based on radiofrequency ultrasound and conventional ultrasound: A preliminary study. Ultrasonics 2019; 99:105951. [PMID: 31323562 DOI: 10.1016/j.ultras.2019.105951] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
This study explored the use of backscattered radiofrequency ultrasound signals combined with artificial neural network (ANN) technology to differentiate benign and malignant thyroid nodules, in comparison with conventional ultrasound techniques. The proposed method uses the gray level co-occurrence matrix algorithm and principal component analysis to identify principal characteristics for use as inputs in the ANN. The dataset consisted of 131 ultrasound images, of which 59 were benign and 72 were malignant, as determined by subsequent surgeries. The nodules were divided randomly into training, validation, and testing groups. Receiver operating characteristic curves (ROC) were drawn to compare the diagnostic efficiency of the ANN when applied to radiofrequency and conventional ultrasound images. The sensitivity, specificity, and accuracy of the ANN in predicting malignancy from the radiofrequency ultrasound images were 100, 91.5, and 96.2%, respectively; from conventional ultrasound, the corresponding values were 94.4, 93.2, and 93.9%, respectively. The area under the receiver operating characteristic curve (AUC) was also higher for radiofrequency than conventional ultrasound (AUC = 0.945 vs. 0.917, 95% confidence interval = 0.901-0.998 vs. 0.854-0.979, using a P-value of 0.26). We then classified each nodule into new risk categories according to the output of each sample generated by the proposed method. The malignancy risks in the proposed Categories 3, 4, and 5 were 0, 18.8, and 94.5%, respectively, compared with 0, 55.1, and 88.2% using the American College of Radiology's Thyroid Imaging Reporting and Data System. Thus, this preliminary study initially indicated that the proposed method of using radiofrequency ultrasound and the ANN was more accurate at predicting malignancy and stratifying thyroid nodules than conventional ultrasound methods, thus offering significant potential to reduce the number of unnecessary thyroid biopsies.
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Affiliation(s)
- Chunrui Liu
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Linzhou Xie
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Wentao Kong
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xiaoling Lu
- Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Dong Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Min Wu
- Department of Ultrasound, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Lijuan Zhang
- Department of Ultrasound, Nanjing Pukou Hospital, Nanjing 210031, China
| | - Bin Yang
- Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
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Davenport C, Alderson J, Yu IG, Magner AC, M O'Brien D, Ghiollagain MN, Kileen S, Heneghan M, Sabah M, Leen E, McDermott JH, Sreenan S, Hickey N, Kyaw-Tun T. A review of the propriety of thyroid ultrasound referrals and their follow-up burden. Endocrine 2019; 65:595-600. [PMID: 30955175 DOI: 10.1007/s12020-019-01920-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/29/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The overdiagnosis of thyroid nodules and indolent thyroid cancers represents an increasing burden on health services, with thyroid ultrasound (US) imaging often representing the initial entry point into the thyroid nodule diagnostic pathway. The aim of this study was to retrospectively review thyroid US referrals to a single Irish hospital to determine if the stated indications for imaging had been appropriate, to review the results of the scans, and to assess the follow-up required in each case. METHODS Patient demographics, scan indications, results, and outcomes were retrospectively reviewed for all patients undergoing thyroid ultrasound from 2012 to 2016. Data were analyzed using GraphPad Prism and expressed in mean ± standard deviation. RESULTS In total, 318 patients (mean age 53 ± 15 years, 85% female) had at least one ultrasound. Most US scans were performed for appropriate indications in order to follow up known thyroid nodular disease and/or malignancy (34.3%), to assess new thyroid goiters or discrete neck lumps (33.3%), and to follow up incidental findings from other imaging modalities (12.6%). However, scans were also requested (in the absence of any palpable goiter or mass) for choking/neck pain/swallowing complaints (12.3%), hypo/hyperthyroidism (6.6%), and miscellaneous reasons (0.6%) that were deemed either potentially or likely inappropriate. Of these scans, approximately half of the identified nodule(s) were deemed unlikely to be related to the stated symptoms, but which subsequently required follow-up imaging ± biopsy. No cases of malignancy were identified. CONCLUSIONS In our center, a significant percentage of thyroid US scans along with their subsequent follow-up were potentially avoidable.
