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Bell C, White SL, Tylee T, Dighe M, Greca AL, Goldner W, Mayson S, Haugen BR, Pozdeyev N. Thyroid Nodule Sphericity Metrics Discriminate Benign and Malignant Follicular and Oncocytic Neoplasms. Thyroid 2025; 35:291-297. [PMID: 39992747 DOI: 10.1089/thy.2024.0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
Background: We investigated if thyroid nodule taller-than-wide (TTW) feature and sphericity metrics are helpful in separating benign neoplastic thyroid nodules (follicular and oncocytic adenomas) from follicular thyroid carcinomas (FTC) and oncocytic thyroid carcinomas (OCA). Methods: This is a retrospective study of TTW sonographic feature as reported by radiologists and nodule sphericity metrics at two academic health systems. Surgical pathology reports for benign and malignant follicular and oncocytic neoplasms, non-neoplastic nodules (hyperplastic and adenomatoid), and classic papillary thyroid cancers (PTC) were extracted from enterprise data warehouses. We independently reviewed each ultrasound and recorded nodule dimensions to identify nodules that were TTW and determine if the proportion of TTW nodules is different in benign and malignant thyroid nodules of various histologies. We also evaluated the sphericity index and sphericity ratio, two quantitative measures of how close the 3D shape of the nodule is to a sphere. Results: In total, 1110 nodules were analyzed: 209 non-neoplastic nodules (hyperplastic and adenomatoid), 398 benign neoplasms (follicular and oncocytic adenomas), and 503 malignant neoplasms (FTC, OCA, PTC, and follicular variant-PTC [FV-PTC]) and noninvasive follicular thyroid neoplasm with papillary-like features (NIFTP). There was no statistical difference for the TTW feature when follicular and oncocytic adenomas were compared with FV-PTC, OCA, FTC, and NIFTP (χ2, p = 0.08, sensitivity of 28% [confidence interval 23-24%]), when follicular adenoma was compared with FTC (χ2, p = 0.64) or when oncocytic adenoma was compared with OCA (χ2, p = 0.08). Benign and malignant neoplasms were more likely than non-neoplastic nodules to be TTW (χ2, p = 0.02). In contrast, the sphericity index and sphericity ratio were significantly different in most comparisons of benign and malignant nodules (Wilcoxon, p < 0.03) except for oncocytic tumors. Conclusions: TTW shape has limited utility in distinguishing benign follicular and oncocytic neoplasms from malignancy. This sonographic feature was more common among all benign and malignant neoplasms when they were compared as a group to non-neoplastic nodules, which suggests this sonographic feature is an indicator of neoplastic growth (benign or malignant) but not cancer. Alternative methods, such as measures of sphericity, are needed to distinguish benign and malignant oncocytic and follicular neoplasms.
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Affiliation(s)
- Caitlin Bell
- Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha L White
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tracy Tylee
- Division of Endocrinology, Diabetes & Metabolism, University of Washington, Seattle, Washington, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Amanda La Greca
- Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Whitney Goldner
- Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah Mayson
- Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bryan R Haugen
- Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nikita Pozdeyev
- Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Wang Y, Tang Y, Luo Z, Li J, Li W. Diagnostic Nomogram Model for ACR TI-RADS 4 Nodules Based on Clinical, Biochemical Data and Sonographic Patterns. Clin Endocrinol (Oxf) 2025; 102:79-90. [PMID: 39279486 PMCID: PMC11612534 DOI: 10.1111/cen.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/09/2024] [Accepted: 08/16/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVES The objective of this study was to develop and validate a nomogram model integrating clinical, biochemical and ultrasound features to predict the malignancy rates of Thyroid Imaging Reporting and Data System 4 (TR4) thyroid nodules. METHODS A total of 1557 cases with confirmed pathological diagnoses via fine-needle aspiration (FNA) were retrospectively included. Univariate and multivariate logistic regression analyses were conducted to identify independent predictors of malignancy. These predictors were incorporated into the nomogram model, and its predictive performance was evaluated using receiver-operating characteristic curve (AUC), calibration plots, net reclassification improvement (NRI), integrated discrimination improvement (IDI) and decision curve analysis (DCA). RESULTS Eight out of 22 variables-age, margin, extrathyroidal extension, halo, calcification, suspicious lymph node metastasis, aspect ratio and thyroid peroxidase antibody-were identified as independent predictors of malignancy. The calibration curve demonstrated excellent performance, and DCA indicated favourable clinical utility. Additionally, our nomogram exhibited superior predictive ability compared to the current American College of Radiology (ACR) score model, as indicated by higher AUC, NRI, IDI, negative likelihood ratio (NLR) and positive likelihood ratio (PLR) values. CONCLUSIONS The developed nomogram model effectively predicts the malignancy rate of TR4 thyroid nodules, demonstrating promising clinical applicability.
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Affiliation(s)
- Yongheng Wang
- Department of Surgical OncologyShaanxi Provincial People's HospitalXi'anShaanxiChina
- The Third Affiliated Hospital, School of MedicineXi'an Jiaotong UniversityXi'anShaanxiChina
| | - Yao Tang
- Department of General SurgeryXi'an No. 3 HospitalXi'anShaanxiChina
| | - Ziyu Luo
- Department of Surgical OncologyShaanxi Provincial People's HospitalXi'anShaanxiChina
- The Third Affiliated Hospital, School of MedicineXi'an Jiaotong UniversityXi'anShaanxiChina
| | - Jianhui Li
- Department of Surgical OncologyShaanxi Provincial People's HospitalXi'anShaanxiChina
- The Third Affiliated Hospital, School of MedicineXi'an Jiaotong UniversityXi'anShaanxiChina
| | - Wenhan Li
- Department of Surgical OncologyShaanxi Provincial People's HospitalXi'anShaanxiChina
- The Third Affiliated Hospital, School of MedicineXi'an Jiaotong UniversityXi'anShaanxiChina
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Richter D, Beck M, Müller SK, Iro H, Koch M, Sievert M. [Thyroid nodules as an incidental finding : Value of sonography and scintigraphy in primary diagnostics]. HNO 2024; 72:908-918. [PMID: 39078487 DOI: 10.1007/s00106-024-01502-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/31/2024]
Abstract
Due to the widespread use of high-resolution sonography, numerous thyroid nodules are diagnosed, often as incidental findings. The challenge lies in evaluating various criteria such as size, shape, and echogenicity to assess the nodules' malignancy risk. Risk stratification systems have been developed to enable systematic assessment as well as to avoid unnecessary medical interventions and malignant findings being overlooked. This article provides an overview of the current diagnostic standards in primary assessment of thyroid nodules.
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Affiliation(s)
- Daniel Richter
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Michael Beck
- Nuklearmedizinische Klinik, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Sarina Katrin Müller
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Heinrich Iro
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Michael Koch
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Matti Sievert
- Hals-Nasen-Ohrenklinik, Kopf- und Hals-Chirurgie, Universitätskliniken Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
- Abteilung für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland.
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Alhajlan M, Al-Masabi M, Al Mansour M, Saihb A, AlAyed S, Alwadai R, Alhamami A, Alzarra A, Almarzooq M, Ahmed F. The accuracy of fine-needle aspiration cytology and ultrasonography in assessing thyroid nodules in correlation with histopathology: a retrospective study. Ann Med Surg (Lond) 2024; 86:7002-7009. [PMID: 39649848 PMCID: PMC11623872 DOI: 10.1097/ms9.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 10/12/2024] [Indexed: 12/11/2024] Open
Abstract
Background Accurately diagnosing thyroid nodules is vital for preventing unnecessary surgeries and providing prompt therapy. Although fine-needle aspiration cytology (FNAC) and ultrasonography (US) are widely used diagnostic methods, their reliability is questioned. This study investigates the effectiveness of US and FNAC in thyroid nodule diagnosis and differentiates benign from malignant nodules in relation to final histopathological diagnosis. Method A retrospective study including 307 adult patients with thyroid diseases who underwent neck US and FNAC before surgery was conducted between April 2019 and May 2023. The diagnostic efficacy of US, FNAC, and their combination usage was compared to histopathological results. Result Histopathological findings revealed that 187 (61%) cases were benign, while 120 (39%) were malignant. The US features of 'taller-than-wider' forms and hypoechoic appearance had the highest diagnostic accuracy in characterizing malignant thyroid nodules, with 83 and 73% accuracy, respectively. The combination of US parameters demonstrated high sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 88.33, 63.10, 60.6, and 89.4%, with a statistically significant area under the ROC curve (AUC: 0.828, P<0.001) than individual parameters. FNAC's sensitivity, specificity, PPV NPV, and accuracy in detecting malignant lesions were 50, 95, 86, 75, and 77%, respectively, with acceptable discrimination and statistical significance (AUC: 0.723, P<0.0001). The combination of US parameters and FNAC significantly improved the AUC value (AUC: 0.878, P<0.0001), sensitivity (83.33%), and specificity (79.14%). Univariate analysis showed that hypoechoic appearance, heterogenicity, large mass size (>4 cm), 'taller-than-wider', infiltrative margins, and microcalcifications were risk factors for malignancy in thyroid nodules and were statistically significant (all P-values <0.05). Conclusion Combining US characteristics with FNAC results can afford the maximum analytical accuracy in distinguishing benign from malignant thyroid nodules. This strategy is practical due to its simplicity, minimal invasiveness, and cost-effectiveness, enabling robust management regimens and avoiding additional surgical procedures.
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Affiliation(s)
- Mana Alhajlan
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | | | - Mohammed Al Mansour
- Department of Otorhinolaryngology, King Khalid Hospital, Najran, Saudi Arabia
| | - Abdullah Saihb
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Salem AlAyed
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Rakan Alwadai
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Abdullah Alhamami
- Department of Otorhinolaryngology, King Khalid Hospital, Najran, Saudi Arabia
| | - Abdullah Alzarra
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Mohammed Almarzooq
- Department of General Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University, Ibb, Yemen
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Saw AK, Kerketta ZH, Rani K, Murari K, Srivastava K, Kumar A, Lnu S, Baxla A, Kumar N, Noor N. Evaluation of the Efficacy of Thyroid Imaging Reporting and Data Systems Classification in Risk Stratification and in the Management of Thyroid Swelling by Comparing It With Fine-Needle Aspiration Cytology and Histopathological Examination. Cureus 2024; 16:e59949. [PMID: 38854328 PMCID: PMC11162270 DOI: 10.7759/cureus.59949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Thyroid nodules are a common clinical challenge, with a significant proportion being cancerous. Fine-needle aspiration cytology (FNAC) is widely used for diagnosis but has limitations. Ultrasound has emerged as a promising tool for distinguishing between benign and malignant nodules. This study aims to compare the diagnostic accuracy of ultrasonography (USG) and FNAC in diagnosing malignant thyroid swelling using postoperative histopathological examinations as the gold standard. METHOD A diagnostic accuracy study was conducted over 1.5 years at Rajendra Institute of Medical Sciences, Ranchi, India. A total of 132 patients with thyroid swellings were included. Patients underwent USG and FNAC, and 99 patients subsequently underwent surgery and histopathological examination. Statistical analysis was performed to evaluate the performance of USG and FNAC, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The study encompassed 132 patients, predominantly 94 (71.21%) females. Most patients, i.e., 76 out of 132 (57.58%), were aged 30-50 years, with an average age of presentation at 41 years. Socioeconomic status revealed 120 (90.9%) belonging to Classes II and III. USG and FNAC exhibited sensitivities of 77.4% and 90.3%, specificities of 94.1% and 98.5%, and accuracies of 88.9% and 96.0%, respectively. FNAC demonstrated superior diagnostic performance metrics compared to USG, with higher PPV and NPV, indicating its stronger ability to correctly identify true-positive cases. Ultrasound features and FNAC findings showed significant associations with biopsy results, reaffirming their utility in diagnosing thyroid nodules. CONCLUSION FNAC emerged as a highly accurate diagnostic tool for distinguishing between benign and malignant thyroid nodules, outperforming USG. Understanding demographic and clinical characteristics can aid in the timely diagnosis and management of thyroid disorders. Further research is warranted to enhance diagnostic algorithms and optimize patient care in resource-constrained settings.
