Diagnostic Performance of Various Ultrasound Risk Stratification Systems for Benign and Malignant Thyroid Nodules: A Meta-Analysis

Kim, Ji-Sun; Kim, Byung Guk; Stybayeva, Gulnaz; Hwang, Se Hwan

doi:10.3390/cancers15020424

Cited by 7 publications

(6 citation statements)

References 90 publications

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“…The diagnostic performance of these two risk stratification systems has recently been assessed by two systematic studies; one concluded that neither of these guidelines is better than the other, while the other found that ACR TI-RADS is the most efficient risk stratification method [ 11 , 18 ]. In our study, the overall sensitivity of ACR TI-RADS was 72.3%, which was significantly higher than the ATA guideline’s sensitivity (49.2%, p = 0.003).…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review

Torshizian,

Hashemi,

Khoshhal

et al. 2023

Diagnostics

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Aim: This study sought to compare two common risk stratification systems in terms of their diagnostic performance for the evaluation of thyroid malignancy. Methods: The American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) guidelines were compared among 571 thyroid nodules with definitive fine needle aspiration (FNA) cytology or postoperative histopathology. Ultrasound characteristics such as composition, echogenicity, shape, margin, size, and vascularity were assessed for each thyroid nodule. Diagnostic performance measures were determined and compared through receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Results: Of 571 nodules, 65 (11.4%) were malignant. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value were 0.691, 49.2%, 84.9%, 29.6%, and 92.8% for ATA guideline, and 0.776, 72.3%, 79.2%, 30.9%, and 95.7%, for ACR TI-RADS, respectively. ACR TI-RADS was more sensitive (p = 0.003), while the ATA guideline was more specific (p < 0.001). DCA demonstrated that the ACR TI-RADS provided a greater net benefit than the ATA guideline. In addition, the net reduction in unnecessary biopsies is higher for ACR TI-RADS than ATA guidelines. The total number of indicated biopsies and unnecessary FNA rates were lower in ACR TI-RADS compared to ATA guideline (293 vs. 527 and 80.2 vs. 87.8). ACR TI-RADS presented no biopsy indication in seven malignant nodules (all categorized as TR2), whereas ATA guideline missed one. Hypoechogenicity was the most significant predictor of malignancy (OR = 8.34, 95% CI: 3.75–19.45), followed by a taller-than-wide shape (OR = 6.73, 95% CI: 3.07–14.77). Conclusions: Our findings suggest that each system has particular advantages in the evaluation of thyroid nodules. ACR TI-RADS reduces unnecessary FNA rates, however, malignant nodules categorized as TR2 might be missed using this system. Further evaluation of this group of nodules using Doppler and other ultrasound modalities is recommended.

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Section: Discussionmentioning

confidence: 99%

“…Several studies have compared ATA guidelines and the ACR TI-RADS to investigate how effectively they predict the presence of malignancy and how efficient they are at minimizing FNA biopsies [ 7 , 8 , 9 , 10 ]. However, these studies have employed distinct methodologies and achieved contradictory results [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review

Torshizian,

Hashemi,

Khoshhal

et al. 2023

Diagnostics

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“…Thyroid nodules are discrete lesions within the thyroid gland, which can be detected by ultrasonography ( 28 ). The incidence rate of thyroid nodules in women is four times that in men, and its incidence rate increases with age and body mass index ( 29 ).…”

Section: Co-occurrence Of Pcos and Thyroid Diseasementioning

confidence: 99%

“…Generally, only nodules>1 cm should be evaluated as they are more likely to become clinically significant cancers. In rare cases, some nodules<1 cm may lead to future incidence rate and mortality ( 28 ). Each thyroid nodule has an independent risk of malignancy, and patients with multiple nodules may need biopsy on multiple nodules.…”

Section: Co-occurrence Of Pcos and Thyroid Diseasementioning

confidence: 99%

The role of the thyroid in polycystic ovary syndrome

Fan,

Ren,

Sheng

et al. 2023

Front. Endocrinol.