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Affiliation(s)
- Colin Davenport
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland.
| | - Jack Alderson
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Ivan G Yu
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Aoiffe C Magner
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Diarmuid M O'Brien
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Meabh Ni Ghiollagain
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Sinead Kileen
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Mark Heneghan
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Muna Sabah
- Department of Pathology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Eamon Leen
- Department of Pathology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - John H McDermott
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Seamus Sreenan
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Neil Hickey
- Department of Radiology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
| | - Tommy Kyaw-Tun
- Department of Endocrinology, Connolly Hospital, Blanchardstown, Co Dublin, Ireland
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Scappaticcio L, Virili C, Castellana M, Paone G, Centanni M, Trimboli P, Giovanella L. An unsuspicious thyroid nodule with fatal outcome. Hormones (Athens) 2019; 18:321-324. [PMID: 31140157 DOI: 10.1007/s42000-019-00110-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/13/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Over the last few years, several scientific societies have introduced specific evaluation systems to stratify the risk of malignancy of thyroid nodules. Most of these classifications have been created on the basis of ultrasonographic features of the commonest thyroid carcinoma histotype. Herein, we report a case of anaplastic thyroid carcinoma presenting at ultrasound (US) examination as an unsuspicious thyroid nodule associated with distant metastases, which was followed by the patient's death a short time later. CASE REPORT A 77-year-old woman, because of worsening weight loss and vague abdominal pain, underwent a whole-body computed tomography scan, which revealed a large mass adherent to the large bowel, multiple pulmonary nodules, and a solitary thyroid nodule of the left lobe. On US, a round, well-defined, mixed solid-cystic, isoechoic lesion with a maximum diameter of 45 mm and peripheral vascularity was confirmed. No microcalcifications, extrathyroidal extension, cervical lateral lymphadenopathy, tracheal deviation, or compression were found. The nodule was classified as low or very low risk according to six US malignancy risk classification systems. Although only two of these recommended fine-needle aspiration cytology, on the basis of a dimensional criterion, the procedure was performed, the cytology report suggesting anaplastic cancer. Following total thyroidectomy, the histological examination revealed the presence of a follicular thyroid carcinoma with diffuse areas of anaplastic dedifferentiation. CONCLUSION This case highlights the importance of defining the US characteristics of rare variants of thyroid neoplasms, since an early diagnosis is decisive in defining the patient's prognosis.
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Affiliation(s)
- Lorenzo Scappaticcio
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Unit of Endocrinology and Metabolic Diseases, University of Campania "L. Vanvitelli", 80138, Naples, Italy.
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, Endocrinology Unit, "Sapienza" University of Rome, Latina, Italy
| | - Marco Castellana
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Gaetano Paone
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Endocrinology Unit, "Sapienza" University of Rome, Latina, Italy
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Monachese M, Mankaney G, Lopez R, O'Malley M, Laguardia L, Kalady MF, Church J, Shin J, Burke CA. Outcome of thyroid ultrasound screening in FAP patients with a normal baseline exam. Fam Cancer 2019; 18:75-82. [PMID: 30003385 DOI: 10.1007/s10689-018-0097-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Familial adenomatous polyposis (FAP) is a hereditary cancer syndrome associated with a substantial lifetime risk for colorectal cancer. The leading extra-colonic causes of cancer in FAP include duodenal and thyroid cancer (TC). Recent guidelines recommend annual thyroid ultrasound (TUS) screening beginning in the teenage years but the evidence to support the interval particularly in FAP patients with a normal baseline ultrasound is lacking. TUS results from FAP patients enrolled in a thyroid screening program from 2006 to 2016 and who had at least 2 TUS were reviewed. TUS findings were classified as normal, low (LR) or high risk (HR) for TC based on nodule characteristics as determined by American Thyroid Association (ATA) guidelines. We assessed the incidence of TC in patient with normal baseline TUS and factors associated with TC. 264 FAP patients were included. Baseline TUS was normal in 167, LR in 74, and HR in 24 patients. Patients were observed for a mean 4.8 years and underwent an average of 3 TUS. Patients with normal baseline TUS did not develop TC during the course of follow up of 5.1 years. TC developed in 6 patients (2.3%) all with baseline nodules; 5 in the LR group and 1 in the HR group. Factors associated with development of TC were presence of baseline nodule(s) and female sex. The development of TC in FAP patients in a TUS screening program with short term follow up is low and no FAP patient with a normal baseline TUS developed TC during observation. Annual TUS in patients with a normal baseline TUS may not be needed. Extending the screening interval to 2 years may be reasonable until nodules are detected.
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Affiliation(s)
- Marc Monachese
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Gautam Mankaney
- Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Margaret O'Malley
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Laguardia
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew F Kalady
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
| | - James Church
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
| | - Joyce Shin
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Carol A Burke
- Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
- Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA.