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Affiliation(s)
- Abhishek K Saw
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Zenith H Kerketta
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Khushboo Rani
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Krishna Murari
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Kritika Srivastava
- Obstetrics and Gynaecology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Ajay Kumar
- Trauma Surgery & Critical Care, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Sunny Lnu
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Anish Baxla
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Nabu Kumar
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Nusrat Noor
- General Practice, Clinica Cure Hospital, Ranchi, IND
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Hu T, Zhou T, Zhang Y, Zhou L, Huang X, Cai Y, Qian S, Huang K, Luo D. The predictive value of the thyroid nodule benign and malignant based on the ultrasound nodule-to-muscle gray-scale ratio. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:51-58. [PMID: 37915163 DOI: 10.1002/jcu.23601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To investigate the efficacy of the ultrasonic nodule to muscle gray scale ratio as a predictive tool for distinguishing between benign and malignant thyroid nodules. METHODS A retrospective study was undertaken at the First People's Hospital of Hangzhou, affiliated with the Zhejiang University School of Medicine, analyzing ultrasound and pathological data of patients with thyroid nodules between May 2020 and December 2022. The study extracted ultrasound features of nodules and employed univariate and multivariate logistic regression analyses to identify independent risk factors for malignant tumors in the nodules. Subsequently, a predictive model for distinguishing benign and malignant thyroid nodules was developed. RESULTS A total of 466 patients were included in this retrospective study, of which 275 cases were malignant tumors. Univariate and multivariate logistic regression analyses showed that the nodular-muscle gray-scale ratio, nodule diameter, margin status, aspect ratio, and calcification were closely related to thyroid malignant tumors. The area under the curve (AUC) of training group was 0.832, with a sensitivity, specificity, and accuracy of 85.5%, 67.4%, and 76.6%, respectively. The AUC of the external validation group was 0.819, with a sensitivity, specificity, and accuracy of 76.4%, 74.5%, and 75.7%, respectively. The calibration and decision curves showed that the model had good diagnostic value. CONCLUSION The research findings indicate that ratio is significantly associated with the malignant nature of thyroid nodules. The application of a line chart model based on these parameters exhibits a high level of predictive performance.
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Affiliation(s)
- Tao Hu
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Tianhan Zhou
- The Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yu Zhang
- The Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Zhou
- The Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuanwei Huang
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Yuan Cai
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Shuoying Qian
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Kaiyuan Huang
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Dingcun Luo
- The Department of Oncological Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Li C, Xin X, Wang X, Wei X, Zhang S. The diagnostic value of a new ultrasonographic method for the measurement of a taller-than-wide shape of benign and malignant thyroid nodules. Endocrine 2023:10.1007/s12020-023-03358-y. [PMID: 37040007 DOI: 10.1007/s12020-023-03358-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the diagnostic value of a new ultrasonographic method in the measurement of thyroid nodules with a taller-than-wide (TTW) shape. METHODS A total of 982 thyroid nodules were analysed, 571 of which were malignant thyroid nodules and 411 of which were benign nodules. Nodules were divided into two groups by size: Group A (<1 cm, n = 627) and Group B (≥1 cm, n = 355). The angle between the maximum diameter of each nodule and the horizontal axis was measured by image analysis software. The best cut-off value for distinguishing between benign and malignant thyroid nodules and the diagnostic accuracy of the new ultrasonographic method in the measurement of TTW shapes were determined by receiver operating characteristic (ROC) curve analysis. RESULTS The cut-off value for distinguishing benign and malignant thyroid nodules was 44.5 degrees. The area under the ROC curve (AUC) was 0.849 (95% CI: 0.822~0.875), and the sensitivity and specificity of the diagnosis of malignant thyroid nodules were 86.9% and 84.4%, respectively. Regarding the angle between the maximum diameter and the transverse axis of the thyroid nodules, an angle greater than 45 degrees was a significant indicator of a diagnosis of malignant thyroid nodules. The AUC for distinguishing malignant from benign thyroid nodules with the new ultrasonographic method in the measurement of TTW shapes was higher than that with the first method (FM) in the whole group, Group A and Group B (respectively, 0.849 vs. 0.812, 0.853 vs. 0.808, 0.852 vs. 0.828). The diagnostic sensitivity of a TTW shape measured by the new ultrasonographic method for predicting thyroid malignancy was significantly higher than that measured by the FM in the whole group, Group A and Group B (respectively, 0.858 vs. 0.760, 0.764 vs. 0.669, 0.890 vs. 0.815). CONCLUSION A TTW shape measured by our new ultrasonographic method showed superior performance for predicting thyroid malignancy.
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Affiliation(s)
- Chunxiang Li
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaojie Xin
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaoqing Wang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China.
| | - Sheng Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key laboratory of Cancer Prevention and Therapy, Tianjin, China.
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Solymosi T, Hegedűs L, Bonnema SJ, Frasoldati A, Jambor L, Karanyi Z, Kovacs GL, Papini E, Rucz K, Russ G, Nagy EV. Considerable interobserver variation calls for unambiguous definitions of thyroid nodule ultrasound characteristics. Eur Thyroid J 2023; 12:e220134. [PMID: 36692389 PMCID: PMC10083668 DOI: 10.1530/etj-22-0134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
Objective Thyroid nodule ultrasound characteristics are used as an indication for fine-needle aspiration cytology, usually as the basis for Thyroid Imaging Reporting and Data System (TIRADS) score calculation. Few studies on interobserver variation are available, all of which are based on analysis of preselected still ultrasound images and often lack surgical confirmation. Methods After the blinded online evaluation of video recordings of the ultrasound examinations of 47 consecutive malignant and 76 consecutive benign thyroid lesions, 7 experts from 7 thyroid centers answered 17 TIRADS-related questions. Surgical histology was the reference standard. Interobserver variations of each ultrasound characteristic were compared using Gwet's AC1 inter-rater coefficients; higher values mean better concordance, the maximum being 1.0. Results On a scale from 0.0 to 1.0, the Gwet's AC1 values were 0.34, 0.53, 0.72, and 0.79 for the four most important features in decision-making, i.e. irregular margins, microcalcifications, echogenicity, and extrathyroidal extension, respectively. The concordance in the discrimination between mildly/moderately and very hypoechogenic nodules was 0.17. The smaller the nodule size the better the agreement in echogenicity, and the larger the nodule size the better the agreement on the presence of microcalcifications. Extrathyroidal extension was correctly identified in just 45.8% of the cases. Conclusions Examination of video recordings, closely simulating the real-world situation, revealed substantial interobserver variation in the interpretation of each of the four most important ultrasound characteristics. In view of the importance for the management of thyroid nodules, unambiguous and widely accepted definitions of each nodule characteristic are warranted, although it remains to be investigated whether this diminishes observer variation.
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Affiliation(s)
- Tamas Solymosi
- Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Hegedűs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Steen J Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Andrea Frasoldati
- Endocrinology Unit of Arcispedale S Maria Nuova, Reggio Emilia, Italy
| | - Laszlo Jambor
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Karanyi
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabor L Kovacs
- 1st Department of Medicine, Flohr Ferenc Hospital, Kistarcsa, Hungary
| | | | - Karoly Rucz
- 1st Department of Medicine, University of Pecs, Pecs, Hungary
| | - Gilles Russ
- Unité Thyroïde et Tumeurs Endocrines – Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Li W, Hong T, Fang J, Liu W, Liu Y, He C, Li X, Xu C, Wang B, Chen Y, Sun C, Li W, Kang W, Yin C. Incorporation of a machine learning pathological diagnosis algorithm into the thyroid ultrasound imaging data improves the diagnosis risk of malignant thyroid nodules. Front Oncol 2022; 12:968784. [PMID: 36568189 PMCID: PMC9774948 DOI: 10.3389/fonc.2022.968784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This study aimed at establishing a new model to predict malignant thyroid nodules using machine learning algorithms. METHODS A retrospective study was performed on 274 patients with thyroid nodules who underwent fine-needle aspiration (FNA) cytology or surgery from October 2018 to 2020 in Xianyang Central Hospital. The least absolute shrinkage and selection operator (lasso) regression analysis and logistic analysis were applied to screen and identified variables. Six machine learning algorithms, including Decision Tree (DT), Extreme Gradient Boosting (XGBoost), Gradient Boosting Machine (GBM), Naive Bayes Classifier (NBC), Random Forest (RF), and Logistic Regression (LR), were employed and compared in constructing the predictive model, coupled with preoperative clinical characteristics and ultrasound features. Internal validation was performed by using 10-fold cross-validation. The performance of the model was measured by the area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, F1 score, Shapley additive explanations (SHAP) plot, feature importance, and correlation of features. The best cutoff value for risk stratification was identified by probability density function (PDF) and clinical utility curve (CUC). RESULTS The malignant rate of thyroid nodules in the study cohort was 53.2%. The predictive models are constructed by age, margin, shape, echogenic foci, echogenicity, and lymph nodes. The XGBoost model was significantly superior to any one of the machine learning models, with an AUC value of 0.829. According to the PDF and CUC, we recommended that 51% probability be used as a threshold for determining the risk stratification of malignant nodules, where about 85.6% of patients with malignant nodules could be detected. Meanwhile, approximately 89.8% of unnecessary biopsy procedures would be saved. Finally, an online web risk calculator has been built to estimate the personal likelihood of malignant thyroid nodules based on the best-performing ML-ed model of XGBoost. CONCLUSIONS Combining clinical characteristics and features of ultrasound images, ML algorithms can achieve reliable prediction of malignant thyroid nodules. The online web risk calculator based on the XGBoost model can easily identify in real-time the probability of malignant thyroid nodules, which can assist clinicians to formulate individualized management strategies for patients.
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Affiliation(s)
- Wanying Li
- Center for Management and Follow-up of Chronic Diseases, Xianyang Central Hospital, Xianyang, China
| | - Tao Hong
- Pediatric Surgery Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Jianqiang Fang
- Ultrasound Interventional Department, Xianyang Central Hospital, Xianyang, China
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Wencai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuwen Liu
- Department of Chronic Disease and Endemic Disease Control Branch, Xiamen Municipal Center for Disease Control and Prevention, Xiamen, China
| | - Cunyu He
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Xinxin Li
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Chan Xu
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Bing Wang
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Yuanyuan Chen
- School of Statistics, RENMIN University of China, Beijing, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Wenle Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Wei Kang
- Department of Mathematics, Physics and Interdisciplinary Studies, Guangzhou Laboratory, Guangzhou, Guangdong, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macao, Macao SAR, China
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Introducing a Pole Concept for Nodule Growth in the Thyroid Gland: Taller-than-Wide Shape, Frequency, Location and Risk of Malignancy of Thyroid Nodules in an Area with Iodine Deficiency. J Clin Med 2022; 11:jcm11092549. [PMID: 35566675 PMCID: PMC9104008 DOI: 10.3390/jcm11092549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: (i) To examine the criterion taller-than-wide (TTW) for the sonographic assessment of thyroid nodules in areas of iodine deficiency in terms of frequency, anatomical distribution within the thyroid gland and risk of malignancy. (ii) To develop a model for nodule growth in the thyroid gland. Methods: German multicenter study consisting of two parts. In the prospective part, thyroid nodules were sonographically measured in all three dimensions, location within the thyroid gland and contact to a protrusion-like formation (horn) in the dorsal position of thyroid gland was noted. In addition, further sonographic features such as the composition, echogenity, margins and calcifications were investigated. All nodules from the prospective part were assessed for malignancy as part of clinical routine at the decision of the treating physician adhering to institutionally based algorithms. In the retrospective part, only nodules with fine needle aspiration and/or histology were included. The risk of malignancy in TTW nodules was determined by correlating them with cyotological and histological results. Results: Prospective part: out of 441 consecutively evaluated thyroid nodules, 6 were found to be malignant (1.4%, 95% CI 0.6–2.7%). Among the 74 TTW nodules (17%), 1 was malignant (1%, 95% CI 0–4%). TTW nodules were more often located in the dorsal half of the thyroid than non-TTW nodules (factor 2.3, p = 0.01, 95% CI 2.1–2.5) and more often located in close proximity to a horn than non-TTW nodules (factor 3.0, p = 0.01, 95% CI 2.4–3.8). Retrospective part: out of 1315 histologically and/or cytologically confirmed thyroid nodules, 163 TTW nodules were retrieved and retrospectively analyzed. A TTW nodule was 1.7 times more often benign when it was dorsal (95% CI 1.1–2.5) and 2.5 times more often benign when it was associated with a horn (95% CI 1.2–5.3). The overall probability of malignancy for TTW nodules was 38% (95% CI 30–46%) in this highly preselected patient group. Conclusion: TTW nodules are common in iodine deficient areas. They are often located in the dorsal half of the thyroid gland and are frequently associated with a dorsal protrusion-like formation (horn) of the thyroid. Obviously, the shape of benign nodules follows distinct anatomical preconditions within the thyroid gland. The frequency of TTW nodules and their predominant benignity can be explained by a pole concept of goiter growth. The difference between the low malignancy risk of TTW nodules found on a prospective basis and the high risk found retrospectively may be the result of a positive preselection in the latter.