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Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disease in women of childbearing age and can cause metabolic disorder, infertility, and increased anxiety and depression; as a result, it can seriously affect the physical and mental health of fertile women. PCOS is a highly clinically heterogeneous disease with unclear etiology and pathogenesis, which increases the difficulty of treatment. The thyroid gland has complex regulatory effects on metabolism, reproduction, and emotion, and produces hormones that act on almost all cells of the human body. The clinical manifestations of PCOS are similar to some thyroid diseases. Furthermore, some thyroid diseases, such as subclinical hypothyroidism (SCH), not only increase the incidence rate of PCOS, but also exacerbate its associated metabolic abnormalities and reproductive disorders. Interestingly, PCOS also increases the incidence of some thyroid diseases. However, the role of the thyroid in PCOS remains unclear. This review is intended to thoroughly explore the critical role of the thyroid in PCOS by summarizing the comorbidity of PCOS and thyroid diseases and their combined role in metabolic disorders, related metabolic diseases, and reproductive disorders; and by analyzing the potential mechanism through which the thyroid influences the development and progression of PCOS and its symptoms. We hope this review will provide a valuable reference for the role of the thyroid in PCOS.

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“…2,3 However, there continues to be a lack of standardization in the use of these various RSSs for thyroid nodules, as well as in the clinical interpretation of their assigned values. [4][5][6] Additionally, distinguishing benign follicular adenomas from follicular carcinoma has posed a particular diagnostic dilemma, as they share many similar sonographic characteristics and may not be accurately stratified on RSSs. 7,8 Since follicular thyroid neoplasms cannot be distinguished on cytology, final diagnosis can only be made after surgical excision with microscopic examination for capsular or vascular invasion.…”

Section: Introductionmentioning

confidence: 99%

A proof-of-concept investigation into predicting follicular carcinoma on ultrasound using topological data analysis and radiomics

Thomas,

Lin,

Deng

et al. 2023

Preprint

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Background: Multiple ultrasound (US) risk stratifications systems (RSS) have been developed to estimate malignancy risk in thyroid nodules and recommend the need for fine needle aspiration biopsy. However, sonographic risk patterns identified in established RSSs may not accurately stratify follicular carcinoma from adenoma, which share many similar US characteristics. Quantitative medical imaging analysis aims to extract high-dimensional textural features from tumor phenotypes imperceptible to the human eye. The purpose of this study is to investigate the performance of a multimodal machine learning model utilizing radiomics and topological data analysis (TDA) to predict malignancy in follicular thyroid neoplasms on ultrasonography. Methods: This is a retrospective study of patients who underwent thyroidectomy with pathology confirmed follicular adenoma or carcinoma at a single academic medical center between 2010-2022. The nodule of interest on pre-operative ultrasound was annotated and masked to only include pixels. Images were scaled to maintain aspect ratio and ensure similar image resolution. Features derived from radiomics and TDA were calculated. High-dimensional radiomics and TDA features were projected onto their first two principal components respectively. Logistic regression with L2 penalty was used to predict malignancy. Classifier performance was evaluated using leave-one-out cross-validation and area under the curve (AUC). Results: Patients with follicular adenomas (n=7) and follicular carcinomas (n=11) with available imaging were included. 910 radiomics features were extracted for each image. 180 topological features from the height filtration, mean and variance of pixel intensities, the aspect ratio of images and two additional persistence statistics were derived from each image. The models achieved an AUC of 0.68 (radiomics only) and 0.88 (radiomics and TDA). The subsampling bootstrap was used to assess the confidence of these estimates. Conclusions: We demonstrate that inclusion of topological features yields strong improvement over radiomics-based features alone in the prediction of follicular carcinoma on ultrasound. Despite low volume data, the TDA features of the height filtration with its connection to the persistent homology transform (PHT), explicitly capture shape information that likely augments performance of the multimodal machine learning model. This approach suggests that a quantitative based US RSS may contribute to the preoperative prediction of follicular carcinoma.

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Diagnostic Performance of Various Ultrasound Risk Stratification Systems for Benign and Malignant Thyroid Nodules: A Meta-Analysis

Cited by 7 publications

References 90 publications

Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review

Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review

The role of the thyroid in polycystic ovary syndrome

A proof-of-concept investigation into predicting follicular carcinoma on ultrasound using topological data analysis and radiomics

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