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Jiang L, Lee CY, Sloan DA, Randle RW. Variation in the Quality of Thyroid Nodule Evaluations Before Surgical Referral. J Surg Res 2019; 244:9-14. [PMID: 31279266 DOI: 10.1016/j.jss.2019.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/19/2019] [Accepted: 06/06/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroid nodules are highly prevalent, and owing to their malignant potential, proper evaluation is imperative. The objective of this study was to characterize variation in thyroid nodule evaluations. MATERIALS AND METHODS This retrospective review included all consecutive surgical referrals for thyroid nodules from October to December 2017 at a single institution. We determined the proportion of evaluations that contained a thyroid-stimulating hormone (TSH) level and a high-quality ultrasound because these components of thyroid nodule evaluations are common to several evidence-based guidelines. RESULTS The study cohort included 64 patients, with a median age of 51.5 y. Primary care providers referred most patients (51.6%), followed by endocrinologists (40.6%), and other specialists (7.8%). In total, 35.9% of evaluations did not include a TSH value, which is vital to any thyroid nodule evaluation. Most evaluations (95.3%) included a dedicated ultrasound, but only 12.3% of ultrasound reports commented on nodule size in three dimensions, structure, echogenicity, and lymph nodes, which we considered the minimum commentary indicative of a high-quality ultrasound. Only 51.5% of evaluations included both a TSH and a thyroid ultrasound. If patients receiving low-quality ultrasound reports were excluded, 9.4% of the entire cohort received a guideline-concordant, high-quality evaluation. CONCLUSIONS Great variation exists in the quality of thyroid nodule evaluations before surgical referral. Two necessary components of thyroid nodule evaluations that contribute most to the observed deviation from guidelines are obtaining a TSH value and obtaining an ultrasound with enough information to risk stratify the nodule.
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Affiliation(s)
- Lan Jiang
- Section of Endocrine Surgery, Department of General Surgery, University of Kentucky, Lexington, Kentucky
| | - Cortney Y Lee
- Section of Endocrine Surgery, Department of General Surgery, University of Kentucky, Lexington, Kentucky
| | - David A Sloan
- Section of Endocrine Surgery, Department of General Surgery, University of Kentucky, Lexington, Kentucky
| | - Reese W Randle
- Section of Endocrine Surgery, Department of General Surgery, University of Kentucky, Lexington, Kentucky.
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Kundra A, Goldstein DP, Wintemute K, Ghai S, Tsang RW, Gupta K, Mutasingwa DR, Weissberger J, Huszti E, Brown P, Jiang H, Sawka AM. A pilot study examining Toronto-area family physician perspectives on thyroid neoplasm evaluation. J Otolaryngol Head Neck Surg 2019; 48:24. [PMID: 31146769 PMCID: PMC6543582 DOI: 10.1186/s40463-019-0349-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 05/21/2019] [Indexed: 12/03/2022] Open
Abstract
Objective The incidence of thyroid cancer (TC) is known to be very high in the Greater Toronto Area of Ontario, Canada. We performed a pilot survey study examining Toronto-area family physician (FP) perspectives on thyroid neoplasm evaluation (i.e. thyroid nodules [TNs] or thyroid cancer [TC]) in this region, to explore for potential factors leading to overdiagnosis. Methods We performed a cross-sectional mail-out written survey of a random sample of 300 FPs in active practice in the Greater Toronto Area (Markham and Brampton). Results The overall response rate was 22.3, 95% confidence interval (CI) 18.0, 27.4% (67/300); the effective response rate was 19.9, 95% CI 15.7, 24.9% (58/291), after excluding 6 FPs that reported TN evaluation was outside their scope of practice and three FPs with an invalid mailing address. There were no missing responses to questions. The demographic characteristics were as follows: 58.6% (34/58) from Markham, 55.2% (32/58) were female, 58.6% (34/58) were in practice > 10 years, and 32.8% (19/58) affiliated with a University. All FPs reported easy access to thyroid ultrasound (TUS). About half of FPs were concerned about overdiagnosis of TC and most did not believe that there was any TC survival advantage with routine screening TUS. Although appropriate indications for TUS were endorsed by most respondents (e.g. palpable TN, incidental TN on other imaging), inappropriate recommendations were observed in a third of FPs (19/57) who recommended TUS for abnormal thyroid blood tests about half of FPs (30/56) who endorsed biopsy of sub-centimeter nodules. About half of FPs (31/58) reported that their patients sometimes request medically unnecessary TUS. Conclusion There are likely multiple complex factors leading to potential overdiagnosis of TC in primary care, including some physicians’ knowledge gaps about appropriate indications for TN investigations as well as patients’ requests and expectations.
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Affiliation(s)
- Arjun Kundra
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Wintemute
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sangeet Ghai
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Richard W Tsang
- Department of Radiation Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Karuna Gupta
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Jeff Weissberger
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Patrick Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Huan Jiang
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada.
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Abstract
This is a brief overview of the initial workup of patients with thyroid nodules. Most nodules are incidentally discovered, benign, and do not require surgery, but the clinician's job is to determine which nodules are concerning and what the appropriate workup should be. Ultrasound examination is the best imaging modality to evaluation thyroid nodules and, when biopsy is indicated, fine needle aspiration is the proper technique to sample thyroid nodules.