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Abstract
Background Ultrasonography has become an essential tool for the evaluation and management of thyroid and parathyroid diseases. Its applications extend beyond neck endocrine conditions to a multitude of pathologies within the head and neck region. Objectives Our study aimed to: (1) provide a broad review of neck ultrasonography and key findings in neck endocrine diseases; (2) support skilled performance office-based diagnostic ultrasonography and its varied applications. Materials and methods A review of the current literature was supplemented with clinical examples of key ultrasonographic findings. Results Current applications and key findings of ultrasonography in the diagnosis and management of neck endocrine conditions are reviewed. Conclusion Ultrasonography is a fundamental component in the evaluation and management of neck endocrine diseases. The reader is encouraged to use this review to enhance office-based performance and application of ultrasonography. Video online The online version of this article contains 11 additional videos. They are provided to illustrate some of the dynamic aspects of US performance. The article and the videos are available online (10.1007/s00106-022-01162-0). The videos can be found in the article back matter as “Electronic Supplementary Material”.
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Affiliation(s)
- Marika D Russell
- Department of Otolaryngology-Head and Neck Surgery, University of California, 2233 Post Street, 3rd Floor, San Francisco, CA, USA.
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Gong Y, Yao X, Yu L, Wei P, Han Z, Fang J, Ao W, Xu C. Ultrasound grayscale ratio: a reliable parameter for differentiating between papillary thyroid microcarcinoma and micronodular goiter. BMC Endocr Disord 2022; 22:75. [PMID: 35331216 PMCID: PMC8952271 DOI: 10.1186/s12902-022-00994-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/18/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The present study aimed to quantify and differentiate the echo levels of papillary thyroid microcarcinomas (PTMCs) and micronodular goiters (MNGs) using the ultrasound grayscale ratio (UGSR) and to investigate the repeatability of UGSR. METHODS The ultrasound (US) data of 241 patients with 265 PTMCs and 141 patients with 168 MNGs confirmed by surgery and pathology were retrospectively analyzed. All patients had received outpatient ultrasonic examination and preoperative ultrasonic positioning. The RADinfo radiograph reading system was used to measure the grayscales of PTMC, MNG, and thyroid tissues at the same gain level, and the UGSR values of the PTMC, MNG, and thyroid tissue were calculated. The patients were divided into outpatient examination, preoperative positioning, and mean value groups, and the receiver operating characteristic (ROC) curves were calculated to obtain the optimal UGSR threshold to distinguish PTMC from MNG. The interclass correlation coefficient (ICC) was used to assess the consistency of UGSR measured in three groups. RESULTS The UGSR values of the PTMC and MNG were 0.56 ± 0.14 and 0.80 ± 0.19 (t = 5.84, P < 0.001) in the outpatient examination group, 0.55 ± 0.14 and 0.80 ± 0.19 (t = 18.74, P < 0.001) in the preoperative positioning group, and 0.56 ± 0.12 and 0.80 ± 0.18 (t = 16.49, P < 0.001) in the mean value group. The areas under the ROC curves in the three groups were 0.860, 0.856, and 0.875, respectively. When the UGSR values for the outpatient examination, preoperative positioning, and mean value groups were 0.649, 0.646, and 0.657, respectively, each group obtained its largest Youden index. A reliable UGSR value was obtained between the outpatient examination and preoperative positioning groups (ICC = 0.79, P = 0.68). CONCLUSION UGSR is a simple and repeatable method to distinguish PTMC from MNG, and hence, can be widely applicable.
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Affiliation(s)
- Yun Gong
- Department of Pediatrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Xiuzhen Yao
- Department of Ultrasound, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Lifang Yu
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Shangcheng District, Zhejiang, 310006, Hangzhou, China
| | - Peiying Wei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhijiang Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianhua Fang
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Shangcheng District, Zhejiang, 310006, Hangzhou, China
| | - Weiqun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, No.234, Gucui Road, Zhejiang, 310012, Hangzhou, China.
| | - Chenke Xu
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Shangcheng District, Zhejiang, 310006, Hangzhou, China.
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Rago T, Vitti P. Risk Stratification of Thyroid Nodules: From Ultrasound Features to TIRADS. Cancers (Basel) 2022; 14:cancers14030717. [PMID: 35158985 PMCID: PMC8833686 DOI: 10.3390/cancers14030717] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Thyroid nodules are a frequent clinical issue. Their incidence has increased mainly due to the widespread use of neck ultrasound scans. Most thyroid nodules are asymptomatic, incidentally discovered, and benign at cytology. Thyroid ultrasound is the most sensitive diagnostic tool to evaluate patients with nodular thyroid disease. It is therefore important to use the ultrasound features to select nodules that require a fine-needle aspiration cytology. Abstract Thyroid nodules are common in iodine deficient areas, in females, and in patients undergoing neck irradiation. High-resolution ultrasonography (US) is important for detecting and evaluating thyroid nodules. US is used to determine the size and features of thyroid nodules, as well as the presence of neck lymph node metastasis. It also facilitates guided fine-needle aspiration (US-FNA). The most consistent US malignancy features of thyroid nodules are spiculated margins, microcalcifications, a taller-than-wide shape, and marked hypoechogenicity. Increased nodular vascularization is not identified as a predictor of malignancy. Thyroid elastosonography (USE) is also used to characterize thyroid nodules. In fact, a low elasticity of nodules at USE has been related to a higher risk of malignancy. According to their US features, thyroid nodules can be stratified into three categories: low-, intermediate-, and high-risk nodules. US-FNA is suggested for intermediate and high-risk nodules.
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Kihara M, Miyauchi A, Hirokawa M, Masuoka H, Higashiyama T, Onoda N, Ito Y, Miya A. Long-term outcomes of cytologically benign thyroid tumors: a retrospective analysis of 3,102 patients at a single institution. Endocr J 2021; 68:1373-1381. [PMID: 34275959 DOI: 10.1507/endocrj.ej21-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Some thyroid tumors that are cytologically diagnosed as benign may be pathologically diagnosed as malignant. Here, we investigated the long-term outcomes of patients with thyroid tumors with benign cytology, and the factors for malignancy. We retrospectively reviewed the cases of 3,102 patients with thyroid tumors >1 cm cytologically diagnosed as benign at our hospital during a 1-year period from January 2007. The median follow-up duration for all patients was 68.7 (range 0.0-168.7) months. Immediate surgery and delayed surgery were performed in 393 and 148 patients, respectively. Eventually, 541 (17.4%) of the 3,102 patients underwent a thyroidectomy, and 2,561 (82.6%) were observed without surgery. Among the surgically treated patients, the tumors of 525 (97.0%) and 16 (3.0%) were pathologically diagnosed as benign and malignant, respectively. There was no significant difference in age, gender, tumor size, serum thyroglobulin level at surgery, or the tumor volume-doubling rate (TV-DR) between the benign and malignant cases. Only the ultrasonographic findings based on our hospital's classification system were directly and significantly linked to pathological diagnosis (p < 0.01). Among the tumors of the 667 patients who were followed without surgery for >10 years, 89.9% remained unchanged and 7.2% were reduced in size. Ultrasonographic evaluation provides important information for therapeutic decision-making regarding surgery versus observation for cytologically benign tumors.
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Affiliation(s)
- Minoru Kihara
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Hiroo Masuoka
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Naoyoshi Onoda
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Yasuhiro Ito
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akihiro Miya
- Departments of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
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Validation of Four Thyroid Ultrasound Risk Stratification Systems in Patients with Hashimoto's Thyroiditis; Impact of Changes in the Threshold for Nodule's Shape Criterion. Cancers (Basel) 2021; 13:cancers13194900. [PMID: 34638380 PMCID: PMC8507673 DOI: 10.3390/cancers13194900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Thyroid Imaging Reporting and Data Systems (TIRADS) optimize the selection of thyroid nodules for cytological examination. There is a question: is the effectiveness of these systems affected by morphological changes to thyroid parenchyma that are visible in the course of Hashimoto’s thyroiditis (HT)? This question is very important because of the increased risk of malignancy in thyroid nodules in patients with HT. We investigated widely accepted ultrasound malignancy risk features with a special consideration of the suspected nodule’s shape in patients with and without HT. We also validated EU-TIRADS, K-TIRADS, ACR-TIRADS, and ATA guidelines in both groups and evaluated the impact of changes in the threshold for nodule’s shape criterion on the diagnostic value of these TIRADS. The presence of Hashimoto’s thyroiditis did not exert any significant adverse implications for the efficiency of examined TIRADS. The impact of changes in the threshold for nodule’s shape criterion was the highest for EU-TIRADS. Abstract The aim of the study was to validate thyroid US malignancy features, especially the nodule’s shape, and selected Thyroid Imaging Reporting and Data Systems (EU-TIRADS; K-TIRADS; ACR-TIRADS, ATA guidelines) in patients with or without Hashimoto’s thyroiditis (HT and non-HT groups). The study included 1188 nodules (HT: 358, non-HT: 830) with known final diagnoses. We found that the strongest indications of nodule’s malignancy were microcalcifications (OR: 22.7) in HT group and irregular margins (OR:13.8) in non-HT group. Solid echostructure and macrocalcifications were ineffective in patients with HT. The highest accuracy of nodule’s shape criterion was noted on transverse section, with the cut-off value of anteroposterior to transverse dimension ratio (AP/T) close to 1.15 in both groups. When round nodules were regarded as suspicious in patients with HT (the cut-off value of AP/T set to ≥1), it led to a three-fold increase in sensitivity of this feature, with a disproportionally lower decrease in specificity and similar accuracy. Such a modification was effective also for cancers other than PTC. The diagnostic effectiveness of analyzed TIRADS in patients with HT and without HT was similar. Changes in the threshold for AP/T ratio influenced the number of nodules classified into the category of the highest risk, especially in the case of EU-TIRADS.
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Fukushima M, Fukunari N, Murakami T, Kunii Y, Suzuki S, Kitaoka M. Reconfirmation of the accuracy of the taller-than-wide sign in multicenter collaborative research in Japan. Endocr J 2021; 68:897-904. [PMID: 33790086 DOI: 10.1507/endocrj.ej20-0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The taller-than-wide sign indicates that the anteroposterior dimension-to-transverse dimension ratio (AP/T ratio) is higher than 1. The aim of the present study was to reconfirm the accuracy of the taller-than-wide sign for diagnosing malignant thyroid nodules by ultrasonography in multicenter collaborative research, and investigate differences according to tumor sizes, histological types, and the influence of the tilt and orientation of the probe. At 6 registered institutes, 2,032 thyroid nodules were successively operated on and diagnosed pathologically. The accuracy of the taller-than-wide sign for diagnosing malignant tumors by ultrasonography was retrospectively analyzed across all nodules as well as in analyses separately stratified by tumor size and histology. The influence of the tilt and orientation of the probe was also assessed. The taller-than-wide sign showed high specificity for diagnosing malignancy in all nodules tested. It also showed high specificity regardless of the tumor size. When tumors were analyzed by histological types, the AP/T ratio of papillary carcinoma was significantly higher than that of benign nodules, whereas no significant difference was observed between follicular carcinoma and benign nodules. The specificity of longitudinal sections was significantly higher, while the AUC of longitudinal sections was significantly larger than those of transverse sections. The AP/T ratio obtained when the probe was tilted was not significantly different from that when it was straight. The present results support the usefulness of the taller-than-wide sign for diagnosing malignant tumors regardless of size, but not follicular carcinoma. The influence of the tilt and orientation of the probe was negligible.
