Diagnostic Value of Sonographic Features in Distinguishing Malignant Partially Cystic Thyroid Nodules: A Systematic Review and Meta-Analysis

Abstract

Ultrasonography (US) is one of the most important methods for the management of thyroid nodules, which can be classified as solid, partially cystic, or cystic by composition. The various Thyroid Imaging Reporting and Data System classifications pay more attention to solid nodules and have reported pertinent US features associated with malignancy. However, the likelihood of malignancy of partially cystic thyroid nodules (PCTNs) is 3.3–17.6%, and few studies have systematically discussed the value of US in differentiating such entities. Therefore, we deemed it necessary to perform a systematic evaluation of US features in recognizing malignant PCTNs. Our systematic review and meta-analysis aimed to assess the value of US features in predicting malignant PCTNs. We searched the PubMed/MEDLINE, Web of Science, and Cochrane Library databases to find studies that researched US features of PCTNs and that were published before June 2020. Review Manager 5.3 was used to summarize suspicious US features and calculate the sensitivity, specificity, and likelihood ratios. MetaDiSc 1.4 was used to estimate receiver operating characteristic curves and calculate areas under the curves (AUCs). Our review included eight studies with a total of 2,004 PCTNs. Seven features were considered to be associated with malignancy. High specificity (>0.9) was found in nodules with a taller-than-wide shape, those that were spiculated/microlobulated or with an ill-defined margin, those with microcalcification, and a non-smooth rim. Among US features, eccentric configuration, microcalcification, and marked or mild hypoechogenicity were more reliable in predicting malignancy (AUC: 0.9592, 0.8504, and 0.8092, respectively). After meta-analysis, we recommend combining PCTN US features including an eccentric internal solid portion, marked or mild hypoechogenicity, and presence of microcalcification to better identify malignant nodules. More studies are needed to explore and improve the diagnostic value of US in PCTNs.

Accuracy of Ultrasound Diagnosis of Thyroid Nodules Based on Artificial Intelligence-Assisted Diagnostic Technology: A Systematic Review and Meta-Analysis

“…Compared with the previous research, some ML, DL models and CAD systems that assist diagnosis are uniformly classified into AI-assisted diagnostic technologies, and the diagnostic efficacy is meta-analyzed. This study found that AI-assisted diagnostic techniques have high sensitivity and specificity, which is consistent with the results of Zhao WJ et al to evaluate the diagnostic efficacy of CAD systems [ 64 , 65 ]. At the same time, this study also found that whether this prospective study has a certain impact on the diagnostic efficacy of AI-assisted diagnostic technology, and retrospective studies have better sensitivity and specificity than prospective studies.…”

Analysis of Differential Diagnosis of Benign and Malignant Partially Cystic Thyroid Nodules Based on Ultrasound Characterization With a TIRADS Grade-4a or Higher Nodules

“…High specificity (>0.9) was found in nodules with a taller-than-wide shape, those that were spiculated/microlobulated or with an ill-defined margin, those with microcalcification, and a non-smooth rim. Among US features, eccentric configuration, microcalcification, and marked or mild hypoechogenicity were more reliable in predicting malignancy (AUC: 0.9592, 0.8504, and 0.8092, respectively) ( 2 ). We also found that the nodules that were ovoid to round, with a smooth free margin in solid parts, isoechoic, macrocalcification, and non-calcification were also associated with benign PCTNs (P<0.01).…”

“…Since most PCTNs are potentially benign lesions induced by degeneration, such as nodular hyperplasia, the management of partially cystic thyroid nodules is often underrated. However, PCTNs still have a 3.3% to 17.6% rate of malignancy, and the incidence of malignancy is not related to the proportion of cystic components ( 2 ). Therefore, it is of great importance to identify sonographic features that distinguish malignant PCTNs in clinical practice.…”

Construction and validation of BRAF mutation diagnostic model based on ultrasound examination and clinical features of patients with thyroid nodules

“…There were few predictive models of BRAF gene mutations in thyroid nodules based on ultrasound as well as clinical parameters. More studies showed that microcalcification, lobulated margins, hypoechogenicity, and vertical position were significantly associated with ultrasound signs of thyroid cancer ( Kwak et al, 2011 ; Kim et al, 2013b ; Shi et al, 2021 ). As BRAF gene mutations were highly correlated with thyroid cancer, our results also showed that microcalcification, hypoechogenicity, lobulated margins, and vertical position were significantly associated with BRAF gene mutations.…”