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Affiliation(s)
- Keri Detweiler
- Department of Surgery, University of California, Irvine, 333 City Boulevard West, Suite 1600, Orange, CA 92868, USA
| | - Dawn M Elfenbein
- Surgical Oncology, Department of Surgery, University of California, Irvine, 333 City Boulevard West, Suite 1600, Orange, CA 92868, USA.
| | - Daniel Mayers
- Department of Surgery, University of California, Irvine, 333 City Boulevard West, Suite 1600, Orange, CA 92868, USA
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Abstract
Office-based ultrasonography is increasingly becoming an integral part of an otolaryngology-head and neck surgery practice. A thorough knowledge of the ultrasonic appearance of normal and abnormal pathology are key for performing/interpreting office-based head and neck ultrasonography. A focused but systematic approach allows for efficient and effective office-based head and neck ultrasonography. Office-based ultrasonography also allows for imaging procedures expanding the otolaryngologist's armamentarium. Ultrasound-guided fine needle aspiration (USgFNA) is an integral part of clinician-performed ultrasonography because it allows cytologic diagnosis of suspicious lesions. Understanding the successful techniques and pitfalls in this procedure are critical for the otolaryngologist performing USgFNA.
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Affiliation(s)
- Cristian M Slough
- Willamette Valley Ear, Nose, & Throat, Willamette Valley Medical Center, 2700 SE Stratus Ave, McMinnville, OR 97128, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, 243, Charles Street, Boston, MA 02114, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, 243, Charles Street, Boston, MA 02114, USA; Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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40
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Pang Z, Margolis M, Menezes RJ, Maan H, Ghai S. Diagnostic performance of 2015 American Thyroid Association guidelines and inter-observer variability in assigning risk category. Eur J Radiol Open 2019; 6:122-127. [PMID: 30976628 PMCID: PMC6443900 DOI: 10.1016/j.ejro.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/17/2019] [Indexed: 01/18/2023] Open
Abstract
Risk of malignancy at 75–90% in the high suspicion sonographic pattern of the 2015 ATA guidelines may have been over estimated. The 2015 ATA guidelines show moderate inter-observer agreement for assigning a final risk category. The study highlights certain sonographic features which are not included in any ATA risk categories leading to inter-observer variability.
Objective To determine the interobserver variability of the 2015 American Thyroid Association (ATA) thyroid guidelines and to evaluate the diagnostic accuracy of the guidelines in detecting thyroid cancer. Materials and methods Sonographic patterns of 189 thyroid lesions were retrospectively analyzed by two radiologists according to the 2015 guidelines. The risk of malignancy was calculated for each pattern and compared with the published expected risk of malignancy. Results The observed risk of malignancy for very low suspicion, low suspicion, intermediate suspicion and high suspicion patterns were 2%, 12.7%, 26.3% and 29.8% respectively. Interobserver agreement for final category assignment was moderate (κ 0.518). Conclusion The estimated risk of malignancy in the high suspicion pattern of the 2015 ATA thyroid biopsy guidelines appears to be less than stated. However, this needs further validation in a larger cohort study.
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Affiliation(s)
- Zhiyu Pang
- Toronto Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Myles Margolis
- Toronto Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Ravi J Menezes
- Toronto Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Hassaan Maan
- Toronto Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Sangeet Ghai
- Toronto Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Abstract
OBJECTIVE Thyroid ultrasound plays a major role in the clinical management of patients with thyroid nodules. Comprehensive reporting enables malignant risk stratification and biopsy decisions. In this study, we aimed at a systematic evaluation of the content and completeness of thyroid radiology reports. METHODS A retrospective study was undertaken. A total of 200 thyroid ultrasound reports of examinations performed over a 1-year period were reviewed. After excluding 18 reports, the remaining 182 were evaluated for the inclusion of the following nodule characteristics: size, 3-axis dimensions, location, presence or absence of five signs suspicious of malignancy, namely microcalcification, hypoechogenecity, irregular margin, height-to-width ratio, and intranodular vascularity. RESULTS While all reported nodules could be stratified easily as being more or less than 1 cm in size, only 23.6% of these nodules were reported in 3 dimensions, and 33.5% of the nodules were specifically localized. For any described nodule, the frequency of reporting on echogenicity was 50%, on vascularity 19.2%, on margin 10.4%, on calcifications 9.3%, and no report contained a description of the height-to-width ratio. The cumulative frequency of reporting on one characteristic per nodule was 84%, of two characteristics 27%, three characteristics 4.4%, and no report included ≥4 characteristics per nodule. CONCLUSION Despite easily accessible templates, reporting of thyroid nodule sonogram continues to be incomplete and inconsistent. This in turn constitutes a waste of a significant tool that could otherwise help in making timely informed medical decisions and in providing a significant platform for patients' future follow-up.