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Affiliation(s)
| | - Nobuhiro Fukunari
- Thyroid Center, Showa University Northern Yokohama Hospital, Kanagawa 224-8503, Japan
| | - Tsukasa Murakami
- Department of Endocrinology, Noguchi Thyroid Clinic and Hospital Foundation, Oita 874-0902, Japan
| | - Yo Kunii
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masafumi Kitaoka
- Department of Endocrinology and Metabolism Center, IMS Miyoshi General Hospital, Saitama 354-0041, Japan
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Papapostolou KD, Evangelopoulou CC, Ioannidis IA, Kassi GN, Morfas KS, Karaminas NI, Karga HJ. Taller-than-wide Thyroid Nodules With Microcalcifications Are at High Risk of Malignancy. In Vivo 2021; 34:2101-2105. [PMID: 32606189 DOI: 10.21873/invivo.12014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIM Previous studies have shown that there may be a diversity in the ultrasonographic (US) features discriminating a malignant from a benign thyroid nodule. We determined the reliability of the specific nodule shape in combination with other US features in predicting thyroid carcinomas. PATIENTS AND METHODS This was a retrospective single-center study investigating the association of the morphological characteristics of nodular goiters from preoperative US and color Doppler images with malignancy based on pathology. RESULTS We evaluated 254 thyroid nodules (malignant, n=131) from 205 patients. Multivariable logistic regression analysis showed that taller-than-wide shape [odds ratio (OR)=25.3, 95% confidence interval (CI)=5.4-118.9; p<0.001], microcalcifications (OR=4.9, 95% CI=2.5-9.5; p<0.001), hypoechogenicity (OR=4.5; 95% CI=2-10.3; p<0.001) and size (OR=0.93; 95% CI=0.89-0.98; p=0.002) were independently associated with thyroid nodule malignancy. Additionally, we found a strong negative correlation between size and taller-than-wide shape of a thyroid nodule (r=-0.41, p<0.001). CONCLUSION Among the important indicators of thyroid malignancy, taller-than-wide nodules with microcalcifications are most likely to be malignant.
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Affiliation(s)
| | | | | | - Georgia N Kassi
- Department of Endocrinology, Metabolism and Diabetes Mellitus, Nikea-Piraeus Agios Panteleimon General Hospital, Athens, Greece.,Endocrine Unit, Alexandra Hospital, Athens, Greece
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Ibrahim TS, Taher ES, Altyar AE, Y. Rizg W. Novel Levothyroxine HIV-TAT Nanoconjugates Suppressing HeLa Cell Lines Growth in Management of Cervical Cancer. INT J PHARMACOL 2021. [DOI: 10.3923/ijp.2021.300.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Han Z, Feng N, Lu Y, Li M, Wei P, Yao J, Zhu Q, Lei Z, Xu D. A Control Study on the Value of the Ultrasound Grayscale Ratio for the Differential Diagnosis of Thyroid Micropapillary Carcinoma and Micronodular Goiter in Two Medical Centers. Front Oncol 2021; 10:625238. [PMID: 33569350 PMCID: PMC7868544 DOI: 10.3389/fonc.2020.625238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/07/2020] [Indexed: 11/14/2022] Open
Abstract
Objective To investigate the value of ultrasound gray-scale ratio (UGSR) for the differential diagnosis of papillary thyroid microcarcinoma (PTMC) and micronodular goiter (MNG) in two medical centers. Methods Ultrasound images of 881 PTMCs from 785 patients and 744 MNGs from 687 patients in center A were retrospectively analyzed and compared with 243 PTMCs from 203 patients and 251 MNGs from 198 patients in center B. All cases were confirmed by surgery and histology. The grayscale values of thyroid lesions and surrounding normal tissues were measured, and the UGSR was calculated. The optimal UGSR threshold for identifying PTMCs and MNGs in two medical centers was determined by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), optimal UGSR threshold, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were compared between the two medical centers. Results The UGSR values of PTMCs and MNGs in medical center A were 0.5537 (0.4699, 0.6515) and 0.8708 (0.7616, 1.0123) (Z = -27.691, P = 0), respectively, whereas those in medical center B were 0.5517 (0.4698, 0.6377) and 0.8539 (0.7366, 0.9929) (Z = -16.057, P = 0), respectively. The UGSR of PTMCs and MNGs did not differ significantly between the two medical centers (Z = -0.609, P = 0.543 and Z = -1.394, P = 0.163, respectively). The AUC, optimal UGSR threshold, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the two medical centers were 0.898 vs. 0.918, 0.7214 vs. 0.6911, 0.881 vs. 0.868, 0.817 vs. 0.833, 0.851 vs. 0.834, 0.853 vs. 0.867, and 0.852 vs. 0.850, respectively. Conclusions UGSR can quantify the echo intensity of PTMCs and MNGs and is therefore valuable for the differential diagnosis of the two diseases. The diagnostic efficacy was consistent between the two medical centers. This method should be widely promoted and applied.
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Affiliation(s)
- Zhijiang Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Feng
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
| | - Yidan Lu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
| | - Mingkui Li
- Department of Ultrasonography, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Peiying Wei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jincao Yao
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
| | - Qiaodan Zhu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
| | - Zhikai Lei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong Xu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
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Solymosi T, Hegedüs L, Bodor M, Nagy EV. EU-TIRADS-Based Omission of Fine-Needle Aspiration and Cytology from Thyroid Nodules Overlooks a Substantial Number of Follicular Thyroid Cancers. Int J Endocrinol 2021; 2021:9924041. [PMID: 34616450 PMCID: PMC8490077 DOI: 10.1155/2021/9924041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/04/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The classification of nodules by Thyroid Imaging Reporting and Data Systems (TIRADS) is important in guiding management. Whether sensitivity in identifying thyroid cancers varies with thyroid cancer phenotype remains unclarified. METHODS The ultrasound (US) characteristics of nodules of 26,908 nodular goiter patients were recorded. Fine-needle aspiration cytology (FNA) was performed in all nodules >1 cm irrespective of US findings (n = 25,025) and in nodules between 5 mm and 10 mm with suspicious US characteristics (n = 1,883). Of the 3281 operated cases, 221, 30, and 23 were papillary (PTC), follicular (FTC), and medullary (MTC) cancers, respectively. The US-based indication of FNA, as defined by EU-TIRADS scores, combined with lesion size, was calculated. This study design is unique in avoiding the common selection bias when TIRADS' sensitivity is tested in a cohort selected for FNA and surgery based on the same US characteristics on which TIRADS is based. RESULTS The EU-TIRADS score influences decision of FNA in the 10-20 mm range. In such nodules (n = 118), the number of suspicious features (marked hypoechogenicity, microcalcifications, irregular shape, and irregular border) per lesion was lower in FTC (0.7 ± 0.6) than in PTC (1.7 ± 1.0) or MTC (1.8 ± 0.7; p < 0.02), resulting in EU-TIRADS scores of 4.1 ± 0.6, 4.8 ± 0.3, and 4.9 ± 0.2, respectively (p < 0.01). The EU-TIRADS-based FNA indication rate was lower in FTC (55.5%) compared to PTC (85.0%) and MTC (88.9%) (p=0.02). CONCLUSIONS EU-TIRADS-defined suspicious US features are less common in FTC than in PTC and MTC. Therefore, a substantial number of FTCs in the 10-20 mm range escape surgery.
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Affiliation(s)
- Tamas Solymosi
- Endocrinology and Metabolism Clinic, Bugat Hospital, 20 Dozsa u, H-3200 Gyöngyös, Hungary
| | - Laszlo Hegedüs
- Department of Endocrinology, Kløvervænget 6, 5.sal, Odense University Hospital, DK-5000 Odense, Denmark
| | - Miklos Bodor
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary
| | - Endre V. Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary
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Li JW, Chang C, Chen JY, Shi ZT, Chen M. Nodule Size Effect on Diagnostic Performance of Ultrasonography and Computed Tomography for Papillary Thyroid Carcinoma. Curr Med Imaging 2020; 15:489-495. [PMID: 32008556 DOI: 10.2174/1573405614666180425142141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 03/12/2018] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND To compare the abilities of ultrasonography (US) and Computed Tomography (CT) to identify calcifications and to predict probability of malignancy for Papillary Thyroid Carcinoma (PTC) and Papillary Thyroid Microcarcinoma (PTMC). METHODS We reviewed 1008 cases of PTC/PTMC with calcifications reported by pre-operative US, CT, or post-operative pathology. The size of the thyroid nodule was obtained from the US report and the maximum diameter (d) was documented. According to the nodule size (d), the PTC and PTMC groups were each divided into two subgroups, as follows: large PTC group (d ≥ 2 cm), small PTC group (1 cm < d < 2 cm), large PTMC group (0.6 cm ≤ d ≤ 1 cm), and small PTMC group (d < 0.6 cm). RESULTS In the 1008 patients, the ratio of females to males was 2.29 and the mean age was 40.9 years (standard deviation: 11.7 years). Of the 1008 records, 92.8% were found to have calcifications according to the US report, while 50.4% showed calcifications according to the CT report. This difference between US and CT reports was statistically significant (p < 0.0005). The percentages of US reports showing calcifications were similar for all four PTC and PTMC subgroups (93.7%, 94.3%, 92.1%, and 85.1%, respectively; p = 0.052), while the percentages of CT reports showing calcifications were significantly different among the PTC and PTMC subgroups (62.3%, 52.2%, 45.4%, and 31.3%, respectively; p < 0.0005). As for the prediction of malignancy, US was superior to CT in all four subgroups (large PTC group: 97.1% vs. 54.1%, small PTC group: 94.8% vs. 42.9%, large PTMC group: 97.2% vs. 32.0%, small PTMC group: 95.5% vs. 14.9%; p < 0.0005 for all pairwise comparisons). No significant difference was observed in terms of the ability of US to predict the malignancy of PTC versus PTMC (p = 0.31), while CT showed significant superiority in diagnosing PTC versus PTMC (p < 0.0005). The predictive value of CT for PTC declined as the nodule size decreased (p < 0.05 for all pairwise comparisons). CONCLUSION Our results showed that US detected calcifications and predicted the malignancy of all nodule sizes of thyroid papillary carcinoma equally well, while the performance of CT declined with the reduction of nodule size.
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Affiliation(s)
- Jia-Wei Li
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Cai Chang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Jia-Ying Chen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; No 270, Dong'an Road, Xuhui District, Shanghai, China
| | - Zhao-Ting Shi
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Min Chen
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Lu C, Wang Y, Yu M. Is ultrasonographic evaluation sensitive enough to detect multicentric papillary thyroid carcinoma? Gland Surg 2020; 9:737-746. [PMID: 32775264 DOI: 10.21037/gs-20-487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to investigate the preoperative ultrasonographic (US) evaluation of multicentric papillary thyroid carcinoma (PTC) and to evaluate the association of US findings with lymph node metastasis and extracapsular extension in PTC. Methods Preoperative US evaluations of patients with PTC who underwent total thyroidectomy were retrospectively investigated. Pathological perspectives and US features of PTC were analyzed. The sensitivity of US in detecting multicentric PTC was evaluated. Results The present study included 89 PTC patients who underwent total thyroidectomy. In total, 164 nodules were detected by preoperative US. Significant differences in US pattern were found between benign and malignant nodules. Of the 89 patients with PTC, 33 (37.08%) cases were confirmed as multicentric PTC by operation and pathological examination, 22 (66.67%) of which were bilateral. Before surgery, only 23 patients were suspected as multicentric PTC based on US findings. Pathological examination revealed that malignant nodules in 17 (51.51%) patients with multicentric PTC had been missed by preoperative US. The malignant nodules that went undetected by US were micronodulars (1-4 mm). Furthermore, ultrasonography was less sensitive for the diagnosis of metastatic lymph nodes in the neck. US had more than 80% sensitivity for detection of extracapsular extension of cases. Conclusions US evaluation is not sensitive enough to detect multicentric PTC. The minute size of some nodules in multicentric PTC, may lead to them being missed by US evaluation. Ultrasonography is an optional tool for the detection of extracapsular extension, but it is less sensitive for diagnosing lymph node metastasis.