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Affiliation(s)
- Laila Qadan
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait,
| | - Adel Ahmed
- Department of Radiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Kusum Kapila
- Department of Pathology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Koseoglu Atilla FD, Ozgen Saydam B, Erarslan NA, Diniz Unlu AG, Yilmaz Yasar H, Ozer M, Akinci B. Does the ACR TI-RADS scoring allow us to safely avoid unnecessary thyroid biopsy? single center analysis in a large cohort. Endocrine 2018; 61:398-402. [PMID: 29744655 DOI: 10.1007/s12020-018-1620-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/26/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The American College of Radiology (ACR) has recently proposed a guideline that recommends clinicians to perform thyroid fine-needle aspiration biopsy (FNAB) on the basis of ultrasound features. In this study, we focused on nodules for which no biopsy is recommended by the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) guideline. SUBJECTS AND METHODS Two-thousand eight-hundred and forty-seven consecutive patients with thyroid nodules who underwent FNAB according to the 2009 American Thyroid Association (ATA) guideline were included. The nodules were re-classified according to the ACR TI-RADS guideline as benign (TR1), not suspicious (TR2), mildly suspicious (TR3), moderately suspicious (TR4) and highly suspicious (TR5). The TR3 category was stratified into two subcategories as regard to the nodule size (TR3; <25 mm and TR3; ≥25 mm). RESULTS Two-hundred and thirty-three (8.2%) patients with non-diagnostic FNABs were excluded. When the TR2 and TR3; <25 mm categories were merged, FNAB was suggestive of thyroid cancer in 17 of 1382 patients (1.2%). FNAB revealed Bethesda IV-VI in 5 of 273 patients with the TR3; ≥25 mm category (1.8%), in 61 of 896 patients with the TR4 category (6.8%), and in 18 of 63 of patients with the TR5 category (28.6%). The ACR TI-RADS scoring was 98.8% (95% CI: 98 to 99.3) specific for identification of a benign nodule. CONCLUSION Our data suggest that ACR TI-RADS scoring is an applicable and potentially cost-effective approach to determine thyroid nodules to be biopsied, although a small proportion of thyroid cancers would be missed.
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Affiliation(s)
| | - Basak Ozgen Saydam
- Division of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, 35340,, Izmir, Turkey.
| | - Nihat Ali Erarslan
- Department of Radiology, Tepecik Training and Research Hospital, 35180,, Izmir, Turkey
| | | | - Hamiyet Yilmaz Yasar
- Division of Endocrinology and Metabolism, Tepecik Training and Research Hospital, 35180,, Izmir, Turkey
| | - Muhammet Ozer
- Department of Internal Medicine, Dokuz Eylul University Faculty of Medicine, 35340,, Izmir, Turkey
| | - Baris Akinci
- Division of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, 35340,, Izmir, Turkey
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Schenke S, Zimny M. Combination of Sonoelastography and TIRADS for the Diagnostic Assessment of Thyroid Nodules. Ultrasound Med Biol 2018; 44:575-583. [PMID: 29305124 DOI: 10.1016/j.ultrasmedbio.2017.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
To evaluate the diagnostic performance of elastography alone and combined with Thyroid Imaging Reporting And Data System (TIRADS) for the assessment of non-autonomous thyroid nodules. We included 244 thyroid nodules and analyzed the visual elasticity scores, strain value (SV) and TIRADS classification. Histologic examination revealed 38 malignant (16%) and 206 benign nodules. The SV was lower in malignant nodules than in benign with an optimal cutoff ≤0.225. The visual elasticity scores showed a better diagnostic performance than the SV measurement. The risk for malignancy increased with higher TIRADS category. The sensitivity, specificity, positive predictive value and negative predictive value of TIRADS were superior to sonoelastography. The combination of TIRADS ≥4C and SV ≤0.225 showed the highest odds ratio to predict malignancy. Kwak-TIRADS classification is superior to elastography for the differentiation of benign and malignant thyroid nodules. Our data demonstrate that a high TIRADS class alone is predictive for thyroid carcinoma and the clinical relevance of sonoelastography is negligible.
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Affiliation(s)
- Simone Schenke
- Institute for Nuclear Medicine Hanau/Gießen/Frankfurt/Offenbach, Gießen, Germany.
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau/Gießen/Frankfurt/Offenbach, Hanau, Germany
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44
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Guo Y, Jiang SQ, Sun B, Siuly S, Şengür A, Tian JW. Using neutrosophic graph cut segmentation algorithm for qualified rendering image selection in thyroid elastography video. Health Inf Sci Syst 2017; 5:8. [PMID: 29109858 DOI: 10.1007/s13755-017-0032-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022] Open
Abstract
Recently, elastography has become very popular in clinical investigation for thyroid cancer detection and diagnosis. In elastogram, the stress results of the thyroid are displayed using pseudo colors. Due to variation of the rendering results in different frames, it is difficult for radiologists to manually select the qualified frame image quickly and efficiently. The purpose of this study is to find the qualified rendering result in the thyroid elastogram. This paper employs an efficient thyroid ultrasound image segmentation algorithm based on neutrosophic graph cut to find the qualified rendering images. Firstly, a thyroid ultrasound image is mapped into neutrosophic set, and an indeterminacy filter is constructed to reduce the indeterminacy of the spatial and intensity information in the image. A graph is defined on the image and the weight for each pixel is represented using the value after indeterminacy filtering. The segmentation results are obtained using a maximum-flow algorithm on the graph. Then the anatomic structure is identified in thyroid ultrasound image. Finally the rendering colors on these anatomic regions are extracted and validated to find the frames which satisfy the selection criteria. To test the performance of the proposed method, a thyroid elastogram dataset is built and totally 33 cases were collected. An experienced radiologist manually evaluates the selection results of the proposed method. Experimental results demonstrate that the proposed method finds the qualified rendering frame with 100% accuracy. The proposed scheme assists the radiologists to diagnose the thyroid diseases using the qualified rendering images.
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Affiliation(s)
- Yanhui Guo
- Department of Computer Science, University of Illinois at Springfield, Springfield, IL USA
| | - Shuang-Quan Jiang
- Department of Ultrasound, Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang China
| | - Baiqing Sun
- School of Management, Harbin Institute of Technology, Harbin, Heilongjiang China
| | - Siuly Siuly
- Centre for Applied Informatics, College of Engineering and Science, Victoria University, Melbourne, VIC Australia
| | - Abdulkadir Şengür
- Department of Electrical and Electronics Engineering, Firat University, Elazig, Turkey
| | - Jia-Wei Tian
- Department of Ultrasound, Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang China
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45
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Abstract
Ultrasound is critical in detection, diagnosis, and management of thyroid nodules. Ultrasound detection of regional nodal metastatic disease is based on abnormal nodal morphology rather than size and is critical to initial surgical and long-term management of thyroid cancer. Fine-needle aspiration biopsy is the gold standard for malignancy diagnosis in thyroid cancer. Thyroglobulin assay of nodal aspirates improves accuracy in diagnosis of metastases. Reporting lexicons assign risk levels to thyroid nodules with the goal of improving and standardizing patient management. Surveillance ultrasound in papillary microcarcinomas is being evaluated and compared with surgical management.
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Affiliation(s)
- Michelle Melany
- Department of Imaging, Cedars Sinai Imaging, Greater Los Angeles VA Medical Center, David Geffen School of Medicine at University of California, Los Angeles, 8700 Beverly Boulevard, Suite M335, Los Angeles, CA 90048, USA.
| | - Sardius Chen
- Department of Imaging, Cedars Sinai Imaging, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Suite M335, Los Angeles, CA 90048, USA
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Yang GCH, Fried KO. Pathologic basis of the sonographic differences between thyroid cancer and noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Ultrasonography 2017; 37:157-163. [PMID: 29137452 PMCID: PMC5885479 DOI: 10.14366/usg.17045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/05/2017] [Accepted: 08/19/2017] [Indexed: 11/18/2022] Open
Abstract
Ultrasonography is pivotal in triage thyroid biopsy in the era after the identification of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This pictorial essay illustrates the pathologic basis of the sonographic features that distinguish NIFTP from thyroid cancers. In this study, we present the correlations of ultrasonography to ×1 histopathology to assess shape and margin characteristics. Markedly hypoechoic nodules correlate to microfollicular/solid nodules, while isoechoic/hyperechoic thyroid nodules correlate to normofollicular/macrofollicular nodules. The ultrasound findings of NIFTP and minimally invasive encapsulated thyroid cancers are similar. Both are well-circumscribed, oval-to-round nodules with regular margins. Blurred or microlobulated margins indicate infiltrating tumors, while lobulated margins are characteristic of expansile tumors. Overtly invasive encapsulated tumors are characterized by oval-to-round nodules with irregular or lobulated margins. The ultrasound findings for infiltrative thyroid cancers show at least one of the following malignant features: marked hypoechoicity, taller-than-wide shape, microcalcifications, and blurred or microlobulated margins.