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Affiliation(s)
- Congqing Lu
- Ultrasound Section, First People's Hospital, Lianyungang 222000, China
| | - Yan Wang
- Ultrasound Section, First People's Hospital, Lianyungang 222000, China
| | - Ming Yu
- Ultrasound Section, First People's Hospital, Lianyungang 222000, China
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Zhang F, Qiao Y, Zhang H. Value of CT Features in the Diagnosis of Papillary Thyroid Tumors in Incidental Thyroid Nodules. Int J Endocrinol 2020; 2020:9342317. [PMID: 33123196 PMCID: PMC7585655 DOI: 10.1155/2020/9342317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022] Open
Abstract
The present work has investigated the value of computed tomography (CT) features in the diagnosis of papillary thyroid tumors in the incidental thyroid nodules (ITNs). In the 82 enrolled patients, 101 thyroid nodules were incidentally found by the neck CT scanning, among which 49 were histologically confirmed to be papillary thyroid carcinoma (PTC) while the other 52 were nodular goiter (NG). The tumor location, size, shape, tiny calcification, cystic change, and signs of an irregular ring, marginal defects, and enhanced blurring were all depicted by CT features. Both univariate and multivariate analyses were employed to identify independent predictors of PTC. The univariate analysis of PTC and NG showed that four CT features were statistically significant, including tiny calcification and signs of an irregular ring, marginal defects, and enhanced blurring. Furthermore, the multivariate logistic regression model indicated that signs of an irregular ring, marginal defects, and enhanced blurring were strongly correlated with PTC, of which the odds ratio (OR) was 27.374 (95% CI: 5.871∼127.636), 28.587 (95% CI: 4.139∼197.460), and 4.315 (95% CI: 0.858∼21.694), respectively. In the predictive model of PTC, the value of sensitivity, specificity, accuracy, and Youden index was 87.8%, 94.2%, 91.1%, and 0.82 with a likelihood ratio of 15.1. Therefore, the signs of an irregular ring, marginal defects, and enhanced blurring may be helpful in the diagnosis of PTC in incidentally found thyroid nodules.
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Affiliation(s)
- Fengyan Zhang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Ying Qiao
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Hui Zhang
- College of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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Smayra T, Charara Z, Sleilaty G, Boustany G, Menassa-Moussa L, Halaby G. Classification and Regression Tree (CART) model of sonographic signs in predicting thyroid nodules malignancy. Eur J Radiol Open 2020; 6:343-349. [PMID: 31890756 PMCID: PMC6909041 DOI: 10.1016/j.ejro.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 11/16/2022] Open
Abstract
Taller-than-wide thyroid nodules are more likely to require surgery. A taller-than-wide, solid and hypoechoic thyroid nodule is likely a Bethesda 4 or 5. Taller-than-wide sonographic sign is the strongest in predicting thyroid malignancy. Purpose To develop a Classification and Regression Tree (CART) model in order to recognize the most suspicious sonographic features of thyroid nodules and efficiently guide their management. Methods 791 thyroid fine needle aspiration cytology (FNAC) performed under ultrasound guidance between January 2015 and January 2017 were reviewed. Retrieved data consisted in qualitative (patient’s gender, composition, echogenicity, shape, margins and echogenic foci of the nodule) and quantitative (patient’s age and maximal diameter of the nodule) variables as well as the Bethesda score. Results Patients were 48.5 ± 13.7 years old with female to male ratio of 8:2. The nodules had median size of 2.3 (1.5–3.5) cm with a majority of solid (62.5 %) and isoechoic (50.8 %) features. 700 nodules (88.5 %) had a wider-than-tall shape, 600 (75.9 %) smooth margins and 113 (14.3 %) ill-defined ones. Echogenic foci were absent in 388 nodules (49.1 %) and, when present, largely dominated by punctate foci (32.5 %). Bethesda classes 3, 4 and 5, which require surgery, represented only 10.6 % of cases. They were significantly correlated with the taller-than-wide shape and with solid or predominantly solid features. There was no significant correlation between echostructure and Bethesda scores but we did find more nodules classified Bethesda 4 and 5 in the categories hypoechoic and severely hypoechoic. In the CART model we developed, the sequence leading to most nodules classified Bethesda 4 and 5 is: taller-than-wide shape, solid composition and hypoechoic or severely hypoechoic feature. Conclusions Taller-than-wide, solid or predominantly solid, hypoechoic or severely hypoechoic nodules are likely to require surgery and might benefit from FNAC.
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Affiliation(s)
- Tarek Smayra
- Radiology Department, School of Medicine, Hotel-Dieu Hospital, Saint Joseph University, Alfred Naccache Street, PO Box: 16-6830, Beirut, Lebanon
| | - Zahra Charara
- Radiology Department, School of Medicine, Hotel-Dieu Hospital, Saint Joseph University, Alfred Naccache Street, PO Box: 16-6830, Beirut, Lebanon
| | - Ghassan Sleilaty
- Clinical Research Center, School of Medicine, Hotel-Dieu Hospital, Saint Joseph University, Alfred Naccache Street, PO Box: 16-6830, Beirut, Lebanon
| | - Gaelle Boustany
- Radiology Department, School of Medicine, Hotel-Dieu Hospital, Saint Joseph University, Alfred Naccache Street, PO Box: 16-6830, Beirut, Lebanon
| | - Lina Menassa-Moussa
- Radiology Department, School of Medicine, Hotel-Dieu Hospital, Saint Joseph University, Alfred Naccache Street, PO Box: 16-6830, Beirut, Lebanon
| | - Georges Halaby
- Endocrinology Department, School of Medicine, Hotel-Dieu Hospital, Saint Joseph University, Alfred Naccache Street, PO Box: 16-6830, Beirut, Lebanon
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Tao W, Qingjun Z, Wei Z, Fang Z, Lei Z, Yuanyuan N, Kefu H. Computed tomography versus ultrasound/fine needle aspiration biopsy in differential diagnosis of thyroid nodules: a retrospective analysis. Braz J Otorhinolaryngol 2019; 87:402-409. [PMID: 31874829 PMCID: PMC9422654 DOI: 10.1016/j.bjorl.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/02/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Ultrasound sonography provides a quick method for determining which nodule to sample for fine needle aspiration biopsy in thyroid nodules. On the other hand, the computed tomography examination is not restricted by echo attenuation and distinguishes between benign and malignant nodules. Objective To compare computed tomography examinations against ultrasound/fine needle aspiration biopsy in the differential diagnosis of thyroid nodules. Methods Data regarding computed tomography examinations, sonographic finding following fine needle aspiration biopsy, and tumor histology of 953 nodules from 698 patients who underwent thyroidectomy were collected and analyzed. The beneficial score for detection of the malignant tumor for each adopted modality was evaluated. Results Ultrasound images did not show a well-circumscribed solid mass in 89 nodules, and ultimately did not detect nodules in fine needle aspiration biopsies (false positive non-malignant nodules). Ultrasound images showed parenchymatous disease (false positive malignant nodules) in several nodules. Computed tomography examinations demonstrated higher difficulty in detection of malignant nodules of 1.0–2.0 cm size than ultrasound examination following fine needle aspiration biopsies; compared to tumor histological data, computed tomography examinations had a sensitivity of 0.879. Conclusion Computed tomography examinations are a more reliable method for differential diagnosis of thyroid nodules than ultrasound examinations followed by fine needle aspiration biopsy. Level of Evidence III.
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Affiliation(s)
- Wang Tao
- Gong'an County People's Hospital, Department of Ultrasound, Gong'an County, Hubei Province, China
| | - Zhu Qingjun
- The People's Hospital of Jinshi, Department of Ultrasound, Jinshi, Hunan Province, China
| | - Zheng Wei
- Gong'an County People's Hospital, Department of Ultrasound, Gong'an County, Hubei Province, China
| | - Zhou Fang
- Gong'an County People's Hospital, Department of Ultrasound, Gong'an County, Hubei Province, China
| | - Zhou Lei
- Gong'an County People's Hospital, Department of Medical Cosmetology, Gong'an County, Hubei Province, China
| | - Ni Yuanyuan
- Gong'an County People's Hospital, Department of Emergency, Gong'an County, Hubei Province, China
| | - Hu Kefu
- Gong'an County People's Hospital, Department of Medical Administration, Gong'an County, Hubei Province, China.
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Chen X, Gao M, Hu L, Zhu J, Zhang S, Wei X. The diagnostic value of the ultrasound gray scale ratio for different sizes of thyroid nodules. Cancer Med 2019; 8:7644-7649. [PMID: 31691509 PMCID: PMC6912051 DOI: 10.1002/cam4.2653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/18/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
At present, hypoechogenicity, as one of the clinically relevant features associated with suspicion of malignant thyroid disease, is affected by the variability of modules and the experience of sonographers, thus leading to unsatisfying results. We propose the ultrasound gray scale ratio (UGSR) to obtain an objective, numerical estimate of the echogenicity degree in different‐sized thyroid nodules, and we then evaluate its diagnostic efficacy in differentiating benign and malignant thyroid lesions. In total, 553 ultrasound images of thyroid nodules from one kind of ultrasonographic scanner were analyzed, among which 281 were papillary thyroid carcinomas (PTCs) and 272 were nodular goiters (NGs). The UGSR of the PTCs, NGs, and surrounding normal thyroid tissue was measured by image analysis software. The best cut‐off value for distinguishing various sizes of PTCs and NGs was determined by receiver operating characteristic (ROC) curve analysis. As the UGSR increased, the sensitivity of the diagnosing PTCs decreased, and the specificity increased. When the maximum Jordan index was 0.611, the best cut‐off value was 0.692, and the corresponding sensitivity and specificity of diagnosing PTCs were 87.9% and 73.2%, respectively. For the analysis of subgroups of different tumor sizes, as the size of thyroid nodules increased from 0.3 to 2 cm, the sensitivity of the diagnosis of PTCs decreased from 97.5% to 58.8%, and the specificity increased from 72.4% to 90.9%. These results strongly suggest that the UGSR is an appropriate objective, numerical method for estimating the echogenicity degree and has various diagnostic efficacies in different‐sized thyroid nodules. Thus, the UGSR can be used as an additional ultrasound parameter in the diagnosis of different‐sized PTCs and NGs.
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Affiliation(s)
- Xiaoyu Chen
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ming Gao
- Department of Thyroid and Cervical Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
| | - Linfei Hu
- Department of Thyroid and Cervical Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China
| | - Jialin Zhu
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Sheng Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Xu D, Wu B, Li X, Cheng Y, Chen D, Fang Y, Du Q, Chen Z, Wang X. Evaluation of the thyroid characteristics of patients with growth hormone-secreting adenomas. BMC Endocr Disord 2019; 19:94. [PMID: 31477080 PMCID: PMC6720980 DOI: 10.1186/s12902-019-0424-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/26/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acromegaly is highly associated with thyroid disorders. However, the clinical characteristics of thyroid nodules in individuals with acromegaly who present with thyroid diseases have not been completely elucidated. METHODS Overall, 134 consecutive participants with growth hormone (GH)-secreting adenoma (n = 67) and non-functioning (NF) pituitary adenoma (n = 67) were recruited from the outpatient and inpatient patient department of The First Affiliated Hospital, Jinan University from August 2015 to August 2017. Thyroid ultrasonography was performed using an ultrasound system. The cytopathological results of fine-needle aspiration biopsy were analyzed by a pathologist according to the Bethesda system. Twenty-one patients with GH-secreting adenoma and thyroid disease underwent transsphenoidal pituitary adenoma resection and were followed up for 1 year. RESULTS The prevalence of thyroid disease increased in the GH-secreting adenoma group compared with that in the NF pituitary adenoma group. The number of hypoechoic, isoechogenic, heterogeneous, and vascular thyroid nodules increased in patients with GH-secreting adenoma plus thyroid disease compared with that in patients with NF pituitary adenoma plus thyroid disease. Finally, we found significant decreases in the morphology of solid nodules and significant increases in the morphology of cystic nodules after surgery compared with those before surgery in the cured group. Moreover, the numbers of heterogeneous and vascular thyroid nodules decreased significantly after surgery compared with those before surgery in the cured group. However, the characteristics of the thyroid nodules did not change after surgery compared with those before surgery in the non-cured group. CONCLUSIONS The numbers of hypoechoic, isoechoic, heterogeneous, and vascular thyroid nodules increased in patients with GH-secreting adenomas. In these patients, surgery resulted in significant changes from solid to cystic nodules and also reduced the numbers of heterogeneous and vascular thyroid nodules.
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Affiliation(s)
- Dianshuang Xu
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province, 510630, People's Republic of China
| | - Bolin Wu
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province, 510630, People's Republic of China
| | - Xiaoju Li
- Department of Medical Ultrasound, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510632, China
| | - Yunjiu Cheng
- Department of cardiology, The First Affiliated Hospital, SunYat-sen University, Guangzhou, 510632, China
| | - Dubo Chen
- Department of laboratory medicine, The first affiliated hospital, Sun Yat-sen university, Guangzhou, 510632, China
| | - Yuefeng Fang
- Asset Management Division, Guangdong University of Foreign Studies, Guangzhou, 510420, China
| | - Qiu Du
- Department of Neurosurgery, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Zhiyong Chen
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province, 510630, People's Republic of China.
| | - Xiaodong Wang
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province, 510630, People's Republic of China.
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Baser H, Topaloglu O, Bilginer MC, Ulusoy S, Kılıcarslan A, Ozdemir E, Ersoy R, Cakir B. Are cytologic and histopathologic features of hot thyroid nodules different from cold thyroid nodules? Diagn Cytopathol 2019; 47:898-903. [DOI: 10.1002/dc.24251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/05/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Muhammet C. Bilginer
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Serap Ulusoy
- Department of General Surgery; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Aydan Kılıcarslan
- Department of Pathology; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Elif Ozdemir
- Department of Nuclear Medicine; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism; Yildirim Beyazit University Faculty of Medicine; Ankara Turkey
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Grasso M, Puzziello A, De Palma M. Preoperative ultrasound evaluation of laterocervical lymph nodes: timing and experience modify the treatment of patients with differentiated thyroid cancer. Updates Surg 2019; 71:711-715. [DOI: 10.1007/s13304-018-00618-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
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Peng Y, Zhou W, Zhan WW, Xu SY. Ultrasonographic Assessment of Differential Diagnosis Between Degenerating Cystic Thyroid Nodules and Papillary Thyroid Microcarcinomas. World J Surg 2018; 41:2538-2544. [PMID: 28540399 DOI: 10.1007/s00268-017-4060-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To enhance the diagnostic accuracy of conventional ultrasonography in differentiating papillary thyroid microcarcinomas (PTMCs) from degenerating cystic thyroid nodules mimicking malignancy (under 10 mm in diameter). METHODS A retrospective analysis of hypoechoic thyroid nodules under 10 mm between 162 cases of degenerating cystic thyroid nodules confirmed by ultrasound-guided fine-needle aspiration (US-FNA) and 150 cases of PTMCs confirmed by both US-FNA and postoperative pathology were performed in the aspects of shape, margin, calcification, and vascularity. RESULTS Significant differences were observed in the aspects of shape, rim calcification, and vascularity (P < 0.05) between two groups in condition of solid hypoechogenicity. An ovoid-to-round regular shape, rim calcification, and no intrinsic blood flow were the statistically significant features for the depiction of a benign degenerating cystic nodule, while a taller-than-wide shape and peripheral or intranodular blood flow were that of a malignancy. Multiple stepwise logistic regression analysis demonstrated each of them as an independent predictor of malignancy (P < 0.05). CONCLUSIONS Shape, rim calcification, and vascularity are efficient criteria to distinguish degenerating cystic thyroid nodules mimicking malignancy from PTMCs in cases of solid hypoechogenic nodules under 10 mm. Such criteria should be acknowledged in cases of solid hypoechogenic thyroid nodules to help guide for the need of US-FNA.
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Affiliation(s)
- Yan Peng
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Wei Zhou
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Wei Wei Zhan
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Shang Yan Xu
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
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Han Z, Lei Z, Li M, Luo D, Ding J. Differential diagnosis value of the ultrasound gray scale ratio for papillary thyroid microcarcinomas and micronodular goiters. Quant Imaging Med Surg 2018; 8:507-513. [PMID: 30050785 DOI: 10.21037/qims.2018.06.04] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background To investigate the differential diagnosis value of the ultrasound gray scale ratio (UGSR) for papillary thyroid microcarcinomas (PTMCs) and micronodular goiters (MNGs). Methods A retrospective analysis was performed using ultrasound images from 521 PTMC patients (561 PTMC lesions) and 405 MNG patients (515 MNG lesions). All cases were surgically and histologically confirmed. Gray scale values of the thyroid lesions and the surrounding normal thyroid tissue were measured. The thyroid lesion to normal thyroid tissue (UGSR) was calculated. Statistical analysis was performed with Mann-Whitney test. Receiver operating characteristic curve determined the optimal UGSR threshold for differentiating PTMCs and MNGs. Results In 561 PTMCs, the mean UGSR was 0.54 (SD: 0.16; range: 0.24-1.26). In 515 MNGs, the mean UGSR was 0.87 (SD: 0.22; range: 0.34-2.06), with significant difference between values of PTMCs and MNGs (P<0.001). The UGSR area under the curve to differentiate PTMCs and MNGs was 0.895. When the UGSR decreased, the UGSR to PTMC sensitivity decreased and the specificity increased. When the UGSR was chosen to be 0.99, 0.72, 0.63 or 0.34, the sensitivity was 98.4% and 87.0%, 73.8% and 5.9% respectively, and specificity was 25.1% and 80.4%, 90.1% and 100.0% respectively. When the UGSR was 0.72, the Youden index maximum was 0.674. Conclusions The UGSR allows potential differentiation PTMCs and MNGs.
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Affiliation(s)
- Zhijiang Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Zhikai Lei
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Mingkui Li
- Department of Ultrasound, Zhejiang Xiaoshan Hospital, Hangzhou 311200, China.,Trying Doctor Group, Hangzhou 311200, China
| | - Dingcun Luo
- Department of Tumor Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Jinwang Ding
- Department of Tumor Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
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Advantages of Routine Ultrasound Combined With Contrast-Enhanced Ultrasound in Diagnosing Papillary Thyroid Carcinoma. Ultrasound Q 2018; 33:213-218. [PMID: 28832401 DOI: 10.1097/ruq.0000000000000309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to evaluate the advantages of routine ultrasound (US), contrast-enhanced US (CEUS), and the combination of these 2 methods in diagnosing papillary thyroid carcinoma (PTC). We subjected 89 patients with calcified thyroid nodules to conventional US and CEUS and then retrospectively analyzed the US and CEUS features of 89 patients with single, solid PTC. On this basis, we then evaluated the ability of US, CEUS, and their combination to diagnose PTC. In the 89 patients with thyroid nodules, US findings differed significantly from CEUS findings (P < 0.05). In the US group, the diagnostic sensitivity, specificity, and accuracy were 87.5%, 78.8%, and 88.0%, respectively; in the CEUS group, these values were 92.9% (P < 0.05), 87.9% (P < 0.05), and 92.9% (P < 0.05), respectively; and when the methods were combined, the diagnostic sensitivity, specificity, and accuracy were 96.7%, 92.7%, and 94.9%, respectively. A typical PTC nodule can be definitively diagnosed using US and CEUS; more specifically, the features of slow progression, late enhancement, and low enhancement were highly associated with a diagnosis of PTC. When these features were combined, they exhibited higher diagnostic performance than any individual method.
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Balancing the benefits and harms of thyroid cancer surveillance in survivors of Childhood, adolescent and young adult cancer: Recommendations from the international Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Cancer Treat Rev 2018; 63:28-39. [DOI: 10.1016/j.ctrv.2017.11.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/08/2017] [Indexed: 12/18/2022]
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Mendes GF, Garcia MR, Falsarella PM, Rahal A, Cavalcante Junior FA, Nery DR, Garcia RG. Fine needle aspiration biopsy of thyroid nodule smaller than 1.0 cm: accuracy of TIRADS classification system in more than 1000 nodules. Br J Radiol 2017; 91:20170642. [PMID: 29182368 DOI: 10.1259/bjr.20170642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify whether or not the same ultrasound features can be applied and should be considered to support the decision as to which subcentimeter nodules should be biopsied with fine needle aspiration (FNAB). METHODS Single-institution, IRB approved, retrospective study conducted from 2008 to 2016 that evaluated 1094 thyroid nodules smaller than 1.0 cm that were classified according to TIRADS and submitted for FNAB. RESULTS The value of FNAB of thyroid nodules smaller than 1.0 cm were assessed and correlated with the sonographic criteria by comparing the obtained results with the cytological findings in 1094 thyroid nodules. In the analysis considering all nodules, the proportion of malignancies among nodules with TIRADS 2 is 0.91% and for TIRADS 3 is 2.87%. Among those classified as 4A, 12.26%; with 4B classification, 34.43%; with 4C classification, 66.6%; and among those with 5 classifications, 85.7%. CONCLUSION In conclusion, the TIRADS classification system, based on the sonographic features reported herein, may help detect which nodules should be investigated for potential malignancies. Advances in knowledge: Few reports compare the efficacy of ultrasound-FNAB for thyroid nodules smaller than 1.0 cm in diameter. The findings of malignancy in this subgroup of nodules may help in the clinical follow-up of which patients should be submitted to an early imaging evaluation or intervention.
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Affiliation(s)
- Guilherme F Mendes
- 1 Department of Interventional Radiology, Hospital Israelita Albert Einstein , São Paulo , Brazil
| | - Marcio Rt Garcia
- 2 Department of Radiology, Hospital Israelita Albert Einstein , São Paulo , Brazil
| | - Priscila M Falsarella
- 1 Department of Interventional Radiology, Hospital Israelita Albert Einstein , São Paulo , Brazil
| | - Antonio Rahal
- 1 Department of Interventional Radiology, Hospital Israelita Albert Einstein , São Paulo , Brazil
| | | | - Daniela R Nery
- 2 Department of Radiology, Hospital Israelita Albert Einstein , São Paulo , Brazil
| | - Rodrigo G Garcia
- 1 Department of Interventional Radiology, Hospital Israelita Albert Einstein , São Paulo , Brazil
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Logistic regression analysis of conventional ultrasonography, strain elastosonography, and contrast-enhanced ultrasound characteristics for the differentiation of benign and malignant thyroid nodules. PLoS One 2017; 12:e0188987. [PMID: 29228030 PMCID: PMC5724846 DOI: 10.1371/journal.pone.0188987] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/16/2017] [Indexed: 11/19/2022] Open
Abstract
The aim of the study is to screen the significant sonographic features by logistic regression analysis and fit a model to diagnose thyroid nodules. A total of 525 pathological thyroid nodules were retrospectively analyzed. All the nodules underwent conventional ultrasonography (US), strain elastosonography (SE), and contrast -enhanced ultrasound (CEUS). Those nodules' 12 suspicious sonographic features were used to assess thyroid nodules. The significant features of diagnosing thyroid nodules were picked out by logistic regression analysis. All variables that were statistically related to diagnosis of thyroid nodules, at a level of p < 0.05 were embodied in a logistic regression analysis model. The significant features in the logistic regression model of diagnosing thyroid nodules were calcification, suspected cervical lymph node metastasis, hypoenhancement pattern, margin, shape, vascularity, posterior acoustic, echogenicity, and elastography score. According to the results of logistic regression analysis, the formula that could predict whether or not thyroid nodules are malignant was established. The area under the receiver operating curve (ROC) was 0.930 and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 83.77%, 89.56%, 87.05%, 86.04%, and 87.79% respectively.