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Affiliation(s)
- Grace C H Yang
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA
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Winther KH, Wichman JEM, Bonnema SJ, Hegedüs L. Insufficient documentation for clinical efficacy of selenium supplementation in chronic autoimmune thyroiditis, based on a systematic review and meta-analysis. Endocrine 2017; 55:376-385. [PMID: 27683225 PMCID: PMC5272877 DOI: 10.1007/s12020-016-1098-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022]
Abstract
By a systematic review and meta-analysis to investigate clinically relevant effects of selenium supplementation in patients with chronic autoimmune thyroiditis. Controlled trials in adults (≥18 years) with autoimmune thyroiditis, comparing selenium with or without levothyroxine substitution, versus placebo and/or levothyroxine substitution, were eligible for inclusion. Identified outcomes were serum thyrotropin (thyroid stimulating hormone) levels in LT4-untreated patients, thyroid ultrasound and health-related quality of life. Eleven publications, covering nine controlled trials, were included in the systematic review. Random effects model meta-analyses were performed in weighted mean difference for thyroid stimulating hormone, ultrasound and health-related quality of life. Quality of evidence was assessed per outcome, using GRADE. Meta-analyses showed no change in thyroid stimulating hormone, or improvements in health-related quality of life or thyroid echogenicity (ultrasound), between levothyroxine substitution-untreated patients assigned to selenium supplementation or placebo. Three trials found some improvement in wellbeing in patients receiving levothyroxine substitution, but could not be synthesized in a meta-analysis. The quality of evidence ranged from very low to low for thyroid stimulating hormone as well as ultrasound outcomes, and low to moderate for health-related quality of life, and was generally downgraded due to small sample sizes. We found no effect of selenium supplementation on thyroid stimulating hormone, health-related quality of life or thyroid ultrasound, in levothyroxine substitution-untreated individuals, and sporadic evaluation of clinically relevant outcomes in levothyroxine substitution-treated patients. Future well-powered RCTs, evaluating e.g. disease progression or health-related quality of life, are warranted before determining the relevance of selenium supplementation in autoimmune thyroiditis.
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Affiliation(s)
- Kristian Hillert Winther
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark.
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark.
| | - Johanna Eva Märta Wichman
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 10, 6th floor, Odense C, 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3. Sal, Odense C, 5000, Denmark
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Brito JP, Singh-Ospina N, Gionfriddo MR, Maraka S, Espinosa De Ycaza A, Rodriguez-Gutierrez R, Morris JC, Montori VM, Tuttle RM. Restricting ultrasound thyroid fine needle aspiration biopsy by nodule size: which tumors are we missing? A population-based study. Endocrine 2016; 51:499-505. [PMID: 26254791 PMCID: PMC5131717 DOI: 10.1007/s12020-015-0713-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/31/2015] [Indexed: 01/02/2023]
Abstract
Clinicians use nodule size to determine which thyroid nodules should receive cytological evaluation. The American Thyroid Association (ATA) has recommended against cytological evaluation for nodules <1 cm. It is unknown, however, if nodule size can accurately discriminate lesions that will represent tumors with favorable versus unfavorable prognosis. Also, the characteristics of thyroid cancers that would not be diagnosed if a strict 1 cm size cut off is used as the threshold for biopsy of intrathyroidal nodules are not well established. Using the Rochester Epidemiology Project, a population-based cohort, we identified all thyroid nodules in Olmsted County residents from 2003-2006. To assess the presence of favorable or unfavorable features for each nodule size cutoff, each patient found to have thyroid cancer was risk-stratified using the ATA risk score, which predicts risk of recurrence and persistent disease. Thyroid cancer cases in which a biopsy was done for factors other than thyroid nodule size or suspicious ultrasound features were excluded. We identified 485 thyroid nodules, 46 (9.5%) harbored thyroid cancer. Of the 46 thyroid cancers, 37 (7.6%) had ATA low risk; 8 (1.6%) had intermediate, and only 1 (0.2%) had an ATA high risk scores. The frequency of thyroid cancer and the distribution of ATA risk scores were similar across tumor sizes. In thyroid nodules of <1 cm, 92 (87%) were benign, while 13 (13%) were malignant (11% ATA low risk, 2% ATA intermediate risk) without extrathyroid extension, aggressive histology, or distant metastasis. For all thyroid cancer patients, no cases of persistent disease were found after a median follow-up of 7 years. In this population-based study, we showed that high risk thyroid cancers are rare; indeed, in this highly selected cohort of patients, the ATA's recommendation to avoid cytologic evaluation in thyroid nodules less than 1 cm would not miss any thyroid cancer with high risk features. However, thyroid nodule size at presentation did not accurately discriminate between tumors with favorable versus unfavorable clinicopathologic features. Thus, if further discrimination is desired, for example, to avoid overdiagnosis, features other than size at presentation need to be evaluated.
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Affiliation(s)
- Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine and Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Naykky Singh-Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine and Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Michael R Gionfriddo
- Mayo Graduate School and Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine and Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Ana Espinosa De Ycaza
- Division of Diabetes, Endocrinology, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Rene Rodriguez-Gutierrez
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine and Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - John C Morris
- Division of Diabetes, Endocrinology, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Victor M Montori
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine and Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA.