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Girardi FM, Silva LMD, Flores CD. A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features. Braz J Otorhinolaryngol 2017; 85:24-31. [PMID: 29162407 PMCID: PMC9442819 DOI: 10.1016/j.bjorl.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 07/26/2017] [Accepted: 10/02/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains. Objective The purpose of this study was to create a statistical prediction model for thyroid nodules management. Methods Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case. Results In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%. Conclusions The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.
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Affiliation(s)
- Fábio Muradás Girardi
- Complexo Hospitalar Santa Casa, Hospital Santa Rita, Departamento de Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil.
| | | | - Cecilia Dias Flores
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Informática, Porto Alegre, RS, Brazil
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Shear Wave Elastography Combining with Conventional Grey Scale Ultrasound Improves the Diagnostic Accuracy in Differentiating Benign and Malignant Thyroid Nodules. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7111103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Melany M, Chen S. Thyroid Cancer: Ultrasound Imaging and Fine-Needle Aspiration Biopsy. Endocrinol Metab Clin North Am 2017; 46:691-711. [PMID: 28760234 DOI: 10.1016/j.ecl.2017.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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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Tang AL, Falciglia M, Yang H, Mark JR, Steward DL. Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration. Thyroid 2017; 27:1077-1082. [PMID: 28657511 DOI: 10.1089/thy.2016.0555] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this study was to validate the American Thyroid Association (ATA) sonographic risk assessment of thyroid nodules. METHODS The ATA sonographic risk assessment was prospectively applied to 206 thyroid nodules selected for ultrasound-guided fine-needle aspiration (US-FNA), and analyzed with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), as well as surgical pathology for the subset undergoing surgical excision. RESULTS The analysis included 206 thyroid nodules averaging 2.4 cm (range 1-7 cm; standard error of the mean 0.07). Using the ATA US pattern risk assessment, nodules were classified as high (4%), intermediate (31%), low (38%), and very low (26%) risk of malignancy. Nodule size was inversely correlated with sonographic risk assessment, as lower risk nodules were larger on average (p < 0.0001). Malignancy rates determined by cytology/surgical pathology were high 100%, intermediate 11%, low 8%, and very low 2%, which were closely aligned with ATA malignancy risk estimates (high 70-90%, intermediate 10-20%, low 5-10%, and very low 3%). ATA US pattern risk assessment also appropriately predicted the proportion of nodules classified as malignant or suspicious for malignancy through TBSRTC classification-high (77%), intermediate (6%), low (1%), and very low 0%-as well as benign TBSRTC classification-high (0%), intermediate (47%), low (61%), and very low (70%) (p < 0.0001). Malignancy rates of surgically excised, cytologically indeterminate nodules followed ATA sonographic risk stratification (high 100%, intermediate 21%, low 17%, and very low 12%; p = 0.003). CONCLUSION This prospective study supports the new ATA sonographic pattern risk assessment for selection of thyroid nodules for US-FNA based upon TBSRTC and surgical pathology results. In the setting of indeterminate cytopathology, nodules categorized as atypia of undetermined significance/follicular lesion of undetermined significance with ATA high-risk sonographic patterns have a high likelihood of being malignant.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adenoma, Oxyphilic/diagnostic imaging
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/surgery
- Adult
- Biopsy, Fine-Needle
- Calcinosis/diagnostic imaging
- Calcinosis/pathology
- Calcinosis/surgery
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Diagnosis, Differential
- Female
- Hospitals, Teaching
- Humans
- Male
- Ohio
- Practice Guidelines as Topic
- Prospective Studies
- Risk Assessment
- Societies, Scientific
- Thyroid Cancer, Papillary
- Thyroid Gland/diagnostic imaging
- Thyroid Gland/pathology
- Thyroid Gland/surgery
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Nodule/diagnostic imaging
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Tumor Burden
- Ultrasonography
- United States
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Affiliation(s)
- Alice L Tang
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Mercedes Falciglia
- 2 Division of Endocrinology, Department of Medicine, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Huaitao Yang
- 3 Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Jonathan R Mark
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - David L Steward
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio
- 2 Division of Endocrinology, Department of Medicine, University of Cincinnati College of Medicine , Cincinnati, Ohio
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Thyroid nodule sizes influence the diagnostic performance of TIRADS and ultrasound patterns of 2015 ATA guidelines: a multicenter retrospective study. Sci Rep 2017; 7:43183. [PMID: 28233806 PMCID: PMC5324396 DOI: 10.1038/srep43183] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/19/2017] [Indexed: 01/02/2023] Open
Abstract
To evaluate the impact of thyroid nodule sizes on the diagnostic performance of thyroid imaging reporting and data system (TIRADS) and ultrasound patterns of 2015 American Thyroid Association (ATA) guidelines. Total 734 patients with 962 thyroid nodules were recruited in this retrospective study. All nodules were divided into three groups according to the maximal diameter (d < 10 mm, d = 10–20 mm and d > 20 mm). The ultrasound images were categorized based on TIRADS and ATA ultrasound patterns, respectively. A total of 931 (96.8%) and 906 (94.2%) patterns met the criteria for TIRADS and ATA ultrasound patterns. The AUC (0.849) and sensitivity (85.3%) of TIRADS were highest in d = 10–20 mm group. However, ATA had highest AUC (0.839) and specificity (89.8%) in d > 20 mm group. ATA ultrasound patterns had higher specificity (P = 0.04), while TI-RADS had higher sensitivity (P = 0.02). In nodules d > 20 mm, the specificity of ATA patterns was higher than TIRADS (P = 0.003). Our results indicated that nodule sizes may influence the diagnostic performance of TIRADS and ATA ultrasound patterns. The ATA patterns may yield higher specificity than TIRADS, especially in nodules larger than 20 mm.
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Godazandeh G, Kashi Z, Zargarnataj S, Fazli M, Ebadi R, Kerdabadi EH. Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB). Acta Inform Med 2016; 24:347-350. [PMID: 28077891 PMCID: PMC5203751 DOI: 10.5455/aim.2016.24.347-350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/10/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Some studies have shown largest thyroid nodule size, especially ≥4cm that can predict malignancy and reduce fine needle aspiration biopsy (FNAB) accuracy. Therefore, this study is designed to evaluate relationship between thyroid nodule sizes with malignancy and its effect on FNBA accuracy. MATERIALS AND METHODS a retrospective analytical study design aims to investigate all patients with thyroid nodules who referred to surgery department of Imam-Khomeini Hospital of Mazandaran University of Medical Sciences in Sari from 20 March 2008 to 22 March 2014. We collected patient's demographic data, nodules size, FNAB reports and final pathology (after surgery) reports from their medical records. All data were analyses performed by SPSS18. RESULTS 167 patients (153 women) with mean age of 41.56±13.24 years old were enrolled for this study. In final pathology; 38 patients (22.8%) had malignant nodules. The mean age of patients with or without malignant nodules were 34.93±11.86 and 42.37±12.26 years old, respectively (P=0.002). The mean size of benign and malignant nodules were 2.91±1.29 cm and 3.38±1.86 cm, respectively (P=0.15). 25.2% of <4 cm nodules and 17.9% of ≥4 cm nodules were diagnosed as a malignant (P=0.29). FNAB was done on 95 patients that reported benign in 60 patients (63.2%), malignant in 18 patients (18.9%) and suspicious in 17 patients (17.9%). Positive and negative results of FNAB in all nodules were 3.5% and 6.3%, in <4cm nodules were 5.8% and 6.2% and in ≥4cm nodules were zero and 6.7%, respectively. The sensitivity, specificity, Positive predict value (PPV), negative predict value (NPV) and overall accuracy (OA) of FNAB in all nodules were 76.19%, 96.49%, 88.88%, 91.66% and 91.02%, and in <4cm nodules were 78.57%, 94.11%, 84.61%, 91.42% and 89.58%, and in ≥4cm nodules were 71.4%, 100%, 100%, 92% and 93.33%, respectively. CONCLUSION the results of this study revealed that the size of the thyroid nodules is not reliable at predicting malignancy and should not be applied in medical decision making. FNAB showed good specificity but the sensitivity was low in our study. In ≥4cm nodules; FNAB sensitivity was decreased and accompanied by higher false-negative results. Furthermore, FNABs with suspicious results were associated with high probability of malignancy.
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Affiliation(s)
- Gholamali Godazandeh
- Department of Thoracic Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Kashi
- Department of Endocrinology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sadegh Zargarnataj
- Department of General Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehran Fazli
- Young Researcher and Elite Club, Kazerun Branch, Islamic Azad University, Kazerun, Iran
| | - Robab Ebadi
- Jupiter Medical Group, Meadow Springs Medical Center, WA, Australia
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Dong Y, Zhan W, Zhou J, Song L, Ni X, Zhang B. Hyper-Echoic Rim in Thyroid Nodules: A New Ultrasonographic Feature for Malignancy Prediction. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2123-2129. [PMID: 27339761 DOI: 10.1016/j.ultrasmedbio.2016.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 06/06/2023]
Abstract
The goal of this study was to verify the ultrasound features of hyper-echoic rims in thyroid nodules and to evaluate their diagnostic value in predicting thyroid malignancies. We retrospectively analyzed 228 pathologically proven thyroid nodules (137 malignant and 91 benign nodules). Forty-eight thyroid nodules had a hyper echogenic rim. All malignant nodules (137) were papillary carcinomas, which were studied to identify the correlation between the hyper-echoic rim (detected by ultrasound) and other histologic features. Presence of a hyper-echoic rim had high specificity (94.51%), but low sensitivity (31.39%) in predicting malignancy (p < 0.05). Thirty-seven of 43 malignant nodules had boundary zones of mixed structure (apparent fibrous stroma bands or dense collagenous border with a mixed population of cancerous cells) under microscopic examination. In conclusion, the hyper-echogenic rim could be one additional ultrasound parameter in the diagnosis of thyroid lesions.
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Affiliation(s)
- YiJie Dong
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - WeiWei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - LinLin Song
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - XiaoFeng Ni
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - BenYan Zhang
- Department of Pathology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Ní Mhuircheartaigh JM, Siewert B, Sun MR. Correlation between the size of incidental thyroid nodules detected on CT, MRI or PET-CT and subsequent ultrasound. Clin Imaging 2016; 40:1162-1166. [PMID: 27569401 DOI: 10.1016/j.clinimag.2016.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/16/2016] [Accepted: 08/02/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to assess the relationship between size of thyroid nodules at computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography CT (PET-CT), and size at ultrasound. MATERIALS AND METHODS We performed a retrospective review of thyroid ultrasound studies over a 2-year period. RESULTS A total of 307 patients were included in the study. There was a statistically significant difference between the size of nodules measured on ultrasound compared with cross-sectional imaging (P < .001). American College of Radiology white paper recommendations would have decreased ultrasound referrals by 24% without any additional missed malignancies. CONCLUSION Cross-sectional imaging underestimates the size of thyroid nodules; however, the difference is small and likely not clinically significant.
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Affiliation(s)
| | - Bettina Siewert
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Maryellen R Sun
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
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Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract 2016; 22:622-39. [PMID: 27167915 DOI: 10.4158/ep161208.gl] [Citation(s) in RCA: 744] [Impact Index Per Article: 82.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).
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Knobel M. Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters. J Endocrinol Invest 2016; 39:357-73. [PMID: 26392367 DOI: 10.1007/s40618-015-0391-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/11/2015] [Indexed: 10/23/2022]
Abstract
Goiter, an enlargement of the thyroid gland, is a common problem in clinical practice associated with iodine deficiency, increase in serum thyroid-stimulating hormone (TSH) level, natural goitrogens, smoking, and lack of selenium and iron. Evidence suggests that heredity also has an important role in the etiology of goiter. The current classification divides goiter into diffuse and nodular, which may be further subdivided into toxic (associated with symptoms of hyperthyroidism, suppressed TSH or both), or nontoxic (associated with a normal TSH level). Nodular thyroid disease with the presence of single or multiple nodules requires evaluation due to the risk of malignancy, toxicity, and local compressive symptoms. Measurement of TSH, accurate imaging with high-resolution ultrasonography or computed tomography, and fine-needle aspiration biopsy are the appropriate methods for evaluation and management of goiter. This review discusses the clinical presentation, diagnostic evaluation, and treatment considerations of nontoxic diffuse and nodular goiters.
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Affiliation(s)
- M Knobel
- Thyroid Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 155 - 8th floor, bl 3, PAMB, São Paulo, 05403-900, Brazil.
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Esfahanian F, Aryan A, Ghajarzadeh M, Yazdi MH, Nobakht N, Burchi M. Application of Sonoelastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules. Int J Prev Med 2016; 7:55. [PMID: 27076893 PMCID: PMC4809115 DOI: 10.4103/2008-7802.178355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 12/15/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Sonoelastography is a new ultrasound method which could be helpful to determine which thyroid nodule is malignant. We designed this study to evaluate the accuracy of sonoelastography in differentiating of benign and malignant thyroid nodules in Iranian patients. Methods: Forty thyroid nodules in forty consecutive patients who had been referred for sonography-guided fine-needle aspiration biopsy were evaluated. Gray scale ultrasound and elastosonography by real-time, freehand technique applied for all patients. Elastography findings were classified into four groups. Nodules which were classified as patterns 1 or 2 in elastogram evaluation were classified as benign and probably malignant if elastogram scans were patterns 3 and 4 of elastogram scan. Results: Mean age ± standard deviation (SD) was 42.2 ± 12.6 years, and mean ± SD thyroid-stimulating hormone level was 1.4 ± 1.9 IU/ml. Thirty-five cases (87.5%) were female and 5 (12.5%) were male. Histological examination indicated 27 (67.5%) benign and 13 (32.5%) malignant nodules. The most elastogram score was 2 (50%) followed by score 3. The cut-off point of 2 considered as the best value to differentiate benign and malignant thyroid nodules with sensitivity and specificity of 61% and 78% (area under the curve = 0.76, 95% confidence interval: 0.6–0.92, P = 0.007). Conclusions: Sonoelastography could help to differentiate benign and malignant thyroid nodules. As our sample size was limited, larger studies are recommended.
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Affiliation(s)
- Fatemeh Esfahanian
- Department of Endocrinology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arvin Aryan
- Department of Radiology, Medical Imaging Center, Advanced Diagnostic and Interventional Radiology Research Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Ghajarzadeh
- Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Meisam Hosein Yazdi
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasir Nobakht
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Burchi
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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47
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Kaliszewski K, Diakowska D, Wojtczak B, Strutyńska-Karpińska M, Domosławski P, Sutkowski K, Głód M, Balcerzak W, Forkasiewicz Z, Łukieńczuk T. Fine-Needle Aspiration Biopsy as a Preoperative Procedure in Patients with Malignancy in Solitary and Multiple Thyroid Nodules. PLoS One 2016; 11:e0146883. [PMID: 26784518 PMCID: PMC4718628 DOI: 10.1371/journal.pone.0146883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/24/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Fine-needle aspiration biopsy (FNAB) is a recognized technique for the basic, preoperative cytological diagnosis of thyroid nodules. AIM OF THE STUDY To analyze the accuracy of FNAB in the diagnosis of thyroid cancer in patients with solitary and multiple thyroid nodules and to compare the demographic, clinical and pathological characteristics of patients with thyroid carcinoma in solitary and multiple tumors. MATERIALS AND METHODS The case records of 2,403 patients with solitary and multiple thyroid tumors treated consecutively between 2008 and 2013 were analyzed retrospectively. We selected 1,645 for further analysis. A solitary thyroid nodule was observed in 493 patients, and multiple nodules were detected in 1,152 patients. Further classification of the patients in these two groups was performed on the basis of the FNAB results, type of surgery performed and histopathology. TC was histopathologically confirmed in 166 patients, and benign disease was found in 1,479. The TC patients were assigned to the study group, and those with benign thyroid disease were placed into the control group. The study group was divided into two subgroups according to the presence of cancer in a single thyroid nodule or in multiple nodules. Malignancy in a solitary thyroid nodule was diagnosed in 98 (59.0%) patients, and cancer in multiple nodules was diagnosed in 68 (41.0%). Comparative analyses of the demographic, clinical and histopathological characteristics were performed for both subgroups. The following statistical analyses were performed: comparative characteristic of subgroups, ROC analysis for study group and subgroup of patients, and multivariable logistic regression analysis for study group. RESULTS The rate of prediction of TC by FNAB was three times higher in the patients with a solitary thyroid nodule compared with those with multiple thyroid nodules and it was statistically significant (p<0.001). The rate of total thyroid resection and lack of necessity for reoperation were also significantly higher in the TC patients with a solitary nodule. The histopathological results showed that significantly more patients with a solitary nodule had advanced-stage TC (stage III or IV) and tumor progression (pT3 or pT4) (p = 0.002 for both). ROC analysis demonstrated that the overall accuracy of FNAB as a predictor of thyroid cancer presence was high, especially for the subgroup of patients with a solitary thyroid nodule (AUC = 0.958, p<0.0001). Multivariable logistic regression analysis confirmed that a positive FNAB result was the sole predictor of the performance of total resection in the TC study group (p<0.0001), while a negative FNAB result and the presence of a papillary cancer type were independent predictors of the risk of reoperation (p<0.0001 and p = 0.002, respectively). CONCLUSIONS FNAB often produces false-negative results in patients with multiple malignant thyroid tumors, which results in reoperation in many cases. False-negative FNAB results are rare in patients with a solitary tumor. Because of the low predictive capacity of FNAB for thyroid cancer in patients with multiple thyroid tumors, total thyroid excision should be considered in most cases despite a "negative" (no malignant) FNAB result.
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Affiliation(s)
- Krzysztof Kaliszewski
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Diakowska
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Strutyńska-Karpińska
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Domosławski
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Sutkowski
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Głód
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Balcerzak
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Zdzisław Forkasiewicz
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Tadeusz Łukieńczuk
- 1st Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Tian W, Hao S, Gao B, Jiang Y, Zhang S, Guo L, Luo D. Comparison of Diagnostic Accuracy of Real-Time Elastography and Shear Wave Elastography in Differentiation Malignant From Benign Thyroid Nodules. Medicine (Baltimore) 2015; 94:e2312. [PMID: 26717367 PMCID: PMC5291608 DOI: 10.1097/md.0000000000002312] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Thyroid nodules are relatively more prevalent in iodine-deficiency area, and the incidence increased sharply in the past decade in these areas. Workup of malignant from benign nodules in clinic was the main problem for managing thyroid nodules.An overall search for the articles about the diagnostic performance of real-time elastography (RTE) and shear wave elastography (SWE) before April 2015 in the databases of PubMed, Embase, and Google scholar. The pooled sensitivity, specificity, and summary receiver operating characteristic (SROC) curve were obtained from individual studies with a random-effects model. Subgroup and meta-regression analysis were also performed.Fifty-six studies involved in 2621 malignant nodules and 7380 benign nodules were contained in our meta-analysis. The pooled sensitivity and specificity of RTE was 83.0% and 81.2%, which is higher than SWE (sensitivity: 78.7%, specificity: 80.5%). The areas under the SROC curve of RTE and SWE were 0.885 and 0.842 respectively. RTE had higher diagnostic value for Caucasians than Asians. Stran ratio (SR) assessment had higher diagnostic performance than elasticity score (ES) system. Similarly, it had higher diagnostic value when malignant nodules were more than 50.In summary, the results revealed that RTE had higher diagnostic performance than SWE in differentiating malignant from benign nodules. However, future international multicenter studies in the region of thyroid risk need to further assess the diagnostic performance of RTE.
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Affiliation(s)
- Wuguo Tian
- From the Department of Breast, Thyroid, and Vascular Surgery, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
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Liu BJ, Li DD, Xu HX, Guo LH, Zhang YF, Xu JM, Liu C, Liu LN, Li XL, Xu XH, Qu S, Xing M. Quantitative Shear Wave Velocity Measurement on Acoustic Radiation Force Impulse Elastography for Differential Diagnosis between Benign and Malignant Thyroid Nodules: A Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:3035-3043. [PMID: 26371402 DOI: 10.1016/j.ultrasmedbio.2015.08.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/27/2015] [Accepted: 08/04/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the diagnostic performance of quantitative shear wave velocity (SWV) measurement on acoustic radiation force impulse (ARFI) elastography for differentiation between benign and malignant thyroid nodules using meta-analysis. The databases of PubMed and the Web of Science were searched. Studies published in English on assessment of the sensitivity and specificity of ARFI elastography for the differentiation of thyroid nodules were collected. The quantitative measurement of ARFI elastography was evaluated by SWV (m/s). Meta-Disc Version 1.4 software was used to describe and calculate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and summary receiver operating characteristic curves. We analyzed a total of 13 studies, which included 1,854 thyroid nodules (including 1,339 benign nodules and 515 malignant nodules) from 1,641 patients. The summary sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules by SWV were 0.81 (95% confidence interval [CI]: 0.77-0.84) and 0.84 (95% CI: 0.81-0.86), respectively. The pooled positive and negative likelihood ratios were 5.21 (95% CI: 3.56-7.62) and 0.23 (95% CI: 0.17-0.32), respectively. The pooled diagnostic odds ratio was 27.53 (95% CI: 14.58-52.01), and the area under the summary receiver operating characteristic curve was 0.91 (Q* = 0.84). In conclusion, SWV measurement on ARFI elastography has high sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules and can be used in combination with conventional ultrasound.
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Affiliation(s)
- Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Ultrasound, Guangdong Medical College Affiliated Hospital, Zhanjiang, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lin-Na Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Hong Xu
- Department of Ultrasound, Guangdong Medical College Affiliated Hospital, Zhanjiang, China
| | - Shen Qu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China; Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingzhao Xing
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China; Department of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hwang S, Shin DY, Kim EK, Yang WI, Byun JW, Lee SJ, Kim G, Im SJ, Lee EJ. Focal Lymphocytic Thyroiditis Nodules Share the Features of Papillary Thyroid Cancer on Ultrasound. Yonsei Med J 2015; 56:1338-44. [PMID: 26256977 PMCID: PMC4541664 DOI: 10.3349/ymj.2015.56.5.1338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/24/2014] [Accepted: 11/05/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE It is often difficult to discriminate focal lymphocytic thyroiditis (FLT) or adenomatous hyperplasia (AH) from thyroid cancer if they both have suspicious ultrasound (US) findings. We aimed to make a predictive model of FLT from papillary thyroid cancer (PTC) in suspicious nodules with benign cytologic results. MATERIALS AND METHODS We evaluated 214 patients who had undergone fine-needle aspiration biopsy (FNAB) and had shown thyroid nodules with suspicious US features. PTC was confirmed by surgical pathology. FLT and AH were confirmed through more than two separate FNABs. Clinical and biochemical findings, as well as US features, were evaluated. RESULTS Of 214 patients, 100 patients were diagnosed with PTC, 55 patients with FLT, and 59 patients with AH. The proportion of elevated thyrotropin (TSH) levels (p=0.014) and thyroglobulin antibody (Tg-Ab) or thyroid peroxidase antibody (TPO-Ab) positivity (p<0.001) in the FLT group was significantly higher than that in the PTC group. Regarding US features, absence of calcification (p=0.006) and "diffuse thyroid disease" (DTD) pattern on US (p<0.001) were frequently seen in the FLT group. On multivariate analysis, Tg-Ab positivity, presence of a DTD pattern on US, and absence of calcification in nodules were associated with FLT with the best specificity of 99% and positive predictive value of 96%. In contrast, a taller than wide shape of nodules was the only variable significant for differentiating AH from PTC. CONCLUSION Suspicious thyroid nodules with cytologic benign results could be followed up with US rather than repeat FNAB, if patients exhibit Tg-Ab positivity, no calcifications in nodules, and a DTD pattern on US.
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Affiliation(s)
- Sena Hwang
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Yeob Shin
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Byun
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea
| | - Su Jin Lee
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Gyuri Kim
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jung Im
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea
| | - Eun Jig Lee
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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