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Singh PK, Sharma SK, Sinha A, Dutta P. Can thyroid volume predict thyroid dysfunction in patients with systemic sclerosis? A prospective cross-sectional study from a tertiary care center in North West India. Clin Rheumatol 2016; 35:765-9. [PMID: 26861031 DOI: 10.1007/s10067-016-3209-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 11/27/2022]
Abstract
Previous studies have documented an association between thyroid dysfunction, predominant hypothyroidism, and antibody positivity in patients with systemic sclerosis (SSc). There are no studies reporting the relationship between thyroid volume and thyroid functions in patients with SSc. This study was conducted to correlate thyroid dysfunction with thyroid volume as measured on ultrasound and antibody positivity. Complete thyroid workup was done in 106 patients of SSc which included thyroid function test, antithyroid peroxidase (TPO) antibody, antithyroid-stimulating hormone receptor (TSHR) antibody, antithyroglobulin antibody, and thyroid ultrasound to assess thyroid volume, echogenicity and blood flow, and fine needle aspiration cytology of suspicious thyroid lesions. Prevalence of subclinical hypothyroidism was 8.5 %, overt hypothyroidism 1.9 %, subclinical hyperthyroidism 2.8 %, and overt hyperthyroidism in 0.9 % of the patients. Antithyroid peroxidase antibody was positive in 16 %, anti-TSH receptor antibody in 5.7 %, and antithyroglobulin antibody in none of the patients. Thyroid volume was in the range of atrophy (<4.5 ml) in 57.5 % patients, echogenicity altered in 15.1 %, and blood flow increased in 15.1 %. Thyroid volume correlated strongly with the pulmonary function test (FEV1). Routine thyroid ultrasound and thyroid function tests may be included in the workup of patients with SSc for the early detection of hypothyroidism since a small but significant percentage of patients developed thyroid dysfunction. Antithyroid antibodies may not correlate with the thyroid functions and hence should not be recommended.
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Affiliation(s)
- Pawan Kumar Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), 4th Floor, F Block, Nehru Hospital, Sector 12, Chandigarh, 160012, India
| | - Shefali Khanna Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), 4th Floor, F Block, Nehru Hospital, Sector 12, Chandigarh, 160012, India.
| | - Anindita Sinha
- Department of Radio-diagnosis, PGIMER, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India
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50
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Moncayo R, Moncayo H. Proof of concept of the WOMED model of benign thyroid disease: Restitution of thyroid morphology after correction of physical and psychological stressors and magnesium supplementation. BBA Clin 2014; 3:113-22. [PMID: 26672672 PMCID: PMC4661508 DOI: 10.1016/j.bbacli.2014.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 12/21/2022]
Abstract
Background The aim of this study was to investigate the influence of a combined supplementation with magnesium, selenium and coenzyme Q10 on the morphology of the thyroid in patients with benign diseases. The clinical examination and treatment approach aims additionally at treating musculoskeletal and psychological stress. Methods A group of 8 patients (5 with hyperthyroidism, 3 with hypothyroidism) who initially attended a public institution received additional treatment at our private institution. The basic pharmacological treatment, i.e. substitution or thyreostatic, was kept unchanged. The inclusion of patients required good quality ultrasound images to be available. Results Initially the changes of the musculoskeletal system were corrected. Following this, stress components were also treated. After a period of 2–4 years of supplementation we observed a normalization of thyroid morphology as evidenced on ultrasound while at the same time there was a reduction of perfusion intensity. Thyroid antibody titers decreased in the majority of cases. Failure of the treatment was seen in 2 cases of chronic thyroiditis that was present for more than 10 years. The ultrasound images of these patients suggest a possible fibrosis. Conclusions In spite of the limitation due to the small number of cases, our observational study has delivered proof of concept for our examination and treatment model for benign thyroid disease. General significance Our results challenge validity of the prevailing dogma of a destructive unstoppable “autoimmune” destructive process of the gland. At the same time it shows new therapeutic options for patients with thyroid disease. Adequate magnesium levels in blood can be attained by long time supplementation. Thyroid morphology in young patients with benign thyroid disease can improve with supplementation. Additional supplementation with selenium and coenzyme Q10 is needed in some cases. Our results challenge the validity of the dogma of thyroid autoimmunity as an immovable process.
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Affiliation(s)
- Roy Moncayo
- WOMED, Karl-Kapferer-Strasse 5, 6020 Innsbruck, Austria ; Dept. of Nuclear Medicine, Medical University of Innsbruck, Austria
| | - Helga Moncayo
- WOMED, Karl-Kapferer-Strasse 5, 6020 Innsbruck, Austria
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